Archived: Burrswood Health and Wellbeing

Burswood Health and Wellbeing is registered to provide accommodation, nursing and personal care for 40 younger adults and older people who have physical and/or sensory adaptive needs. The service was principally designed to accommodate people on a short term basis. Some people were admitted from hospital to the service’s reablement unit. This was so that they could receive physiotherapy and occupational therapy in order to become more independent before returning home. Other people were admitted from their own homes to the service’s assisted living unit. This was for a variety of reasons including receiving care while their family members were away. On the day of our inspection visit there were seven people receiving care in the reablement unit and four people accommodated in the assisted living unit.

The service was run by a charitable body who described themselves as being ‘Christian but welcoming people of all faiths or none’. During the inspection visit the charity was represented by their chief executive officer. The former registered manager had left the charity’s employment shortly before our inspection visit. In their place the charity had appointed a new manager who was about to apply to the Care Quality Commission to become registered in their 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 2008 and associated regulations about how the service is run. In this report when we speak about the charitable body we refer to them as being, ‘the registered provider’. When we speak about nurses, care staff, physiotherapists and occupational therapists as a group we refer to them as being, ‘the professional staff’.

This was the first comprehensive inspection of the service using our new way of quality rating services. The service was registered on 21 January 2011 and we completed our last inspection on 11 and 26 July 2013 using our legacy inspection model.

At the present inspection we found four breaches of the regulations. The first breach was because the registered provider had failed to consistently reduce risks to people’s wellbeing by providing safe care and treatment. Lessons had not always been learned when things had gone wrong as a result of which robust arrangements were not in place to suitably safeguard people from the risk of experiencing harm. The second breach was because the registered provider had failed to establish the necessary systems and processes to ensure that we were promptly told when a person not been suitably safeguarded from the risk of experiencing harm. The third breach was because the registered provider had not established reliable procedures to ensure that only trustworthy people were employed to provide care. The fourth breach was because the registered provider had not made suitable arrangements to enable the service to learn, improve and assure its sustainability by ensuring that all regulatory requirements were met.

After our inspection visit the registered provider sent us information to show that they had addressed all the breaches of the regulations to provide people with safe care and treatment.

Our other findings were as follows: Medicines were managed safely in line with national guidance. There were enough professional staff on duty. Suitable arrangements were in place to prevent and control infection.

The registered provider had not given nurses and care staff all of the training and guidance they were said to need to consistently deliver care in the right way. People’s citizenship rights under the Equality Act 2010 were respected. People were supported to eat and drink enough to have a balanced diet to promote their good health. Suitable steps had been taken to ensure that people received coordinated support when they used or moved between different services. People had been supported to access any healthcare services they needed. The accommodation was designed, adapted and decorated to meet people’s needs and expectations.

People were supported to have maximum choice and control of their lives. In addition, the registered provider had established the necessary arrangements to ensure that people only received lawful care that was the least restrictive possible.

People were treated with kindness and they were given emotional support when needed. They had also been helped to express their views and be actively involved in making decisions about their care as far as possible. This included them having access to lay advocates if necessary. Confidential information was kept private.

People received person-centred care that promoted their independence. This included them having access to information that was presented to them in an accessible way. People were supported to meet their spiritual needs. They were also given interesting and innovative opportunities to pursue their hobbies and interests. The registered provider and staff recognised the importance of promoting equality and diversity. This included appropriately supporting people if they followed gay, lesbian, bisexual, transgender and intersex life-courses. Suitable arrangements were in place to resolve complaints in order to improve the quality of care. People were supported to make decisions about the care they wanted to receive at the end of their life in order to have a comfortable, dignified and pain-free death.

People who received support, their relatives and members of staff were actively engaged in developing the service. The registered provider was actively working in partnership with other agencies to support the development of joined-up care.

During our inspection we spoke with directors, managers and a range of medical, domestic, and administrative staff. We spoke with two patients. We reviewed policies, minutes, audits, training records and care documentation.

The improvements required to comply with the regulations in relation to obtaining consent, safeguarding patients and ensuring that robust governance systems were in place have been made.

The hospital treats a diverse patient population ranging from those staying for a brief post-operative convalescent period through to long term patients with complex care needs. Without exception the patients and relatives told us that the care was 'Exceptional'. One person told us 'I cannot speak too highly or describe to you the care that I am getting ' it exceeds not only my expectations but that of my family'.

Patients told us that although they were involved in their treatment there were not consistent systems in place to obtain, record and review their consent. One person said, 'I have never been asked formally if I consented to anything, but this is implicitly understood, I would not be here if I did not consent to my being cared for'. Where people did not have the capacity to consent staff did not act in accordance with the legal requirements outlined in the Mental Capacity Act 2005.

There were sufficient staff with appropriate competencies and qualifications to meet the needs of the patients. Staff were supported to receive supervision, undertake training and participate in the appraisal process.

Information was provided to staff about the procedures to follow if there were any concerns that people were at risk of abuse and patients told us they felt safe in the hospital. However, staff had not received appropriate safeguarding training and were not knowledgeable about the correct procedures to follow if they had concerns.

The organisation had a robust governance structure in place to identify and manage risk but did not have a mechanism to supervise the practice of medicine in the hospital or provide appropriate professional support to medical and clinical members of staff.

The patients that we spoke to during our visit told us they were very happy with the service and care. One patient told us 'the staff are very efficient here and nice and you couldn't wish for anything better'. Another person remarked 'I cannot speak highly enough of the staff, they are always so friendly and nothing is ever too much trouble'.

Patients said that there were choices of food to suit every taste and if they wanted something individual it had been provided for them quickly and with the minimal of fuss. When we asked patients to describe the meals they told us they found the choice and quality to a good standard. One patient told us 'absolutely excellent and delicious food with an amazing choice for a hospital'.