At our last inspection on the 08 and 09 August 2017, we found the service required improvement under the key questions, is the service responsive and well-led with an overall rating of requires improvement for the service. At this inspection we found there had been sufficient improvement to now rate this service as good.

The unannounced inspection took place on the 12 December 2018 with a second announced visit on the 13 December 2018. Bromford Lane Care Centre provides accommodation over three floors comprising five separate units offering support for up to 116 adults with nursing care needs. Two units catering for the needs of people living with dementia, nursing care. Units A and G catering for the requirements of people living with complex needs including alcohol/drug dependency and/or other mental health conditions. The home also provides short stay interim beds (EAB unit) for people discharged from hospital, who may require further assessment of their care and support needs before returning to their own home or another form of care placement. At the time of our inspection there were 114 people living at the home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People were kept safe. Staff understood how to protect people from risk of harm. People's risks were assessed, monitored and managed to ensure they remained safe. Processes were in place to keep people safe in the event of an emergency such as a fire. People were protected by safe recruitment procedures to ensure suitable staff were recruited. People received their prescribed medicines when required by trained staff. Staff understood their responsibilities in relation to hygiene and infection control.

People told us they received support from staff they felt had the skills required to support them safely. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. People were encouraged to eat healthily. People had access to healthcare professionals when needed in order to maintain their health and wellbeing.

Staff encouraged people's independence where practicably possible. People received a service that was caring and respected their privacy. People were supported by staff who knew them well.

People received a service that was responsive to their individual needs. Care plans were personalised and contained details about people's preferences and their routines. People were supported to pursue hobbies and activities that interested them and processes were in place to respond to any issues or complaints. Where people’s faith was important to them, they were supported to continue with following their beliefs. This included their end of life (EOL) wishes.

The registered manager understood their role and responsibilities and staff felt supported and listened to. People and staff were encouraged to give feedback and their views were acted on to enhance the quality of the service provided to people. People and staff were complimentary about the leadership and management of the. The provider worked in conjunction with other agencies to provide people with effective care.

Quality assurance systems were in place to identify where improvements could be made and when needed implement these changes. The provider notified us of significant events that occ

This was an unannounced inspection visit which took place on 08 and 09 August 2017. We last inspected this service on 29 May and 01 June 2015 where the service was meeting all of the regulations and rated as ‘Good’.

Bromford Lane Care Centre currently provides nursing care and support for a maximum of 116 people. Accommodation is provided over three floors comprising five separate units. Two units catering for the needs of people living with dementia, nursing care. Units A and G catering for the requirements of people living with complex needs including alcohol/drug dependency and/or other mental health conditions. The home also provides short stay interim beds (EAB unit) for people discharged from hospital, who may require further assessment of their care and support needs before returning to their own home or another form of care placement. At the time of our inspection there were111 people living at the home.

It is a legal requirement that the home has a registered manager in post. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

We saw that the management of the service was stable and that the provider had established management systems to assess and monitor the quality of the service provided. However, they were not always effective at identifying the issues we found at this inspection. For example, dependency tools used to assess staffing levels had not recognised the need to increase staff numbers on the nursing unit for the first day of our inspection visit. Medicine audits had not identified gaps in recording topical creams and protocols for some ‘when required’ medicines were not in place.

There was a dedicated activities team that provided opportunities to optimise people’s social and stimulation requirements. However, there was mixed opinions on the effectiveness of those activities and whether people were being supported to maintain their individual hobbies and interests. People and most of their relatives were confident that if they had any concerns or complaints they would be listened to and matters addressed quickly. Although, some concerns discussed with us by relatives had not been recorded in the provider’s complaint’s process and this required some improvement.

The management team had a number of systems to gain feedback from people living at the home, relatives and visitors. This included resident/relative meetings, satisfaction questionnaires and regular reviews. People, most of their relatives, staff and visiting professionals told us the home was well organised and well-led.

People who lived at the home were kept safe. Staff were trained to identify signs of abuse and supported by the provider’s processes to keep people safe. Potential risks to people had been identified and appropriate measures had been put in place to reduce the risk of harm. People were supported by suitably trained staff that had been recruited safely. People received their medicines as prescribed.

Staff were trained and had the skills to meet people’s needs. Staff received supervision and appraisals, providing them with appropriate support to carry out their roles. Staff treated people as individuals, offering them choices whenever they engaged with people. Staff sought people's consent for care and treatment and ensured people were supported to make as many decisions as possible, where possible. Where people lacked the mental capacity to make informed decisions about their care, relatives, friends and relevant professionals were involved in best interest's decision making processes. Therefore, the provider had acted in accordance with the Mental Capacity Act 2005 (MCA) a

We had received concerns that people had been left without adequate heating, not receiving adequate care, amounts of food and, a lack of choices in food that they had. We were told that staff were being moved around the home meaning they were not receiving continuity of care.

At the time of our inspection there were 95 people living in the home. We spoke with four people who lived there, four relatives, three staff and the registered manager.

All the people spoken with and their relatives told us they were happy with the care provided and that the service had improved.

People were able choose the food they ate. One person old us, “The food is good.” People were supported to get the nutrition they required but some improvements could be made to mealtime experience.

We saw that the home was warm. Relatives and staff spoken with told us that the home was warm and systems were in place to maintain temperatures when the heating had been off.

We saw that that people received support as required. This showed there were adequate numbers of staff on duty at the time of our visit to meet people’s needs. One person told us, “The staff are good.”

We saw that there were systems in place to monitor the quality of the service and actions were taken to make improvements where possible.

Improvements could be made to the management of records to ensure that they were stored safely and that they showed that all the required actions were taken to protect people.

At the time of our inspection 80 people were living in the home. We spoke with 10 people, nine staff and seven relatives. We looked at the care records of seven people. We observed the interactions between staff and people living in the home to get a view of how people were being treated when they could not verbally express their needs.

We saw that the interactions were caring and friendly. People told us, “It’s alright here” and “Get nice food and a choice. I choose when I go to bed and get up. I choose what I want to wear and they help me.” Relatives told us, “X always looks clean, well presented, we can see him in private but we are happy to see him in lounge” and “Treat mom with dignity and respect, carers seem to know her well and what she likes.” This showed people were happy with the service they received and were supported to make choices.

Where people had complex needs our observations were that not all staff had the skills they needed to meet their needs so that people were safe from the risk of harm.

Systems in place for the management of medicines ensured that people received their medicines as prescribed.

There were sufficient staff on duty to meet the needs of people and staff were supported to carry out their roles.

The systems in place for monitoring the quality of the service provided were not robust.

Records in place did not ensure that staff had the information they needed to care for people and did not reflect the care provided.

We carried out this visit in response to concerning information we had received. We were told that people were being disturbed by an individual’s behaviour and the care provided to the individual. During this visit we only looked at these issues.

Three relatives we spoke with not happy about the care provided in the home. Three people who lived in the home told us that they were being disturbed by an individual who was constantly shouting out.

During our visit we heard the individual shout out and their relative confirmed that this was a regular occurrence. Staff were not available on the unit to reassure the individual. The individual had developed skin damage since being provided with care in the home. This meant that people’s quality of life was negatively affected on that unit.

On 31 August 2012 we sent a warning notice to Bondcare (Bromford) Ltd for failing to monitor and assess the quality of the service being provided at Bromford Lane Care Centre.

At our inspection on 17 October 2012 we spoke with the acting manager, two representatives of the provider, six people using the service, three relatives and five staff.

Some of the people who lived at the home had dementia and are not always able to tell us about their experiences so we observed the way staff interacted with them. Staff spoke with people kindly and respectfully using their preferred names. People responded to staff with smiles. One person told us “We are fed well here. It’s like being on my holidays.”

Relatives we spoke with told us that things “Seem okay, it’s hard to tell,” and “Generally happy with the care. The manager is approachable.” Staff told us “Things such as care plans, charts and sharing of tasks has improved,” and “New staff were being recruited and doing induction training before starting work.”

We saw that the provider had made some progress towards meeting the warning notice and there was a lot of input into the home from other agencies including pharmacists, continuing healthcare nurses and staff from other homes owned by the provider. The provider was not fully compliant at this inspection. We decided not to take any further action in respect of the warning notice but the service will be monitored for compliance and sustainability of compliance.

For this inspection a team of inspectors visited the home. This included two compliance inspectors, a pharmacist inspector and an expert by experience. An expert is a person who has experience of using or caring for someone who uses this type of care service. There were 71 people living at the home on the day of our visit and no one knew we would be visiting. We spoke to 12 people visiting people receiving a service, two visiting professionals, six staff, the acting manager, the quality manager and the regional manager for the service.

Some of the people who lived at the home had dementia care needs. People with dementia are not always able to tell us about their experiences. To understand people’s experiences we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

We saw that people had been asked about their needs and hobbies. People had been asked about their preferred time to get up and go to bed, religious requirements were asked and met in the home. Some relatives had been involved in providing information for people’s care plans and had given permission for photographs to be taken and for preventative injections to be given. This showed that people or their relatives were involved in giving consent to the care they received.

We found the quality of interactions between staff and people receiving a service varied. We saw some good interactions where people were addressed by their preferred names and were reassured when they were getting agitated. We also saw people not being listened to at mealtimes and some people said that they felt ignored.

One person we spoke with told us they were happy at the home and they were given the opportunity to join in with activities if they wanted. Two relatives we spoke with told us that they were very happy with the care being provided.

Care and treatment was not always planned and delivered in a way that ensured people’s safety and welfare. Care plans varied in detail some contained good information whilst others identified the problem and what needed to happen but not how. This meant that people could not be confident that there needs would be consistently met in a way they needed and preferred.

People were provided with a choice of suitable and nutritious food and drink. We saw that special diets such as pureed and vegetarian diets were available for people who needed them. We saw that people were offered a variety of drinks during our visit. Two people told us they really enjoyed their lunch.

Staff spoken with knew how to raise concerns if they suspected abuse was occurring. Robust recruitment practices were in place so that people were looked after by people who were suitable to work with vulnerable people. Sometimes people received injuries because the correct moving and handling procedures had not been followed by staff

People did not always receive their medicines as prescribed because the process for ordering medicines was not robust.

During our inspection we found that the home was clean and provided a pleasant environment for people to live in.

Equipment was available to help staff meet the needs of people. Equipment was not always serviced within the recommended timescales. This meant that people could not always be assured that adequate actions had been taken to ensure that equipment was safe to use.

Not all staff had received training in a timely way so that people could not be confident that they were cared for by well trained and knowledgeable staff

The provider had not got an effective system in place to assess and monitor the quality of service that people received. Some people were happy with the service but other people were not happy with the way the home was being managed.

Comments and complaints people made were responded to. People’s concerns were listened to and they were not discriminated against for making a complaint.

We visited Bromford Lane Care Centre on 24 May 2012 to review improvements with the management of medicines. At the time of our visit there were no managers on duty. We spoke with a nurse on duty on the unit where we were looking at the management of medicines. People receiving a service on the unit were unable to talk to us about how their medicines were being managed due to their health conditions.

We looked at the medication records of four people. We spoke with one member of staff and two agency nurses.

People were not fully protected against the risks associated with the unsafe use and management of medicines by means of making appropriate arrangements for the obtaining, recording, handling, using, safe keeping, dispensing, safe administration and disposal of medicines. Arrangements were not in place to ensure that prescribed medicines were available to give to people as prescribed.

We found three people's medicines had run out and had not been reordered in a timely manner leaving people without access to their prescribed medication. This can compromise people’s health and wellbeing.

We found that people did not always receive their medicines as prescribed.

This visit was to follow up on the previous visit by the pharmacist inspector on 29 March 2011 and compliance inspectors on 12 September 2011. The service had been non compliant with the management of medicines at these visits.

The safe handling of medicines was assessed by a pharmacist inspector on 26 January 2012. We visited three units and looked at the storage of medicines, a selection of people’s medicine records and some care plans.

A pharmacist from the supplying pharmacy visited the service on 19 October 2011. They provided written advice for the service to follow in order to ensure that medicines were handled safely.

We spoke to one person who looked after their own medicines. The told us they were happy with the arrangements for medicines and were able to retain their own independence.

We found that people did not always receive their medicines as prescribed. The management of medicines in the home did not ensure that medicines were always available to people when they need them and as prescribed.

When asked if care workers treated them respectfully one person living in the home told us that some do and some don’t. They told us that sometimes they were short staffed but they came when the call system was used.

Most people told us that they had not been involved in planning their care but that they were able to go to bed and get up when they wanted.

We were told that activities had begun to be provided in the home by the recently appointed activities co-ordinator. They were pleased about this.

Some people were happy with the food but some people told us that there were still some problems with the meals they received. This included the quality of the meat and not getting the choice they had made.

People living in the home told us that the staff:

"The staff were very good."

"The level of comfort in the home was good."

"They were kept warm."

Two people living in the home told us that the food was good. Four people said they were only able to choose from the meals that had already been cooked. They were not consulted before meals were prepared. They were not happy with the quality of the food provided.

They told us that although there were good choices available for breakfast the tea time meal was very repetitive stating:

"Soup, sandwiches and a sweet were available every evening. Occasionally a sausage roll "

"Ran out of Horlicks 3/4 weeks ago"

People visiting the home told us that the food was poor. Their relative didn't like the teas.

When asked about mealtimes relatives said:

"No it is always like this, staff don't seem to know what they are doing."

Two people told us that other people living in the home kept going into their bedrooms. They also told us that they couldn't have a key to their bedrooms.

When asked if there were enough staff to help them one person told us "The care workers have to go to different floors. They need more. You can't blame the carers"

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Some relatives and care professionals involved with people living in the home had raised concerns with us about the care workers. They were concerned about the numbers and skills of staff in caring for vulnerable adults.

A care worker told us that on occasions the hoist was used by one person as it took so long to get assistance.

Care professionals had raised concerns about peoples' weights and food intake not being monitored regularly.

Relatives that we spoke to told us:

"They understood that it was a new home but there were areas that could be improved."

"There were no activities and their relative was bored. The staff did not help their relative to keep moving."

The inspection took place on 29 May 2015 and 1 June 2015 and was unannounced.

We last carried out a comprehensive inspection of this service on 15 April 2014. At that inspection we found the provider required improvements in the management of medicines. At this inspection we saw that improvements had been made in respect of the management of medicines.

On 12 November 2014 we carried out a responsive inspection because we had received some concerns about staffing levels at night. At that inspection we saw that there were sufficient staff to meet people’s needs.

Bromford Lane Care Centre provides accommodation and support for up to 116 people who require support with their personal or nursing care. The accommodation was split up into five units. Two units supported people with complex needs, one supported people living with dementia and another that supported people with nursing needs. The fifth unit supported people who had moved from hospital into the home for a short stay before they moved onto other permanent accommodation or were able to return home. At the time of our inspection there were 99 people living in the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were protected from the risks of abuse because the provider had systems in place to minimise the risk of abuse and staff were trained to identify the possibility of abuse occurring. Staff understood their responsibility to take action to protect people from the risk of abuse and how to escalate any concerns they had.

People were protected from risks of injury associated with their needs because risks had been identified and management plans put in place so staff had the information they needed to minimise risks. Staff knew how to protect people in emergency situations such as illness, injury or fire.

Staff had a good understanding of how to ensure that consent was obtained and how people’s rights were to be protected if they did not have the ability to make decisions for themselves.

People were provided with sufficient food and drinks throughout the day that met their needs. Support and advice was sought where people were not eating or drinking enough to remain healthy. People were supported to see health care professionals to ensure they received medicines and medical treatment as required.

Staff were caring and had an understanding of the needs of the people they were supporting. Staff received the training and supervision they needed to carry out their roles. At the time of our inspection there were sufficient staff available to meet people’s needs but some people and relatives told us they sometimes had to wait for assistance.

People were supported to maintain contact with their friends and relatives. Group and individual activities were available for people to take part in if they wanted.

Systems were in place to gather the views of people so that improvements could be made based on their wishes. Regular auditing and monitoring of the service ensured that the quality of the service continued to improve.