Burlington Villa

Burlington Villa accommodates nine people in one adapted building. The service provides support to people with a learning disability. At the time of our inspection there were nine people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was not always able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture.

Right Support

Staff did not always support people to have the maximum possible choice and control over their own lives.

The service had locked all internal and external doors to manage the behaviour of one person but consequently it impacted on other people’s freedom. There was a wider concern relating to how the provider manages behaviours that challenge and whether the service supported a human rights approach.

Staff did not always support people with their medicines in a way that achieved the best possible outcome. The service did not maintain accurate and up-to-date records about people’s medicines.

When ‘as required’ (PRN) medicines were used to manage behaviour, records were not thorough or detailed. There was no evidence of post incident analysis or evidence of how well the medicines were effective in managing the behaviour.

People were supported by staff to pursue their interests and make plans for the future.

The service gave people care and support in a safe, clean and well-maintained environment. People had a choice about their living environment and were able to personalise their rooms.

Right Care

Some people were able to express their views and make choices.

People received kind and compassionate support. Staff were appropriately trained and had completed training in autism and equality and diversity.

People had access to healthcare professionals and were supported by staff to attend appointments.

Care plans were person-centred and demonstrated a good amount of knowledge about the people they supported.

Right Culture

Restrictions were put in place with no evidence of the least restrictive options being considered. There was limited opportunity for staff to learn from incidents and improve practice.

Audits were completed at the home to monitor the service and make any improvements needed although they did not always identify shortfalls we found at this inspection.

Staff turnover was very low, this gave people a more consistent approach from staff who knew them well. Some staff members had been in post for several years.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not 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 the service under the previous provider was good, published on 1st November 2017.

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding. 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 COVID-19 and other infection outbreaks effectively.

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 will continue to monitor the service.

We have identified breaches in relation to the safe care and treatment, safeguarding service users from abuse and improper treatment and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

At the last inspection, in August 2015, the service was rated Good. At this inspection we found that the service remained Good, however the rating for the Caring question had improved from Good to Outstanding. .

People continued to feel safe and staff ensured that risks to their health and safety were reduced. There were sufficient staff to meet people’s needs in a timely manner and systems were in place to support people to take their medicines.

Staff received relevant training and felt well supported. People were asked for their consent and appropriate steps were taken to support people who lacked capacity to make particular decisions. People were supported to eat and drink enough to maintain good health.

The service was exceptionally caring. Positive relationships existed between people who used the service, their relatives and staff. Staff were extremely kind and caring and treated people with dignity and respect. People's diverse needs were recognised and catered for and their rights to privacy and dignity were valued and respected.

People's right to make choices was respected by staff and they had access to advocacy to help them express their views if needed. Staff had an in depth understanding of how people communicated and had insight into the anxieties experienced by people who used the service and used this to shape people’s support and routines. The culture of the service was focused on enabling each person to live a fulfilled life, as independently as possible and this resulted in people being valued and treated as individuals.

People received person-centred and responsive care from staff who had a clear understanding of their current support needs. Care plans were in place which provided detailed information about the care people required. People knew how to make a complaint and there was a complaints procedure in place.

There was an open and transparent culture which enabled people and staff to speak up if they wished to. The management team provided strong leadership and a clear direction to staff. There were robust quality monitoring procedures in place.

Further information is in the detailed findings below.

There were significant improvements in the care plans in place and these were helpful and up to date. One person told us, "I think what is written is right about me. I get the care and support I need when I need it, I don't need much, only to go into the community.' People had their health and recreational needs met well.

People lived in a comfortable environment and the premises were safe for them to live in.

People we spoke with said they were happy at the service. They knew they could complain. One person commented, 'I have not had to complain but I would speak to (the acting manager), she is really good and I know that she would sort it out.' The staff knew how they should respond to complaints. This meant there were effective systems in place for responding to concerns.

Improvements had been made to the systems to make sure people could make their own decisions unless they did not have the capacity to do this for themselves. This meant their rights were considered.

There was mixed evidence about how people's care and welfare needs were met. In most cases this was done well, with warmth, compassion and understanding. However we found the staff did not have the appropriate guidance to help them understand more challenging needs and to help them respond consistently to meet these needs. We thought improvements were needed.

We found there were improvements in the arrangements for making sure people took their medication as their doctor had prescribed. This meant people got their medicines at the right time.

We looked at the staff files of people who had just started working at the home and we saw they had been recruited safely to make sure they were suitable to work with people living at the home.

We found the complaints system was not good enough and did not follow the policies the providers had in place to make sure they could investigate and respond to people with concerns.