Burn Brae Lodge

Burn Brae Lodge is a residential care home providing personal care to up to 31 people. At the time of the inspection there were four people at the home.

The home is a large adapted detached building set in its own grounds. The accommodation for people is on ground and first floor levels.

People’s experience of using this service and what we found

People and relatives said the home was a safe place to live. They made many positive comments about the caring nature and attentiveness of staff.

Medicines were managed in the right way.

Infection control procedures were in place and all staff had training in this. The provider had kept up to date with the latest national guidance about infection control and personal protective equipment (PPE).

People and relatives praised the management style of the provider and manager and described them as open and approachable.

People and relatives valued the way the staff had kept them well-informed throughout the pandemic and recent outbreak. The culture of the home is one of an extended family.

The home had good working relationships with local health and social care agencies to support the needs and well-being of the people who live there.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published October 2017).

Why we inspected

We received concerns in relation to cleanliness and safe working arrangements in the home during the recent outbreak of COVID-19. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Burn Brae is a residential care home situated in a rural location on the outskirts of Corbridge. The service is able to provide accommodation to 31 people, some of whom have physical and/or mental health conditions, including people who live with dementia. At the time of our inspection 29 people lived at the service.

The registered provider was also the registered manager. 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 2008 and associated Regulations about how the service is run.

There were policies and procedures in place to support the smooth running of the service. These included a safeguarding policy which staff told us they understood along with their responsibilities towards protecting people from harm. They told us they would report any concerns without hesitation.

People told us they felt safe. Everyone we spoke with told us they had no major concerns about staffing levels, although people, relatives and staff all told us that at times it was busy.

Checks on the safety of the home were routinely carried out by maintenance staff and by external contractors when required. Personal emergency evacuation plans (PEEPS) were in place and the provider had an emergency contingency plan which would be used in any crisis.

We observed medicines being administered to people during the inspection. People received their medicines in a timely manner, and were treated with dignity and respect during the process. Records were well maintained. We found on occasions the medicines trolley was left unsecure while medicines were given to people. Staff were nearby but when we spoke to the registered manager and deputy about this they recognised that this should not have happened.

Risks to individuals had been identified and assessments to reduce the hazards to people put in place. Accidents and incidents were recorded and monitored to identify trends. Where people needed additional advice or support, they were referred to external healthcare professionals as necessary.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. We found that the registered manager had an understanding of the principles and had acted in accordance with the law. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes.

Staff received an induction and had received suitable training with a staff member dedicated to monitor this. Staff supervisions and appraisals had been undertaken although we have made a recommendation to the provider in connection with this. Staff told us they felt supported by the manager and senior staff. Meeting for staff had taken place but not regularly, we therefore made a recommendation regarding this.

People were supported by staff to maintain a well-balanced, healthy diet and their comments were positive about the food and refreshments they received. We have however, made a recommendation that the provider incorporates the use of various menu formats to support people during meal experiences.

We observed staff respected people, and their privacy and dignity was maintained. Staff displayed caring and kind attitudes and treated people as individuals. We saw staff offered people choices and encouraged them to make decisions about daily life where this was appropriate.

People participated in a range of activities. The service was continually developing their activities programme to better suit the needs of the people who used the service. Staff supported people to maintain links by welcoming family, friends and visitors into the service.

Everyone we spoke with told us they knew how to complain and would do so if they thought it was necessary. We saw complaints had been recorded and investigated, although we noted that not all verbal complaints had been recorded. The registered manager told us they would rectify this.

‘Residents/Relatives’ meetings and surveys were used to gather feedback about the service and the care provided.

The registered manager had improved quality assurance with a range of checks and audits in place to monitor the care and the overall service provided at the home.

This inspection took place on the 26 and 27 May 2016 and was unannounced.

The registered provider was also the registered manager of the service and had been registered with the Commission in this role since October 2010. 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 2008 and associated Regulations about how the service is run.

People were complimentary about the service and staff who supported them. They described staff as "kind" and "lovely". Staff were aware of their own personal responsibility to report matters of a safeguarding nature and we saw that historic safeguarding matters had been handled appropriately. Risks that people had been exposed to in their daily lives had been assessed and documented. Environmental risks within the home had been assessed and mitigated against. Accidents and incidents were monitored and measures put in place to prevent repeat events.

Recruitment procedures were robust and medicines were managed safely and appropriately in line with best practice guidance. Staffing levels were sufficient on the days that we visited the home to meet people's needs. Whilst we did not identify any issues with staff practice, skills or the care we saw being delivered, staff training records showed staff had not been supported to develop and maintain their skills through regular role-specific training. There was a basic induction programme in place but this was limited and did not incorporate the Care Certificate brought into force in April 2015, in line with best practice guidance. Supervisions took place regularly but there was no appraisal system in place. The provider told us annual appraisals of staff performance were due to be introduced shortly.

CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. The Mental Capacity Act (MCA) was appropriately applied and applications to deprive people of their liberty lawfully had been made to prevent them from coming to any harm where they lacked capacity. The service understood their legal responsibility under this act and although they informally assessed people’s capacity when their care commenced and on an on-going basis when necessary, this was not documented. Decisions that needed to be made in people’s best interests had been undertaken but records about such decision making were not maintained.

The staff approach was kind and caring and people said they enjoyed good relationships with staff. People were involved in the service and had signed their care plans to evidence they were involved in the care planning process. People received information about the service and explanations about the care that was being delivered to them. Advocacy services could be made available to those people who needed them. Most people living at the home at the time of our inspection had relatives who were actively involved in their care and who supported them in decision making.

Activities were offered regularly but some people expressed a desire for more stimulation. People were afforded the opportunity to make their own choices in their lives, although choices around food options were limited. A complaints policy and procedure was in place and no formal complaints had been received in the 12 months prior to our inspection.

People, their relatives and staff described an open culture within the home and we found a welcoming and homely atmosphere. The registered provider was actively involved in the operation side of the business. The requirements of the provider's registration were met and we were satisfied that notifications of deaths and other incidents were made in line with the requirements of the Care Quality Commission (Registration) Regulations 2009.

Audits were carried out but documentation around these audits and checks could be improved. Action plans were not utilised within the service as a tool through which to drive improvements. In some areas there were shortfalls in recording, for example, some care plans and risk assessments lacked detail, supervisions were basic and the application of the MCA was not appropriately evidenced through documentation.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Regulation 18 entitled Staffing, and Regulation 17 entitled Good Governance. You can see what action we asked the provider to take at the end of the full version of this report.

People and their relatives told us they were happy with cleanliness levels within the home. One person said, "The cleanliness is pretty good. They change the beds and things go to the laundry and come back." One relative told us, "It is always very clean and tidy. It is very homely here. I have never found it unhygienic or dirty in any way." We found that the home was clean, tidy and well maintained, and significant improvements had been made to infection control procedures.

People told us their consent was gained before care was delivered and we found that staff acted in accordance with their wishes. Where people did not have the ability to consent themselves we found the provider acted in line with legal requirements.

We found that people's care and support needs were appropriately assessed and their care was planned. They received care safely, and to an appropriate standard. Where people required input into their care from external healthcare professionals, this had been arranged.

We found the provider had a structured staff selection and recruitment policy in place which aimed to ensure staff were suitably skilled, experienced and qualified to deliver care safely.

People told us they were asked if they were happy with the service they received, and they confirmed that they were. We found the provider had effective systems in place to measure the quality of the service that people received.

However, although people who received care and support told us they were happy, and we saw they were well supported, we found that failures to maintain and manage cleanliness and infection control, may put people's safety at risk.