Burnham Lodge

Updated 22 December 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector and one Expert by Experience, with remote telephone support from an additional two Experts by Experience.

An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Burnham Lodge is a ‘care 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

During the inspection we spoke with thirteen people using the service, eight of whom were able to give us their opinions about the service. We also spoke with 24 relatives and 19 members of staff including seven care assistants, a laundry assistant, a servery assistant, a chef, two nurses, a senior nurse, a maintenance staff, administrator, registered manager, regional support manager, quality director and the operations director who is appointed nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. Some staff we spoke with were working at the service as agency staff.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We observed infection control and medicines practices, reviewed the environment and looked at 20 people's records on the electronic care plan system, either in full or in part. We looked at five staff recruitment and supervision files. We also examined a variety of other records including medicine records and cleaning schedules.

After the inspection

We continued to review records shared electronically and continued to seek clarification from the provider to validate evidence found. We looked at a range of records including audits, staff rotas, safeguarding records, meeting records, policies and procedures and staff training records. We received feedback from four professionals who had contact with the service.

Updated 22 December 2021

About the service

Burnham Lodge is a nursing care home providing accommodation for a maximum of 60 people. At the time of the inspection 31 people were using the service which is operated from a large stately home set in vast acreage. Four floors offer bedrooms and facilities, including large communal dining areas, an activities room based in the conservatory and a large day room. Each bedroom has an en-suite with additional toileting and bathing facilities offered per floor.

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

We found risks to people using the service were not always clearly identified and managed. We also identified concerns in relation to the safe management of medicines. We made a recommendation in relation to systems in place to identify and respond to safeguarding concerns. People indicated they felt safe, with comments including, “I do feel safe here, the staff are sensible” and “Yes, I always feel safe living here, I am being looked after very well as far as I’m concerned.”

Staff were safely recruited. We observed positive interactions between staff and people, with some examples of less person-centred care also observed. The service utilised technology, providing staff with hand-held devices with access to people’s care plans, details of care tasks required, and a link to alerts from movement sensors and call bells.

Some people felt they would benefit from improved staffing continuity. People’s comments included, “Some of the carers are very kind and helpful, the carers do change all the time, sometimes it feels like they are never the same for long” and “Some of the staff are absolutely amazing here, although we rarely have conversations, those we have are always short… they simply haven’t got the time.” A relative also commented, “Generally the staff are very good, but she doesn’t like being washed by strangers…if she had regular staff it would make a difference to her.” A second relative commented, “I have no major concerns but he is not stimulated...it’s a fairly quiet atmosphere, some residents seem cheerful.”

We received positive feedback regarding the service’s environment. A relative commented, “The atmosphere is nice, they have amazing gardens and it feels like home.” Other comments from relatives included, “It’s very homely, friendly” and “They get tea and coffee throughout the day. The ambience is good, and the building warm and nicely furnished with a big TV.”

Systems were in place to monitor the quality and safety of the service, however these were not always fully effective and we found some gaps in recording, such as records used to document support given with personal and oral care. The service planned additional staff training to help improve documentation.

Systems were in place to engage with people and their relatives. Some relatives raised concerns regarding the accessibility of communication with the service, with particular difficulties in making telephone contact. Comments from relatives included, “[Registered manager’s name] always provides me with updates”, “The manager is okay, approachable, accessible and will get others to sort stuff out and then let me know” and “There was nothing before but recently they started having [relative] meetings…There was a couple of issues initially and I think they were acted upon but I did not get feedback.” The telephone system was due to be replaced.

People were generally supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

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 09 January 2020).

Why we inspected

We received concerns in relation to an increased number of falls resulting in injury and concerns expressed from families in relation to the quality of people’s care and communication with the service. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Burnham Lodge on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to safe care and treatment and in informing the Commission of information they are required to.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.