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Inspection carried out on 11 November 2019

During a routine inspection

About the service:

Burnham Lodge provides accommodation for a maximum of 60 people and also offers day care, where people could choose to visit for a day, a week or several weeks. At the time of the inspection 28 people were using the service which is operated from a large stately home set in vast acreage. Four floors offer bedrooms and facilities, including a hair salon, 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:

The provider had acted to ensure the premises was safe to use for their intended purposes. Risks to people’s health and welfare were assessed and managed appropriately. We found all concerns found at our last inspection in December 2018 had been addressed.

People spoke positively about the caring nature of staff. A relative commented, “(Care is) amazing! Can't ask for anything better. Staff are kind, caring, friendly. They’re always great and address us and [name of family member], very welcoming."

Throughout our visit we observed warm, friendly interactions from staff towards people. People received care and support from staff who knew and understood their care and support needs. People and relatives felt they were able to express their views and staff ensured their privacy and dignity was maintained, and their independence promoted.

People said they generally felt safe. Staff understood the signs of abuse, reporting procedures and had attended the relevant training. A person told us of instances when they did not feel safe. We discussed this with the management team who told us they would look at ways of improving the person’s experience of feeling safe. Recruitment checks ensured people were cared for by staff who were suitable. We found there were enough staff to provide care and support to people. There were safe medicines management and infection control procedures.

The service had participated in a hydration project with the local clinical commissioning group (CCG) which had resulted in improved hydration for people. Staff had the qualifications, competence and skills necessary for the work to be performed by them. Care records documented how people wanted to be cared for but, did not identify all individual needs which related to the protected characteristics identified in the Equality Act 2010. We have made a recommendation about this.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests; as the policies and systems in the service did support this practice. We found the service acted in accordance with the Mental Capacity Act 2015.

People’s care and support needs were assessed to enable staff to meet their specific needs. Care records were detailed and documented people’s preferences for care, such as end of life care. However, this was not always clear when it came to people’s preferences for staff based on their gender. We have made a recommendation about this.

The service did meet the requirements of the Accessible Information Standard (AIS) but management acknowledged they were not familiar with the AIS. Information contained in care records was detailed, documented if people had disabilities or sensory impairments, showed what people’s level of communications were and how staff should support them. People were supported and had the choice to be socially active and they knew what to do if they had any concerns. The provider operated an accessible system for identifying, receiving, handling, and responding to complaints.

People and relatives felt the service was well-led. A relative commented, "Best care anywhere. [Name of family member) didn't want to come to a care home but they (staff) helped them settle. Better than we thought. Quality of life has improved since [name o

Inspection carried out on 17 December 2018

During a routine inspection

This inspection was completed on 17 and 20 December 2018, by two inspectors. The inspection was unannounced, which meant the provider did not have any advanced knowledge of the date of the visit.

Burnham Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Burnham Lodge can accommodate a maximum of 60 people in the premises with 49 bedrooms, and the remainder as day patients. At the time of the inspection 36 people were using the service which is operated from a large stately home set in vast acreage. Four floors offer bedrooms and facilities, including a hair salon, large communal dining areas, an activities room based in the conservatory and a large day room. Each bedroom is en-suite with additional toileting and bathing facilities offered per floor.

The service has a registered manager. However, at the time of the inspection, the registered manager had been on maternity leave for 11 months. The service was overseen by the deputy manager, and a peripatetic management team. 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 not kept safe. Adequate risk assessments and comprehensive documentation were not in place to ensure people were offered responsive, safe care and treatment. Staff could not always tell us how to safely care for people and meet their needs, and people's care plans and risk assessments contained conflicting and inaccurate information. The inconsistent information meant people were put at risk of harm.

Medicines were not always managed safely. Whilst we found that medicines were stored in people’s rooms, temperatures were not maintained, therefore were at risk of the efficacy of medicines became altered. Furthermore, the method of administration was not in line with best practice guidance, or with the provider's own medicine administration policy.

People were not being kept safe due to a failure in appropriate monitoring and recording of the environmental risks and risks to people. The service did not have robust recruitment processes in place to ensure staff employed were safe to work with people.

Nutrition and hydration records were maintained for all people. However, information was not cross referenced or analysed as required. As a result, some referrals were not made to health professionals to seek further clarity on change in people’s hydration and nutrition.

Staff were not supported with adequate training, with their training not always being in date. Staff did not have training that would help them meet people’s changing needs.

Effective systems were not in place to audit care documentation and identify any shortfalls in the quality and safety of care provided.

People's care was not always delivered in a dignified way. Privacy was not always protected, with bedroom doors being left open for most of the day and night. Care was found not to be responsive to people’s changing needs, and often not effective. People were not always consulted about how they wished to have care delivered, or were not consulted prior to being assisted. This meant that whilst staff had received training in the Mental Capacity Act, they did not practice the fundamental standards of the legislation. Furthermore, people were having their liberty restricted without confirmation from the local authority that this was authorised.

The management completed ad hoc audits. The provider did not have a comprehensive overview of the service. Whilst a management structure existed, this was not effective in ensuring governance of the provisi

Inspection carried out on 26 January 2016

During a routine inspection

Burnham Lodge is a nursing and care home that is registered to provide nursing care for up to 60 people. At the time of our inspection, 44 people were living at the service. Burnham Lodge is a private family owned service.

This inspection was undertaken on the 26 & 27 January 2016 and was unannounced.

Burnham Lodge had a registered manager in place. 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.

Burnham Lodge is a large period property located in Burnham, Buckinghamshire. Burnham Lodge is set over four floors and is a registered nursing home. The home provides care to people who require assistance with personal care and nursing needs. Staffing at Burnham Lodge consists of registered nurses, care assistants and domestic staff.

We found people were receiving good care at Burnham Lodge. People were protected from harm as there were appropriate risk assessments and staff training in place. Medicines were managed in a way which prevented potential harm and promoted people’s rights.

People were cared for by staff who were polite, caring and responsive to their needs. When people requested assistance, staff acted promptly. People we spoke with were complimentary about the staff team at Burnham Lodge.

People’s needs were assessed to ensure their needs were met in a way which promoted their rights, dignity and privacy. Where people required support with their nursing needs, these were done by clinical staff who had the knowledge and skills to promote people’s wellbeing.

We found there to be clear management oversight of the service. Many positive changes had occurred since the new manager came into post which appeared to have a positive impact on the people living at Burnham Lodge.

People were supported to access a range of activities and we observed these to be well received by those who participated. People had free access to the grounds of Burnham Lodge. The home was well maintained and had a homely atmosphere. People told us they were happy living at Burnham Lodge.

Inspection carried out on 2 January 2014

During an inspection to make sure that the improvements required had been made

When we visited Burnham Lodge on 21 August 2013 we found people�s dignity and freedom of choice was not always respected and promoted. We also found the provider was not notifying the Care Quality Commission about events which were reportable under this regulation. We set a compliance action and required the provider to tell us how and when they would become compliant. Following the inspection we saw evidence the home had taken immediate action on the areas of concern. We received an action plan dated 13 November 2013 which set out what actions were to be taken, to achieve compliance. During this inspection we found the action plan had been put in place.

We spoke with five people who lived in Burnham Lodge and one relative. One person told us "I am very happy here, I choose what I like to eat and activities I want to take part in." Another person said "The food is lovely, always plenty of it and we have many options to choice from." A third person told us "All the staff here respect me and my choices and my dignity and independence is respected." A relative we spoke with told us "I come very often here, and I have always found the staff respectful and they respect people's dignity and independence."

The home had a policy in place, which clearly set out how mealtimes should be planned to ensure people�s choice, dignity and independence were promoted. The manager had introduced dining room audits, to ensure staff respected people's dignity and independence.

We found people could now be confident that important events that affected their welfare, health and safety were reported to the Care Quality Commission so that, where needed, action could be taken.

Inspection carried out on 21 August 2013

During a routine inspection

During our visit we spoke with four people and one relative. All the people we spoke with were complimentary about the home and the staff. People told us staff were polite and treated them with respect. People said they could choose how they spent their time and had opportunities to be involved in activities. Comments included �I have variety of entertainment to choose from which pleases me�, �I choose what I would like to eat and the time I get up and retire for the day.� The relative we spoke with told us told us �They always talk nicely to my (X) and treat (X) with respect�I am happy we decided to bring (X) here.�

We found people were involved in making decisions about their care and were offered choices in what they wished to eat and activities they wished to take part in. However, people's dignity was not always respected and promoted. People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found there were enough qualified, skilled and experienced staff to meet people's needs. We found that events which affect people's welfare, health and safety were not being reported to the Care Quality Commission as required.

Inspection carried out on 12 November 2012

During a routine inspection

We spoke to five people and one visitor. People said the care was �very good.� One person said, �My wishes, privacy and dignity are respected.� Another said, �The care is excellent. I cannot fault it.� A third person said �Staff are very good with washing me as well as getting me into bed. They always make sure the door is shut.� A fourth person said �We receive a high standard of care.�

People said they received their medicines at the right time. We spoke to a person who was managing their own medicines. The person said, �I am able to take my medication by myself. Staff keep my medication in a safe place and assist me by getting what I want when I request it.�

People said their bedrooms were cleaned daily. A visitor we spoke with said, �The home is spotless.�

People said staff supported them to maintain their independence.

People described staff as �most helpful, pleasant, polite and professional.�

We found people received the appropriate care and support that met their needs. People�s medicines were safely administered. The environment was appropriately maintained to promote people�s safety and wellbeing. The service ensured there was an effective recruitment and selection procedure in place. Staff were appropriately trained, supervised and appraised.

Inspection carried out on 8 December 2011

During a routine inspection

People said that the home provided them with choices and staff respected their privacy and dignity. They said that they were registered with a GP who visited the home weekly or as and when required.

Relatives of people living in the home said that the home was recommended to them. They said that they initially visited the home on behalf of their family member. Staff were able to answer their questions and provided them with written information about the home.

People told us that they felt safe living in the home. They said that they knew how to make a complaint and whom to speak to if they were not happy with a situation.

People said that the home was well maintained and their rooms were clean and tidy.

People told us that staff were trained appropriately to meet their needs and staff spoke to them appropriately.

Relatives of people living in the home said that staff were approachable and were knowledgeable about their family member�s care needs.

People told us that their views were sought about the care they received.

Reports under our old system of regulation (including those from before CQC was created)