Burleigh House

Burleigh House is a care home providing accommodation for up to 44 older people, some of whom are living with dementia. At the time of the inspection there were 41 people living at the home.

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

People and their relatives told us they felt safe and that staff were kind. They told us the staff team did a good job. Staff told us people were well cared for and they would be happy for their relatives to live at Burleigh House. Visiting professionals also gave positive feedback about the home.

Staff spoke with people nicely and gave them choices about their day. However, on the day of the inspection, some people were not always dressed appropriately for the weather, such as not wearing socks or appropriate footwear or clothing such as short sleeves. It was not clear if this was people’s choice or an oversight. Visiting professionals told us they had never had concerns about people’s welfare in the home. While staff knew people well, care plans needed further development to ensure they were personalised and included all care needs.

Medicines were managed safely in the most part. Supervisions were carried out with staff if an error occurred and audits needed to check that plans for medicines prescribed as needed were in place.

Staff knew how to recognise and report abuse. However, unexplained injuries, such as bruises or skin tears, that were either observed on the inspection or recorded on people’s body maps, were not always logged on the registered manager’s incidents and accident overview. As a result, they were not aware of all injuries and they had not been investigated. Following the inspection, the provider submitted information stating that one injury was a scratch and they had not considered this to require recording. They also stated that they were not able to see injuries on another person’s arm as reported by us. We were also advised that when some injuries had occurred, they liaised with the visiting nurse or GP who did not raise concerns. However, there was a lack of oversight and monitoring of these injuries to help identify themes or trends and to ensure all appropriate actions had been taken.

Training relating to infection control and COVID-19 had been delivered. Staff felt confident in their knowledge. However, we did note that the chef did not wear a mask in the kitchen. There were processes in place to help keep people safe from being at risk of COVID-19 and there had been no cases in the home.

Staff training, supervision and support was given, and staff felt they could go to the registered manager if they had any concerns. There was a robust recruitment process in place to help ensure staff employed were suitable to work in a care setting.

Since the last inspection, a new registered manager had been in post since February 2020. There were quality assurance systems in place, however these needed to be further developed to ensure they were robust. The provider and the registered manager were committed to make the required improvements and started implementing new systems following the inspection.

Rating at last inspection

The last rating for this service was Good (published 10 October 2017).

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about people’s safety and welfare. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with safety and welfare of people, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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 coronavirus and other infection outbreaks effectively. Please see the safe section of this full report.

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

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, the service was rated good. At this inspection, we found the service remained good.

People told us they felt safe living at Burleigh House. Risks assessments were in place to support people and promote independence.

Staff received appropriate training, support and development to carry out their roles effectively. People received appropriate support to maintain healthy nutrition and hydration.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). People were supported to have 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 and their relatives told us and we observed that people were treated with kindness by staff who respected their privacy and upheld their dignity.

There were regular meetings and independent surveys to promote people to feed back on the service and express their views.

People received personalised care that met their individual needs. People were given appropriate support and encouragement to access meaningful activities.

People told us they knew how to complain and were confident they would be listened to if they wished to make a complaint.

There was an open, transparent and inclusive atmosphere within the home. People and staff were supported to have a voice.

There was a quality assurance system in place and shortfalls identified were promptly acted on to improve the service.

Further information is in the detailed findings below.

The Inspector gathered evidence 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 based on the evidence gathered during our inspection carried out on 04 September 2014. This included speaking with people who used the service, some of their relatives and members of staff who supported them and by looking at records.

The detailed evidence that supports our findings can be read in the full report.

Is the service safe?

We looked at the care records relating to most of the 43 people who lived at the home at the time of our inspection. These showed that people's individual needs had been assessed, documented and reviewed on a regular basis. They included information about people's mobility needs, medicines and dietary requirements together with their mental and physical health needs.

During our inspection we found that the provider had clear management structures and systems in place that were followed, reviewed and regularly monitored to ensure that staffing levels were managed and maintained effectively.

Appropriate steps had been taken to ensure there were sufficient numbers of suitably qualified, skilled and experienced staff available to meet people's needs. For example, we saw that in-depth dependency assessments had been used to determine staffing levels based on people's health and welfare requirements.

However, we found that the provider had not ensured that people were protected against the risks of unsafe or inappropriate care arising from a lack of proper information about them. This was because the care and support records relating to some people who lived at the home were not accurate, fit for purpose or held securely at all times.

Is the service effective?

We spoke with healthcare professionals who had recent experience of the home and some of the people who lived there. They had no concerns about the standard of care provided. One told us, "Staff are knowledgeable of residents [needs] and are quick to report any concerns. People are well looked after and I am happy with the care."

Is the service caring?

Most people we spoke with indicated they were happy living at the home and with the levels of support and care they received. One person said, "Oh yes, they [staff] are brilliant here, they're kind." Another person told us, "Yes, we're generally well looked after. I get what I need." Another person commented, "All of the staff are wonderful and work so very hard to look after everybody. I am very happy here and feel quite safe."

Is the service responsive?

We looked at records which showed that people had regular access to relevant healthcare professionals where necessary and appropriate. These included dentists, chiropodists, GPs, community nurses and physiotherapists.

Is the service well led?

We saw that risk assessments had been completed and regularly reviewed in relation to a wide range of issues relevant to people's care needs and personal circumstances. These included assessments relating to the management of people's medicines, skin integrity and risks associated with pressure care, nutrition and hydration, mobility and the risk of falls.

Staffing levels were kept under review and adjusted where necessary to take account of people's changing needs. We saw that the number of staff available at the home often exceeded requirements identified by the dependency assessments. This meant that the provider used a needs analysis process as the basis for deciding sufficient staffing levels at the home.

However, the provider had not ensured that people's personal records, including medical records, were accurate and fit for purpose in all cases.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

People were being cared for in an environment that was safe, clean and hygienic. The records we read showed that the home was cleaned daily. We found the environment neat and tidy with no unpleasant odours. The people we spoke with told us that they felt safe in the home. 0ne of the people we spoke with said 'I never feel frightened here'. Equipment at the home had been well maintained and was serviced on an annual basis under maintenance agreements that we saw.

There were enough staff on duty to meet the needs of the people living at the home and keep them safe. The staff records we read showed that the staff had received appropriate training to keep people safe including health and safety, safeguarding, manual handling and risk assessment training. Staff were able to explain how this training kept the people who used the service safe. We observed staff interaction with people who used the service and found that they did not rush people and took time to ensure tasks were carried out with due care and attention. We observed one staff member say 'don't worry X, I will go at your pace, take your time' when delivering care to a person that used the service.

We saw that the service had emergency plans and business continuity plans in place detailing how the service would respond to emergency situations. One plan details the location of emergency accommodation in the event of an emergency accruing in the building.

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The staff we spoke with had received DoL's training and understood their responsibilities in relation to this legislation.

Is the service effective?

People told us that they were happy with the care they received and felt the needs identified when they were referred to the service were being met. One of the people we spoke with said 'staff know what I like. I don't have any complaints'. We observed staffs interaction with people and they appeared to be familiar with their needs and they had a good understanding of the people who used the service. The staff we spoke with told us that the records that the service kept on people made it 'very clear' how care should be provided to them. They told us that they knew the people who used the service 'well'.

Is the service caring?

People were supported by kind and attentive staff. The staff we saw were patient and gave encouragement when supporting people. The people we spoke with said 'The staff are always friendly'. We observed staffs interaction with people and found that they treated people in a pleasant manner and took time to re-assure people and understand what they wanted. The feedback form that we read showed that people were very positive about the service provided. Comments included 'While dad could not communicate well you could always tell he was happy and felt safe at Burleigh House, ' and ' x felt happy at Burliegh House and All the staff are polite and kind to her'.

Is the service responsive?

People's needs had been assessed before they moved into the home. People told us the service had asked them about their likes and dislikes prior to them moving into the home. The records we read showed that the service had completed pre-admission assessments for people who used the service. The records included 'Getting to know our residents 'forms which detailed people's family background, medical history, likes and dislikes, routines and special interests. We saw activities records that showed people had access to activities that were important to them and had been supported to pursue activities that they enjoyed.

Is the service well-led?

The staff we spoke with were aware of the aims and objectives of the home and had a good understanding of the quality assurance processes that were in place. We saw that the service regularly asked people for feedback and act upon what they found. We read the most recent annual customer feedback questionnaire and found that the majority of residents were positive about the service. The questionaires were used to identify areas for improvement and the homes management had developed improvement targets and plans in response to any issues identified in the surveys. People told us that the management had consulted with them before implementing changes to services the home provides and that their views had been taken into consideration. One example of this we saw was changes to menus that were made following a food survey.

You can see our judgements on the front page of this report.

We observed staff talking to people politely and with respect, and taking the time to ensure that people received the support they needed.

We found that overall, care records were detailed, current and reflected the needs of people who lived in the home. Staff we spoke with demonstrated a good understanding and knowledge of the care and support people who lived in the home required.

Procedures were in place to ensure that people using the service received their medication appropriately and staff had undertaken training.

The provider had a recruitment procedure in place to ensure that only people suitable to work with vulnerable people were employed. Staff received a wide range of training to equip them for their role.

The provider had effective systems in place to check that people were satisfied with the service and to monitor and audit the quality of services provided to people who lived in the home.

We carried out this inspection, on10 January 2013, to monitor improvements with outcome areas 5 and 13. We visited the home at breakfast time and observed people getting up and eating their breakfast. Some people who used the service had different abilities in relation to verbal communication. We spent time observing everyday life to help us understand care experience at the home. We found this to be positive. We saw that staff were kind and considerate and they supported people's independence but gave assistance where it was needed.

We saw that there were an adequate number of staff on duty to meet the needs of the people who used the service. We observed the staff to be skilled, competent and knowledgeable of the needs of the people who used the service.