Burnham Lodge

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 83 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The service had a clear and structured admission process for people moving in for emergency, respite, or long‑term care. A relative told us that the registered manager had been “very helpful to us from assessment at [hospital] throughout [moving to the home],” this helped people and their families build relationships with staff and ensured the service gathered essential information before admission.

Initial assessments captured people’s physical, emotional, sensory, and communication needs, reflecting their views and preferences. Staff explained that they used these assessments to develop initial risk assessments and care plans; however, these documents did not always contain sufficient detail, which made them difficult to use in practice. As a result, staff did not always have comprehensive information about individuals before they moved in.

Over time, assessments became more detailed as staff got to know people better, and many care plans and risk assessments showed significantly improved clarity and depth. Audit actions identifying gaps had been addressed.

Records evidenced that monthly reviews of people’s care and treatment were carried out with people, their relatives or representatives and professional partners. Staff told us they checked people’s care plans and risk assessments for any changes before they started work. Changes in people’s need were communicated on the electronic care planning system, in staff handovers, and meeting minutes. A person’s relative told us “On the whole, they are good at keeping me up to date on how [person] is and we have regular care review meetings. I know [they're] being safely cared for.”

We observed a “resident of the day” initiative in place, where a person’s care records were reviewed on a particular day of the month, including a review of their care in general. We observed staff discussing this during meetings, and records evidenced this happened every day. This meant that people’s care was continuously monitored and reviewed.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The service carried out appropriate nutrition and skin integrity assessments, and care plans were put in place accordingly. The home supported people to access SALT (Speech and Language Therapy) services where they were identified to be at risk of not being able to swallow or chew their food safely. A person’s relative told us, “They’ve recognised that [person] was not eating enough [due to health condition] and they’re working with the nutritionist and GP to try different ways to get [person] to eat. They purify [their] foods and are now giving [them] little and often to get [them] to eat more.”

Kitchen staff kept up‑to‑date, accurate records of people’s dietary needs and preferences. They provided meals on request alongside the daily menu that had been designed with people living at the service. Staff also worked closely with individuals who required modified diets to ensure meals were as appealing and enjoyable as possible. However, whilst a person’s daily records did identify the texture of meals offered to them, these were sometimes inconsistent. This meant it was not always clear what texture of meal had been provided to the person.

People’s skin integrity was monitored, reviewed, and treated accordingly. We observed staff working with people to treat their wounds. The service made appropriate referrals to tissue viability nurses where necessary. Nurses had training in wound care and tissue viability treatment. However, people’s records did not always indicate that repositioning was carried out at required intervals. One person’s care plan did not always contain consistent information about the severity of a person’s wounds. We did not identify that the person’s skin integrity had deteriorated as a result. We gave feedback to the provider, and they took action to rectify this.

The provider always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

We observed the service to work exceptionally well with healthcare services to support people to settle into the home on a long-term basis. The service provided a structured, gradual transition for people moving into the home by arranging several visits with their trusted health professionals over several weeks, to allow people to settle in, meet other people and staff at the service, choose their rooms and make them their own. The home worked with other healthcare services to support people to build effective risk assessments and care plans during this time to ensure the person only needed to tell their story once, and that staff knew how to support them.

The service could contact out-of-hours professional support for emergency healthcare advice including psychiatry support. The service also operated an on-call system so that staff could access support from the provider outside of usual business hours.This meant that people were able to access a safe, effective and timely transfer of care when moving between services.

We observed thorough handovers of information taking place. Records evidenced that senior leaders in the service held daily meetings to discuss team feedback around daily tasks, concerns and training needs. Manager feedback from daily walkarounds was also given during these meetings. Staff told us, “All staff attend handover before the start of [their] shifts”, and “Everything is discussed in handover by the nurse.” This meant that staff always had the most up-to-date information regarding people and their care needs.

People had hospital passports in place which contained information about their care needs. The service was visited by a GP on a weekly basis for review of people’s medical health needs. This meant that people’s immediate health needs were met on a local basis. A professional partner told us they trusted the home to look after people they worked with, saying “I know that [they] will be well cared for.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

When people came to the home for respite care, care plans and risk assessments were put in place, including guidance for staff to support people to access rehabilitation services. The registered manager was able to demonstrate where they had supported people to reduce their future needs for care and support, including the removal of 1 to 1 care at night. This meant people were able to regain some of their independence.

People were encouraged to carry out personal care, activities, eating and drinking independently, and were given discreet support by staff where necessary. People were supported to access vaccinations, neurological health, audiology, optometry and dental services both inside and outside of the home.

The home had a designated salon where people could access hair care services. A range of exercise activities were available, including seated exercises, yoga, ball games, garden walks, and table tennis.

Staff received appropriate training in first aid, diabetes, and how to monitor people for signs of urinary tract infections and skin breakdown. This meant people were supported to increase and maintain their mobility.

The provider monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

Staff knew how to monitor people’s food and fluid intake. We observed people to always have access to food and fluid. Staff demonstrated a clear understanding of signs of malnutrition and dehydration and how these might present in a person’s appearance, for example, low energy levels or poor skin integrity. Staff knew who to escalate these concerns to when required. Audits had identified any gaps or concerns with records. We found no concerns during this assessment.

Relatives told us that they were included in monitoring and improving people’s health outcomes. Comments included, “[Person] is putting on weight as [they] need to. [The home] put a little fridge in [their] room so [they] can keep some of [their] favourite snacks to eat”, and “They are really accommodating. [Person] has been really struggling with food, and they let me bring food in and help [person].”

Relatives also told us, “When [person] was hospitalised [they] lost weight. [Staff are] encouraging [person] to eat and weighing [person] regularly and updating me on how [person is] doing”, and “I honestly have no complaint, I’ve seen how much improvement [person has] made in a few weeks.” Visitors were warmly encouraged to join their loved ones for meals, helping to support their involvement and enjoyment of eating. This meant people and their relatives were involved in reviewing people’s care and expected outcomes.

Staff supported people to understand their care and support options with positive outcomes set within care plans, for example, to reduce isolation and join communities inside and outside the service. People were able to choose how they spent their time. People told the provider that they wanted communal areas that enabled them to socialise independently of activity times. We observed people using these areas when they wished with others in the home. The provider hosted a range of social opportunities and hobbies, including seasonal events, faith and birthday celebrations, floristry, sports and craft activities.

Staff told us, “We have lovely grounds which we take [people] out into every day if we can. We have an orchard and the chef uses the fruit for cooking, and we have beehives and solar panels. We love to do cooking with everyone too and today we made pies. We are always busy and have lots going on.”

People’s relatives told us, “They’ve encouraged [them] to join in the activities, and [they’ve] made a little circle of friends”, and “[Staff are] very good at reading [person]. If [they’re] able to they get [them] up and take[them] to the lounge to be with other people which is very good for [them].”

People who could not access communal activities were also supported to engage in activities on a 1 to 1 basis. A person’s relative told us, “[Person] doesn’t join in the activities, but the activities coordinator comes and has long chats with [person], which is brilliant for [them].”

We observed activities coordinators working well with a person to encourage them to join others to eat in communal areas, to reduce their isolation. Staff were supportive and encouraging when they joined others to eat. People were supported to use technology such as a large “tiny tablet” to contact their families via video call where visits were not possible.

We observed the registered manager working closely with people’s relatives to ensure personal relationships were respected, and that individuals could spend as much meaningful time together as possible, despite any health needs.

The environment was calm, free from excessive noise, with call bells mostly diverted to staff devices. People’s distress was responded to immediately and effectively, using recognised de-escalation techniques, including the use of non-verbal gestures such as gentle touch on hands. A person’s relative told us, “They know [person] very well and read their non-verbal language.”

This meant that people enjoyed a good quality of life, which was constantly monitored. The service identified actions from reviews of people care and ensured these were actioned to improve people’s experience of the home.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

We observed staff asking permission to give people support for specific care tasks such as personal care and eating or drinking. We observed staff to knock on people’s doors and introduce themselves as needed.

People told us, “They knock on the door before they come in but I’d not worry if they walked in. They usually ask or they tell me, I’ve come to do your [care task] and it’s up to me if I say no”, and “Yes, they do [ask for consent]. They say, do you want help with whatever you are doing, do you need help. I’ve known them for quite a few years.” This meant that people were always involved in making decisions about their care.

Staff were trained in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), and demonstrated a good understanding of the assessment process, and how they supported people subject to a DoLS order. MCA assessments were in place for people who did not have capacity, and were completed in detail, with thoughtfulness and care, however, it was not always clear if the assessments were decision specific. We did not find any evidence documentation held had impacted a person’s ability to consent to their care and treatment. We observed people’s wishes very clearly respected and adhered to.