Brompton House Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe - this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment we assessed a total of 8 quality statements from this key question the rating has changed to good. This meant people were safe and protected from avoidable harm. At this assessment improvements were found and the provider was no longer in breach of the regulations.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s experience of care and support had improved as the provider listened to concerns and addressed these promptly. Communication within the staff group had improved, which drove forward improvements in consistency and accuracy of record keeping and overall monitoring of changes in people’s care. The provider had systems in place to continually identify concerns, ensure these were investigated and learnt from, to help reduce the risk of them from happening again. For example, the provider shared lessons learnt from across the provider group and implemented these promptly within the home to embed good practice.

People had reviews with external health and social care professionals to ensure their overall healthcare needs were being met. Staff understood people’s individual risks and were able to share their knowledge and understanding of this with health care professionals who were involved in people’s care. However, care records required strengthening to ensure that people’s care was joined-up and did not conflict between health care specialists. For example, instructions given by one specialist health care team would have not been suitable or safe for the person if staff had followed this, as it contradicted the person’s requirement for a textured modified diet. While staff were aware of how to support the person safely, and no harm had occurred, records did not accurately reflect staff’s knowledge and holistic approach of the person’s care needs. External health and social care agencies told us the staff worked with them to ensure continuity of care for people. They felt people received positive outcomes because of this. The provider’s policies and processes for safety were aligned with other external agencies who were involved in people’s care journey to enable shared learning and drive improvement.

All people we spoke with told us they felt safe by the staff who supported them. One person told us, “I do feel safe here, cared for and well looked after.” While another person said, “Staff are very good to me and that makes me feel safe.” All relatives we spoke with also felt their family member was kept safe. Staff received training on how to recognise and report abuse and knew the processes to follow to keep people safe. All staff felt confident to raise concerns with the management team. All staff were confident any issues raised with the management team, or the provider, would be fully investigated to make sure people were protected. The provider understood their responsibilities regarding the action to take to protect people from harm, we saw examples where action had been taken to protect people where required. Health and social care professionals confirmed that where safeguarding concerns had been raised, prompt action had been taken to safeguard people and notify relevant agencies, and where appropriate the person’s relative. During the site visit we saw kind and respectful interactions between people and staff. Staff were seen to offer people choices and seek consent before supporting. The provider’s safeguarding policy gave clear guidance for staff about how to raise a safeguarding alert. Any safeguarding concerns were recorded appropriately and reviewed to ensure the relevant professionals were notified. Where the provider had deemed people were being deprived of their liberty, applications had been sent to the local authority for authorisation. They kept track of application processes, to ensure key dates were met. The provider met their legal requirement to notify the CQC where a person had been legally deprived of their liberty.

People and where appropriate, their relatives were involved in managing their individual risks to ensure they remained safe. One person told us, “The staff walk with me. Staff help me. They help me out of the chair. I feel safe because they are doing it properly.” Relatives felt staff knew how to keep their family member safe, and were involved in their family member’s care, with any changes or incidents also being communicated well. One relative said, “‘I am informed if [person’s name] has had a fall. Staff treat [them] and attend to [them].” Staff recognised risks to people and were consistent in their knowledge as to how they supported people to mitigate risk in the least restrictive way. People were supported to do the things they wanted to do, and staff helped them to do this safely. We saw staff supporting people safely around the home and in activities. Staff were patient and supported people at their own pace. People’s care plans and risk assessments were personalised to them. Details held within the records we looked at showed a good understanding of the person’s needs and how to meet these. However, some records needed strengthening to provide staff with information around condition specific increased risks. For example, records did not detail that routine checks should be in place to ensure a person’s diabetes monitoring system remained in place and the skin remained healthy and intact. There had been no negative impact to the person, and the provider acted upon this during our onsite visit. Incidents and accidents were reported to the management team in a timely way, so that prompt reviews of their care could be taken. In addition to this, regular reviews were also completed to ensure care plans and risk assessments remained relevant and up to date.

People did not express any concern in relation to the safety of the environment. Relatives also felt the environment of the home was safe. People had access to a secure garden area and a choice of communal areas to sit in throughout the day. Key coded access meant people were secure in the home in line with their best interests. Staff were clear what their responsibilities were in relation to the upkeep of the home. The environment of the home appeared safe and well maintained. However, we identified that staff did not routinely record water temperatures of people’s baths and showers prior to them using this. This is a potential risk of harm, as some people may have altered sensations which would prevent them from knowing if the water was too hot. From the baths and showers we looked at, there were thermometers in place. The provider confirmed they would ensure staff monitored temperatures prior to people using them. The provider’s maintenance team carried out regular monthly checks of water temperatures. The provider took prompt action to rectify where we found the window restrictors were not always tamper proof. Maintenance was mostly well managed and there was clear information to demonstrate services and system checks were completed. However, we found that where an external company had checked the fire extinguishers these had not consistently been updated as checked and compliant. This meant the provider could not always be assured the fire extinguishers were in full working order. Air flow pressure mattresses were not consistently checked to ensure they were set at the right level for the person using this. This was something the provider had been made recently aware of and were in the process of ensuring staff were aware of the correct settings for these mattresses.

People did not raise concerns about staffing levels with us and told us the staff were attentive to their needs. One person said, “Yes there are enough staff because I never have a long wait.” Relatives felt there were enough staff on duty to meet their family member's needs. One relative said, "There are enough [staff] after lunch things are quietening down.” All people and relatives felt staff had the right skills and experience to support them with the care needs. There had been significant changes in the staff group since our last assessment, due to this, there had been a higher than usually use of agency staff. The interim manager confirmed agency staff were booked in advance to promote consistency for people. All staff we spoke with felt their training had benefited them to provide safer care. However, we found some inconsistencies in the provider’s checks of new care staff’s competency and understanding. For example, 1 newer staff member was due to undertake fire training, but did not feel confident around fire safety procedures specific to the home. The provider confirmed they would address this immediately. Staff told us there were enough staff deployed to meet people's needs and keep people safe. Staff were attentive to people's needs and requests and supported people at their own pace. A dependency tool was used to determine staffing levels based on people’s dependency requirements. It was recognised by management that there were a reduced number of people living in the home at the time of our visit, this meant management would continue to monitor staffing levels and deployment of staff, when occupancy increased, to ensure standards remained at a good level. The management team completed supervisions and spot checks to test staff's knowledge and observe if they applied this in practice or whether further training and support was required. The provider followed safe recruitment procedures before staff began working in the home.

All people we spoke with told us the home was always clean and tidy. One person said, “I have no complaints it is all very clean, always somebody around cleaning, nice and clean everywhere.” People were protected from the risk of infection as staff were following safe infection prevention and control practice. Staff had access to personal protective equipment (PPE). Cleaning staff told us they had enough cleaning equipment to support them to carry out their roles effectively. The home appeared clean and clutter free. Regular audits were undertaken to ensure the areas of the home were maintained to a good standard.

All people we spoke with had no concerns around the management of their medicines. One person said, “Very careful with the medication. They [staff] bring it in, give it to us and they also wait until we have taken it.” People also felt supported with management of pain. One person said, “If I have pain in the first instance, sent to hospital for a thorough medical. Any general pain they give me painkillers.” Nurses and senior care staff had received training in medicine administration, and their competencies were regularly checked. Staff told us they had sufficient time to administer medicine, and the medicines were well organised with sufficient stock. Medicine record keeping was clear and accurate. Staff followed safe practice when administering medicine to people. The process of receiving, storing, and returning medicines was good. There were medicine audits in place, which included spot checks of staff’s practice, record keeping and medicine counts. Where shortfalls were identified, further training and support was given.