Archived: Burrowbeck Grange Nursing Home

We asked the service to provide us with an action plan demonstrating what they had done to address the issue of non-compliance. We received an action plan from the registered manager. This detailed the procedures put in place to address the concerns. This inspection was to see what actions had been taken.

On this inspection, these areas of concern had improved and the service was compliant. We found care plans were being modified to ensure all information was accessible. Records seen were accurate and informative.

We spoke with a range of people about the home. They included people who lived at Burrowbeck Grange, where they were able, staff, and a professional working with the home. We also observed how people were supported by staff. Most people we spoke with indicated or told us they were satisfied with the care being provided. They told us they felt well cared for. One person said, "The staff are nice and helpful.' Although another person said they didn't like anything.

We saw that care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. People were treated with respect and dignity and personal care was given discretely.

We observed the home was clean and tidy. Actions had been taken to ensure flooring and equipment protected people from the risk of infection.

At the last inspection there were concerns about the effectiveness of the audits. On this inspection formal audits were in place and regular informal monitoring was carried out regularly. These included looking at care, medication management and infection control.

As well as the provider's quality governance meetings, the manager had started to complete monthly reports for the Directors. In addition, the newly appointed Head of operations was starting to carry out regular spot checks, where he walked around the building, observed care and talked to people, as well as formal audits. This was to ensure there was an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

We saw that people were treated with respect and dignity by the staff team. Most people were cared for in an environment that was safe, clean and hygienic but we had concerns about standards in some communal areas.

The manager was reviewing practices in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DOLS). This was in response to recent national events and was being reviewed in conjunction with supervisory bodies in Lancashire, who were the homes major commissioners.

We saw that audits were in place but that these were not always sufficiently robust. The provider had not always identified concerns. This meant that some concerns had not been addressed prior to external inspection.

Is the service effective?

People told us that they were pleased with the level of care that was being delivered to them. We saw that staff treated people kindly with an understanding of individual each person's preferences.

People's health and care needs had been assessed with professional help and in consultation with relatives. Most people were unable to participate in writing their plans of care because of their conditions. Specialist assessments of nutrition, behaviour, mobility and pressure care management had been identified in care plans. We found these did not always translate into the required follow up actions, and that in some cases the records contained discrepant information.

Is the service caring?

We saw that people were supported by kind and sensitive staff. Staff were attentive to people's needs and showed patience and encouragement when supporting them. We saw that staff were engaged in a number of activities with residents in addition to offering personal care. These included playing dominoes, and carpet bowls.

Is the service responsive?

We saw that breakfasts were available as and when residents wanted to eat, and that they included a wide choice from full English fry ups to toast or porridge. We saw that staff were encouraging people to eat or drink, and were giving them time to do so.

We saw that residents were engaged in a range of activities. Individual preferences were recorded and used by the activities co-ordinator to tailor their likes and dislikes into daily activities. These records should help to make sure that people were provided with an individualised service that met their specific requirements. However they were stored in the attic rather than being easily available to staff on day to day basis.

Is the service well-led?

Burrowbeck is managed by Optima Care Limited. The provider conducts regular audits of all its services on a planned basis. These quality assurance systems helped to ensure that the quality of the service was continually monitored. However, we found some audits had failed to identify issues, suggesting a lack of robustness.

We found the registered manager to be caring and knowledgeable about the people living in the home. However at the time of the inspection, she lacked a deputy and was over stretched in seeking to complete all her duties.

We found that clear accounts of people's histories and current care were difficult to find. It was unclear how records were maintained contemporaneously. Some key information was not communicated in an effective way between management, nursing and care staff. We found there was a shortfall in nursing numbers, which was not being fully covered. On the day of our inspection we also found a shortfall in care staff. Whilst we found individual care staff pleasant and patient, the shortfall in numbers had adverse effects on the standards of care for people. There were significant gaps in staff training which the service provider considered essential. There was no evidence that staff had relevant, recognised training to manage pressure ulcers.

We inspected Burrowbeck Grange to look at aspects of care, the safe handling of medicines, record keeping, how well staff were supported and how complaints were handled.

We found that the care at Burrowbeck Grange continued to be of a good standard. People were well looked after, and staff to resident ratios were high both in the daytime and at night. This meant staff had time to give individual attention to people. We found medicines were safely stored and that systems for dispensing them were appropriate. We found record keeping in relation to people living in the home, and staff records, were well managed and helped to ensure safe and appropriate care. We spoke with a number of staff who told us that they were well supported, had regular supervision and training. We verified this by looking at records.

We looked at the complaints policy and found that the corporate policy issued by Optima Care was up to date and helpful. However, information for people using the service or their relatives was out of date and inaccurate. Initial complaints were logged, with brief details, but we found follow up information hard to follow or unavailable. We found that company policy was not been adhered to in how complaints were responded to.

On this inspection we found that the service had introduced a new care plan format. In addition the service had introduced new systems to continuously monitor and review the care records. This meant that the care being provided was relevant and meeting people's needs.

We did not speak in depth with people living at the home. However we observed staff being responsive and attentive when managing people's care and support.

This home cares for people with a range of dementia conditions and conversation with most residents was limited. We therefore spent much of the time in the communal areas making observations of how people were being cared for. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed.

We observed staff assisting people who required care and support. Staff treated people with respect. They provided support or attention as people requested it.

We spoke with family members about their experience of visiting the home. One person said, 'The home has been fantastic, I know I don't have to worry about my relative'.

We also spoke to Lancashire County Council's Procurement Centre during our inspection. They told us they currently had no concerns with the service being provided by the home.