Burgess Care

Burgess Care is a residential care home that provides care for 20 people who have a primary diagnosis of a learning disability or autism spectrum conditions, that require specialist care and support. There were 20 people living at the service at the time of our visit. This service was in a rural location and accommodation was provided across four houses. The service can also provide care for people in their own homes.

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

Managers and staff worked in partnership with people, their relatives and health professionals to ensure people received safe care. Staff were confident to identify any safeguarding concerns and knew how to report them.

There were enough staff to provide the level of support people needed, however there was a reliance on agency staff to cover shifts. The provider recognised a consistent staff team was an integral aspect of managing physical and emotional risks and was actively recruiting to the permanent staff team.

Holistic assessments of needs were developed into person-centred care plans with guidance for staff to follow. Relatives told us staff were responsive when events occurred that had potential to impact on people’s emotional well-being.

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.

People’s behaviour was not controlled by excessive and inappropriate use of medicines. Staff understood and implemented the principles of STOMP (stopping over-medication of people with a learning disability, autism or both) and ensured people’s medicines were reviewed by prescribers in line with these principles.

We were assured the service were following safe infection prevention and control procedures to keep people safe.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the key questions Safe, Responsive and Well-led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: Model of care and setting maximises people’s choice, control and independence.

Staff knowledge, observations and understanding of people as individuals encouraged a continuous review of what worked well for them. Staff understood people’s individual communication needs and used a variety of methods to communicate with people to enable them to express their views.

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights.

Where people needed physical intervention by staff to support them at times of anxiety or distress, staff reflected afterwards to identify where changes could be made to develop more effective strategies and to understand the meaning of the behaviour. This promoted people’s dignity and respected their human rights.

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

Relatives consistently praised staff for being kind, caring, intuitive, proactive, and professional and praised the management team for the running of the service. Staff spoke positively about the training and support they were given to meet their responsibilities and the working culture within the service.

For more details, please see the full report which is on the CQC website at

www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 July 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to staffing and the culture within the service. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. We also checked they had followed their action plan following the last inspection and to confirm they now met legal requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from these concerns. The overall rating for the service has changed from Requires Improvement to Good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Burgess Care on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People’s experience of using this service:

People did not always receive care which was responsive to their individual needs. Staff were matched with people and some staff had a good understanding of how to support them well, however this varied with other temporary staff.

There were enough staff to ensure people were safe, however at times staffing levels limited opportunities for people to engage in social activities. Staff turnover was high and there were challenges in relation to recruiting permanent staff.

Where risks associated with people's health and wellbeing had been identified, there were plans to manage those risks. Risk assessments ensured people could continue to be as safe as possible and maintain their independence.

Care records provide information in relation to people’s backgrounds, interests and care needs however some information required updating.

Staff understood their responsibility to safeguard people from harm and knew how to report concerns. Staff told us there was a ‘zero tolerance’ policy in relation to this and any concerns would be addressed.

The provider ensured care was based upon good practice guidance to help ensure people received an effective service.

People were supported to maintain relationships with people important to them. Staff were caring in their approach and regular staff had good relationship with people.

Promoting independence was a part of the ethos of the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received a suitable diet of their choosing and plenty of drinks. The provider and staff team worked closely with external healthcare professionals to ensure people's health and wellbeing was promoted and maintained.

People, relatives and staff had some opportunities to feedback about the running of the service.

Positive feedback was received in relation to the new manager and area manager. Quality checks were carried out to monitor the service. There had been a number of management changes recently and staff morale was low. Some staff felt less supported by the provider.

Rating at last inspection:

Good published in July 2017.

Why we inspected:

This inspection was brought forward due to some concerns we received about staff practices when supporting people. These concerns were not substantiated at our visit.

Follow up:

There will be ongoing monitoring and routine inspections of the location based on the rating of ‘Requires improvement’.

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

Burgess Care is a residential care service and provides accommodation, care and support for up to 20 adults who have a learning disability. People who use the service may also have behaviour that challenges, or autism spectrum conditions that require specialist care and support. At the time of our inspection there were 20 people living at the home. The home is in a rural setting and divided into four houses known as Treetops, Meadows, Acorns and Paddocks. These all provided care for people with differing needs.

A requirement of the service’s registration is that they have a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. There was a registered manager in post.

At the last inspection in March 2015 the service was rated good. At this inspection we found the service remained good, although we found the responsiveness of the service to people’s needs was now outstanding. Each person who lived at Burgess Care was treated as an individual with their own unique qualities and characteristics, no matter how challenging some of their behaviours could be. Both managers and staff were extremely committed to making things possible for people that others may take for granted.

Staff had an extremely in depth knowledge of each person, their likes and dislikes, their important routines and how they demonstrated anxiety. Staff were very creative in thinking of ways of meeting people’s needs and felt empowered to share ideas and suggestions for the good of the people in the home.

People’s desire for more independence and their potential for more independent living was recognised and actively promoted which meant people’s lives had improved and their horizons expanded.

There were enough staff to meet the varying and complex needs of the people living in the home. Staff understood their responsibilities to protect people from the risk of abuse and the registered manager checked staff’s suitability for their role before they started working at the service.

Potential risks relating to each person’s care had been identified and plans had been developed to inform staff how to manage and reduce the risks. Staff had received training and support to meet the specific needs of people living in the home. They felt confident to support people at times of agitation or distress to keep the person and others safe.

The provider worked in partnership with other health and social care professionals to support people’s needs. Medicines were stored, administered and managed safely.

People had developed strong relationships with staff. Staff listened to people and responded in a kind and compassionate manner. Staff knew about the care people needed, gave them time to express their views and respected the decisions they made. People had opportunities to do things they liked and that interested them.

The registered manager had a good understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Where people’s care plans included restrictions on people’s right, choices or liberties, the registered manager had applied to the Supervisory Body for the authority to do this in people’s best interests.

The service had a clear management structure with effective systems and processes for overseeing all aspects of care. Staff were motivated and inspired by the management team to deliver a person centred service, displaying the value of putting people at the heart of what they did. The registered manager was enthusiastic to seek out best practice to drive improvement in the home.

We received the report and we asked the provider to send us an update of progress by the end of December 2013.

We received documentation in December 2013 which demonstrated they were meeting part of the outstanding action. We saw copies of records had been maintained of medication temperatures in the separate units at Sharmer Fields.

In March 2014 we received information which confirmed the provider had involved people's relatives and representatives in their care and treatment.

Please note Ms Jill Davis is no longer the registered manager at Sharmer Fields. Lee Clayson is the registered manager.

We therefore observed staff interaction and talked with care staff about how they met the needs of people they supported.

Staff demonstrated a clear understanding of people's needs and engaged with people in a positive manner. People appeared relaxed and happy in the company of the staff and were not hesitant when they approached them.

We looked to see if consent to care had been obtained for people who lived at the service. We found there was a lack of signed documentation in place to confirm this.

People who lived at the home told us they were happy at Sharmer Fields.

We looked at the care planning documentation and we found that care plans were very detailed and demonstrated that staff treated each person as an individual based upon their needs.

We found systems were in place to safely manage people's medication.

Staff told us about their induction program and we saw records which showed robust recruitment processes were in place.

We saw that systems were in place to monitor the quality of the service.

We saw family's involvement within the care plans had not been signed and medication temperature checks were not always completed.