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Inspection carried out on 13 September 2017

During a routine inspection

Burleigh House is registered to provide accommodation with personal care for a maximum of 44 older people, many of whom live with dementia.

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.

Inspection carried out on 11/06/2015

During a routine inspection

This inspection was carried out on 11 June 2015 and was unannounced.

Burleigh House provides accommodation and personal care for up to 44 older people. There was a registered manager in post. 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.

At our previous inspection on 03 September 2014 we found that the provider had not ensured that people were protected against the risk of unsafe or inappropriate care due to lack of information about them. Care records about people were not accurate, fit for purpose or held securely. The provider submitted an action on 14 October 2014 which stated that the necessary improvements would be completed by 31 October 2014. At this inspection we found that the provider had taken action to address the identified concerns. Care records were completed and reviewed regularly. People were involved in planning their own care and changes in their needs were reflected back in their plan of care and were held securely.

Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that the provider identified people who lived at the service who required DoLS and applications had been made to the local authority. Staff were aware of their role in relation to MCA and DoLS and how people were at risk of being deprived of their liberty.

People had their individual needs met. Staff knew people well and provided support in a timely manner. There was sufficient food and drink available and people were assisted to eat and drink where needed.

People had regular access to visiting health and social care professionals. Staff responded to people’s changing health needs and sought the appropriate guidance or care by healthcare professionals. Medicines were managed safely to ensure people received them in accordance with their needs.

Staff were clear on how to identify and report any concerns relating to a person’s safety and welfare. The manager responded to all concerns or complaints.

Staff were recruited through a robust procedure and provided with regular training to ensure their knowledge was up to date. Staff were clear on what their role was. People and staff were positive about the leadership of the service.

Inspection carried out on 4 September 2014

During an inspection in response to concerns

We received information of concern about inadequate staffing levels and some aspects of the quality of care and support provided at the home.

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.

Inspection carried out on 10 April 2014

During a routine inspection

During the inspection the following five key questions were asked of the service is the service safe, effective, caring, responsive and well-led?

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.

Inspection carried out on 12 July 2013

During a routine inspection

During our inspection on 12 July 2013 we spoke with three people who lived in the home. One person told us, “Staff are very nice”. People we spoke with told us they felt the care they received met their needs. Relatives we spoke with told us that care staff were attentive and kind to their family member. One relative commented that, “Staff encouraged their [family member] to keep their independence”.

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.

Inspection carried out on 10 January 2013

During an inspection to make sure that the improvements required had been made

We inspected Burleigh House on 1 August 2012. We were concerned that people were not always protected from the risks of inadequate nutrition and dehydration. We also had concerns about whether there were always sufficient staff available to meet people’s needs. As a result of the non compliance with the regulations of the Health and Social Care Act 2008 we issued compliance actions on outcomes 5 and 13.

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.

Inspection carried out on 1 August 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an ‘expert by experience’, a person who has experience of using services and who can provide that perspective.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Relatives with whom we spoke praised the service for the care and support provided for the people living in Burleigh House. One person said their relative, “Loves it here, and particularly enjoys the arts and crafts never done anything like it before they moved here.”

People told us they believed their family members were treated with dignity and respect at all times. They said, “Our relative is totally comfortable, the dignity they are able to keep means they are seen as a special person, which they are.”

A person using the service told us, “They are too busy here – looking after 43 people. I have to ask permission to go anywhere.” Another person said they found the care home, “Very nice” and said, “I love this place.”

Visitors to the home told us their relatives enjoyed the food, one person told us their relative must be enjoying the food because they were putting weight on. A group of people seated in the dining room waiting for their lunch to be served told us they always enjoyed the food.

Relatives of people living in the home told us they believed their relatives were safe at Burleigh House. One person said, “They are so patient with people.” Relatives also said that people were, “Always pleased to come back here after a day out.”

One person using the service with whom we spoke told us, “I think it’s wonderful. I really do. The people here are very good and helpful. I’m very happy here. I’m eating fine. If there was something wrong I’d let you know. They [staff] are all good company. They all get on. They’re good people who work here.” Relatives of people living in the home told us they thought the staff were very good, one person said, “They are so wonderful and caring.”

People living in Burleigh House were not aware that they had a care plan. They also said that they really were “not interested.” People told us they were confident that any records relating to their care and well being were looked after appropriately.

Reports under our old system of regulation (including those from before CQC was created)