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Archived: Burrswood Care Home Good

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Reports


Inspection carried out on 7 March 2016

During a routine inspection

This was an unannounced inspection carried out on the 7, 8 and 9 March 2016. We last carried out a routine inspection on 8, 9 and 27 April 2015 when we found four breaches in the regulations that we reviewed which related to, staffing levels, medicines management, control and prevention of infection and provision of food and drink. At this inspection, we found that breaches had been met or plans were in place to make improvements.

Burrswood House Residential and Nursing Home is registered to provide accommodation and support for up to 125 mainly older people. The home is a purpose-built, two storey building which comprises of four separate houses.

On the first floor, Dunster House provides general nursing care and Crompton House provides residential social care. On the ground floor, Peel House provides nursing care for people who are living with dementia who also have complex mental health needs and Kay House, which provides residential care to people living with dementia care.

The home had 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was present throughout our inspection.

We saw improvements had been made in relation to medicines management, infection control and staffing. We saw that improvements had been made to food and nutrition arrangements with further improvements being agreed with the regional and finance managers during our inspection.

We found that all four houses were clean and clutter free and no malodours were detected. A person who used the service said, “They clean my room every day and do my laundry. They do a good job.” Relatives said, “[Relative’s] bedding is always clean. They are always cleaning,” and “It’s a lovely home. It’s been painted and always clean and tidy.”

There had been a reduction in staff sickness levels and therefore the use of agency care staff had ceased. This helped to ensure that people were provided with consistent care, treatment and support by staff who knew them well. Staffing arrangements at the home had improved by changes being made to the rota and an increase in staffing at busy times of the day. Additional staffing was also agreed to help support people who needed additional help to eat their meals.

People told us, “The food is very good,” “It’s lovely,” “I like the sweets,” and “If we don’t like it then we can have something else. They make sure my wife when she visits can have a meal with me in the dining room. You can have anything you want at the drop of a hat!”

The staff we spoke with told that they had received safeguarding adults training. They were all able to inform us what they would do should they find that abuse was taking place. Staff members said, “I know the Speak Up number and I would use it” and “I would not hesitate to speak to [the house manager and registered manager] and they would definitely take action.”

We saw that the required checks had been made when employing new staff. This helped to ensure that people were kept safe from potential staff who were unsuitable to work with vulnerable adults.

A major refurbishment program had been completed to make improvements to the home. This included people’s bedrooms being redecorated, new carpets being fitted and new bedroom furniture. There was also a new lighting system, new radiators and a new ‘nurse call’ system had been fitted. Further work was planned to take place to improve the dining experience of people who lived with dementia on Peel House and Kay House. A quiet lounge with a seaside theme was also in progress of being developed on Peel House.

A pre-admission assessment was undertaken with the person and their relatives if appropriate before agreement was reach

Inspection carried out on 8 9 and 27 April 2015

During a routine inspection

This was an unannounced inspection carried out on the 8, 9 and 27 April 2015. We last carried out a routine inspection on 19 September 2013. All areas we reviewed at that time met the relevant regulations. We also carried out a responsive review after concerns were raised with us about staffing levels on 2 May 2014. The concerns were substantiated and a breach in the staffing regulation was made. We returned to the home on 8 August 2014 and found that the home was compliant with the staffing regulation.

Burrswood House Residential and Nursing Home is registered to provide accommodation and support for up to 125 mainly older people. The home is a purpose-built, two storey building which comprises of four separate houses. On the first floor Dunster House provides general nursing care and Crompton House provides residential social care. On the ground floor Peel House provides nursing care for people with mental health and dementia care and Kay House provides dementia care.

The home had 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was present throughout our inspection visits.

At this inspection we spent time observing care and support in communal areas, spoke to people who used the service, their visitors and staff and looked at care and management records.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to medicines management because controlled medicines were not always administered as prescribed and the reason why had not been recorded. Control of infection due to staff not always following procedures. Staffing levels were not always sufficient to meet people’s assessed needs and issues identified in relation to the provision of food and drink.

You can see what action we asked the provider to take at the back of the full version of this report.

Everyone we spoke with who used the service said they felt safe. When asked, people said “Very safe”, “The staff are all very kind” “I feel very safe, the staff are very caring, they look after you” and “There is no bullying and there is a very good atmosphere.”

The staff we spoke with told that they had received safeguarding adults training. They were all able to inform us what they would do should they find that abuse was taking place.

We saw that relevant checks had been made when employing new staff.

During our visit there was a major refurbishment being undertaken to make improvements to the home. Improvements included people’s bedrooms being redecorated and new carpets being fitted. Plans were in place for new bedroom furniture as well as a new lighting system, new radiators and a new ‘nurse call’ system had been fitted.

We were told that the registered manager carried out the pre-admission assessments for the home before a person moved in and in her absence a qualified nurse did the assessment. This should help ensure people’s individual needs could be met at the service.

The registered manager and staff we spoke with were able to demonstrate their understanding of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. When necessary applications had been made to the Local Authority, to lawfully deprive people of their liberty so that their rights were protected. Staff were aware that some people’s capacity could fluctuate.

A person who lived at the home told us; “I can’t describe how well they are looking after me they are wonderful”. They also said that the “Food was excellent; I have not turned anything down yet” and “Staff are absolutely wonderful all the time; I have no complaints quite the opposite”. Another person said that the food was very good and that the home was “Very good” and the staff “Were very nice.”

People’s care plans and monitoring records were regularly reviewed and updated so that people’s current and changing needs were clearly reflected.

Systems were in place to show the service was being monitored and reviewed. People told us the manager and staff were approachable and felt confident they would listen and respond to any concerns raised.

Inspection carried out on 8 August 2014

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

The purpose of this inspection was to check whether Burrswood House Nursing and Residential home had taken action to ensure there were sufficient staff on duty at all times to meet the needs of the people who used the service. During the night time hours of 2 May 2014 we undertook an unannounced inspection as we had received an allegation that there were not enough care staff on duty. Our inspection of 2 May 2014 identified there were not enough staff on duty during the night time hours to meet the needs of the people who used the service.

After the inspection we made a compliance action requiring the provider to tell us what they were going to do to ensure that at all times, sufficient numbers of suitably qualified, skilled and experienced staff were provided. Following the inspection the provider sent us an action plan telling us what steps they were going to take to make the necessary improvements.

During this inspection we found that improvements had been made. Sufficient staff were provided to meet the needs of the people who used the service. All four units had sufficient skilled and experienced staff on duty.

People we spoke with told us, �No problems here. I am quite happy� and �There is nothing to be bothered about�. One person spoke very highly of the staff�s kindness and attitude and told us they felt there were enough staff to look after them safely

Staff told us they felt there had been a big improvement in the staffing provided. Comments made included; �Things have greatly improved. It is 100% better� and �The new manager is certainly on the ball when it comes to sorting out staffing. She is definitely putting things right. She is fantastic�.

Inspection carried out on 2 May 2014

During an inspection in response to concerns

The purpose of this inspection was to investigate concerns that had been brought to our attention anonymously. The person alleged there were not enough care staff on duty on Crompton and Peel Units during the night time hours. We were told that inadequate staffing levels resulted in the needs of people using the service not being met.

We considered all the evidence we had gathered under the outcome we inspected. We used the information to answer the five questions we always ask;

� Is the service safe?

� Is the service caring?

� Is the service effective?

� Is the service responsive?

� Is the service well led?

Below is a summary of what we found. The summary is based on observing how people were being cared for, speaking to people using the service, speaking to staff and looking at records.

Is the service safe?

There were not enough staff on duty to meet the needs of the people using the service. People who were at risk of falling out of bed and were calling for help were left for long periods of time until staff could assist them.

Inadequate staffing resulted in medicines not always being given at the time they were prescribed. The health and welfare of people living in the home is at risk of harm if their medicines are not given at the times they are prescribed.

One person we spoke with, who had a pressure ulcer and was waiting to go to bed at 23:45 hours, told us, �I am ready for a rest�. We were made aware they had been sitting in their chair for a long period of time. Prolonged periods of pressure on the body can put the health and welfare of people at risk of harm.

Is the service caring?

The staff we spoke with had a very good understanding of the needs of the people they were looking after. We saw staff worked hard to try to meet people�s needs. The staff were kind, patient and attentive.

Is the service effective?

A discussion with the staff showed that people�s needs and preferences were assessed and discussed before they were admitted to the home. Following the assessment a care plan was put into place to show how those needs and preferences were to be met. We were made aware that, due to inadequate staffing, some people were denied choice in some aspects of their care; such as rising and retiring to bed.

Is the service responsive?

Management did not respond to the concerns expressed by staff when it was identified there were not enough staff on duty to meet people�s needs

Is the service well led?

Management did not take into account people�s care needs when making decisions about the number of staff required to ensure people�s needs were met.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that, at all times, there are sufficient numbers of suitably qualified, skilled and experienced staff on duty to meet people's needs.

Inspection carried out on 19 September 2013

During a routine inspection

During the inspection, we spoke with three people who use the service and the relative of a person using the service. They told us the staff listened to them and asked permission before they carried out their duties.

The people we spoke with told us they were happy with the care they received and that they were looked after well. They also told us they chose the times they went to bed or woke up in the morning and that the staff respected their wishes.

We found that people were asked for consent and the provider acted in accordance with people�s wishes. People received care in a way that met their needs and preferences.

The people we spoke with told us they felt the home was clean and safe. We found the environment and equipment in the home to be clean, safe and well maintained.

The people we spoke with told us they were happy with the staff. They told us the staff were friendly and helpful. Two people told us they felt more staff were needed, especially during busy periods, such as mornings and lunch times. We found that there were enough qualified, skilled and experienced staff and the provider was in the process of recruiting additional staff to fully meet people�s needs.

The people we spoke with told us they had no concerns about the services they received and were confident they could speak to the staff if they had any concerns. We saw that there was an effective complaints system available, in case anyone wished to raise a complaint.

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