Burnt Tree Croft

Burnt Tree Croft is a residential care home that provides accommodation and personal care for adults with a range of care and support needs. This includes adults who are living with dementia. The home can accommodate up to 40 people in one adapted building over three floors. At the time of this inspection there were 37 people using the service.

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

People felt safe at Burnt Tree Croft and they were cared for by staff who knew how to protect people from abuse. Some improvements were needed to the management of risk, to ensure staff consistently reviewed and acted upon identified risks. People were supported by staff who responded to them promptly, however there were times when staff could have been deployed more effectively to promote people’s safety. Some people had not received topical medicines such as creams, as prescribed, however there was no evidence people had suffered any harm because of this. People’s medicines were ordered, stored and disposed of safely and people were protected from the spread of infection.

People were cared for by staff who knew them well. People and their relatives told us staff were kind and caring. People had enough to do, to keep them meaningfully occupied. People provided positive feedback about the activities and entertainment on offer. People had opportunities to provide feedback about the care they received and to raise any concerns. People knew how to complain, and we found any complaints were acted on appropriately.

Staff received training in a range of different areas to ensure they had the right skills to deliver effective care. Staff were happy with the training they received, and people told us the staff knew what they were doing. However, staff told us the support they received via supervision meetings was not always effective. We found improvements were needed to the communication between staff and managers, to ensure staff had opportunity to raise ideas or concerns about the service and request any additional support they needed to undertake their roles effectively.

People were happy with the food available at Burnt Tree Croft and they were encouraged to drink enough. People and their relatives were happy with the quality of care they received. People’s independence was promoted and their dignity was maintained. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

Staff told us they enjoyed their jobs and it was evident they had a clear desire to provide good quality care to people. However, the morale of the staff team was low. Staff felt their ideas for improvement were not acted upon by the registered manager or provider and staff told us they were not kept informed about changes to the service.

The provider and senior staff regularly completed a range of checks and audits to assess the quality and safety of the service. The registered manager used the results of these audits to make improvements to the service. However, some of systems used to monitor the safety of the service were not embedded and therefore were not effective; they had not identified some of the issues we observed during this inspection.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 19 July 2016). There was also an inspection on 21 January 2019, however the report following that inspection was withdrawn as there was an issue with some of the information we gathered.

Why we inspected

This is a planned inspection because of the issue highlighted above.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

Our last inspection at Burnt Tree Croft took place on 2 May 2014. The home was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on 16 June 2016 and was unannounced. This meant the people who lived at Burnt Tree Croft and the staff who worked there did not know we were coming. On the day of our inspection there were 37 people living at Burnt Tree Croft.

People spoken with were positive about their experience of living at Burnt Tree Croft. They told us they felt safe and they liked the staff.

Relatives spoken with had no concerns regarding their relative’s care. They told us they knew staff well and they were always kept up to date with any news.

Healthcare professionals spoken with told us they had no concerns about Burnt Tree Croft.

We found systems were in place to make sure people received their medicines safely.

Staff recruitment procedures were thorough and ensured people’s safety was promoted.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role. Staff understood their role and what was expected of them. They told us they liked their jobs, worked well as a team and were well supported by the registered manager.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves.

People had access to a range of health care professionals to help maintain their health. A varied and nutritious diet was provided to people that took into account dietary needs and preferences so their health was promoted and choices could be respected.

People living at the home, and their relatives said they could speak with staff if they had any worries or concerns and they would be listened to.

We saw people participated in a range of daily activities both in and outside of the home which were meaningful and promoted independence.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. People using the service and their relatives had been asked their opinion via questionnaires, the results of these had been audited to identify any areas for improvement.

We gathered evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People supported by the service, or their representatives told us they felt safe.

People told us that they felt their rights and dignity were respected.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

We found that risk assessments had been undertaken to identify any potential risk and the actions required to manage the risk. This meant that people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded as required.

The service was safe, clean and hygienic.

Is the service effective?

People's health and care needs were assessed with them and their representatives, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Staff were provided with training to ensure they had the skills to meet people's needs. Managers' were accessible to staff for advice and support. Staff were provided with formal individual supervision and appraisals at an appropriate frequency to ensure they were adequately supported and their performance was appraised.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

We asked people using the service and a relative for their opinions about the support provided. Feedback from people was positive, for example; 'they are smashing, can't do enough for you', 'they give me the help I need' and 'they (staff) are very good. I can't fault them'.

When speaking with staff it was clear that they genuinely cared for the people they supported and had a detailed knowledge of the person's interests, personality and support needs.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People regularly completed a range of activities in and outside the service. The home had access to a shared adapted minibus, which helped to keep people involved with their local community.

Some people required specialised diets for health or personal reasons. We found the service provided food and drinks specifically requested by people. People told us, 'The food is good, we get a good choice' and 'they (staff) keep us well fed and watered'.

People spoken with said they had never had to make a complaint but knew how to make a complaint if they were unhappy. We found that appropriate procedures were in place to respond to and record any complaints received. People could be assured that systems were in place to investigate complaints and take action as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

Relatives spoken with said that they were happy with the care their loved one received. Comments included, 'the staff are very caring' and 'I've no worries at all. It is homely and friendly here.'

During the inspection we were able to observe people's experiences of living in the home. The interactions between people living at the home and staff appeared positive. Staff spoken with knew the people living at the home well. We found that care and support was offered appropriately to people.

We found that before people received any care or treatment they were asked for their consent and the staff acted in accordance with their wishes.

We found that people's care and welfare needs were assessed and each person had a written plan of care that set out their identified needs and the actions required of staff to meet these.

We found that medicines were being obtained, recorded, handled, dispensed and disposed of in a safe way.

The provider had a satisfactory recruitment and selection procedure in place to ensure that staff were appropriately employed. Staff were provided with relevant training to maintain and update their skills and knowledge.

The provider had an effective complaints system available. A system was in place to respond appropriately to any complaints received.