Burlington Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. The provider was in breach of legal regulation in relation to recruitment. Improvements were found at this assessment and the provider was no longer in breach of this regulation. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 75 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff recognised incidents and reported them appropriately. Action was taken to understand why an incident occurred and what could be changed to prevent further occurrences. Discussions between staff and people took place to ensure practice was reviewed and changes made to improve the service. The registered manager consulted with other healthcare professionals when needed, to monitor and learn from incidents. Staff discussed incidents and whether interventions had worked well or not. They shared their experiences so these could be learnt from. This ensured a consistent and person-centred approach to supporting people.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Staff worked with external professionals to ensure people’s needs were suitably met. Staff had made appropriate referrals to other health and social care services where needed to enable people safe continuity of their care. People were supported appropriately with health appointments. The registered manager told us that everyone had been seen by a visiting dentist and staff had completed ‘My Dental’ training.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Systems and processes were in place to identify, review and investigate safeguarding matters. Appropriate action had been taken when any concerns were raised. Documents showed how the registered manager had oversight of safeguarding matters. The registered manager also kept track of those who were under Deprivation of Liberty Safeguards (DoLS) and, when these needed to be renewed, had made appropriate referrals. There was a whistle-blowing policy so if staff had concerns, they could report these. Staff told us they were confident their concerns would be listened to.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks to people were assessed on admission to the service and regularly updated. Where risks had been identified, these were assessed and appropriate actions were in place to mitigate them. For example, where people were at risk of choking, staff sought input from a speech and language therapist (SaLT). This included advice on what people required to safely maintain their nutrition and hydration.

People and their relatives told us they were involved in decision making including around risks, where appropriate. Care plans were robust and clearly considered risks to people. Clear guidance was provided to staff in how to minimise risks to people but still encourage them to be as independent as possible. Staff were aware of this guidance. A staff member told us, “We have a falls procedure. We ring the emergency bell, we get a pillow, wait for the nurse, we write up the story of what happened. It all goes onto [electronic care plan system]. Then nurses would do observations over the next 24 hours or so.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The facilities were going through scheduled refurbishment. The registered manager had a schedule of completion for the building works. There was a comprehensive plan in place to ensure the associated risks were mitigated.

The registered manager had a robust routine of environment checks in place. Appropriate maintenance audits were effective and completed within the allocated and suitable timeframes to promote a safe environment. Checks such as fire alarm and water safety were completed regularly.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staffing levels were appropriate to meet people's needs and there were sufficient numbers of skilled and experienced staff deployed to keep people safe. We saw staff supported people in a relaxed manner and spent time with them. During our visit we saw staff were available and responded to people. People and their relatives told us they were happy with the staffing numbers. They confirmed that people’s care needs were being met by staff who were well trained and knew them well. Comments from people included, “[They are] good, really good, brilliant. I get what I want. There is the odd one with a language problem.”

Staff training was focussed on the individual people living at the service. For example, there was specific moving and handling training for each person. All staff had undertaken Oliver McGowan training, and training in behaviours that challenge (distressed behaviours). The registered manager kept oversight regarding staff training to ensure this was kept up to date. Regular competency checks were completed to monitor staff knowledge and practice. Staff told us they were happy with the training. A staff member told us, “I had an induction, then training and shadowing. I feel it was the right training. We did workshops. Everyone is different, all dementia is different. I feel confident to work with people with challenging behaviours.”

The registered manager told us, “All our staff want to be here. We have a tough interview process. People have a chance to give feedback on new staff before they are permanently employed. New staff have a trial shift so everyone can see how they work.” They told us during new staff’s trial shifts they monitored their interactions and ascertained whether they were caring, motivated and a good fit with the home.

Staff were recruited in line with safe practice. For example, checks were made to ensure staff were of good character and suitable for their role. This included obtaining references from previous employers. Checks with the Disclosure and Barring Service (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff received training on infection control. There was liquid soap and paper towels at hand washing areas and additional hand sanitizers throughout the service. There was a good supply of Personal Protective Equipment (PPE), and we saw staff using this when needed. Staff were trained in PPE use. Infection control audits were completed and reviewed practice, equipment and standards of cleanliness. A member of care staff told us, “Cleaners are all on top of the cleaning in the home, they stay longer if they need to.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People’s medicines were stored and administered safely. Medicines were stored securely following current guidelines for the storage of medicines. There was a dedicated room for storing people’s medicines. The room was clean and organised. We saw a lockable fridge was available to store medicines that required lower storage temperatures. Daily temperatures of the fridge were taken and recorded to ensure the fridge remained at a safe temperature

Each person had a medication administration record (MAR) detailing each item of prescribed medication and the time they should be given. People did not raise any concerns regarding the administration of their medicines.

Staff had received training, and competency checks were completed to ensure staff were suitably skilled to do their roles. All the staff we spoke to regarding the administration of medicines told us they felt confident and competent.