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Archived: The Burnham Care Home Good

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Reports


Inspection carried out on 17 March 2015

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

This inspection was unannounced and took place on 17 March 2015.

The Burnham Nursing and Residential Centre is registered to provide personal and nursing care for up to 54 people. The home specialises in the care of older people.

There is 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 2008 and associated Regulations about how the service is run.

Throughout the inspection there was a relaxed and cheerful atmosphere; staff and people living in the home were happy and at ease when they spoke with us. We observed friendly but professional banter with staff discussing the St Patrick’s day celebrations and topics of interest with people. One person said, “It’s always a happy place, I like all the green hats, we are going to see some Irish dancing later.” We were told one of the care workers had entertained people with Irish dancing. One person said, “Gone are the days I could have got up and danced. It was good to watch though.”

Prior to this inspection we received concerns that care was not being carried out properly due to a shortage of staff. The registered manager confirmed they had been short of staff but a recruitment program had solved the problem and they had a full team who worked well together. One staff member confirmed that the home had been short of staff but that staff morale had improved and they had enough staff to meet people’s needs. One visitor said, “There has been a vast improvement, plenty of staff and they are willing to chat and take time with you.”

Records showed there were adequate staffing levels on each shift. The manager confirmed staffing levels could be flexible to meet the care needs of people and to support other staff with activities such as parties and trips out. We observed staff took the time to chat and socialise with people and call bells were answered promptly.

The manager’s vision for the home was to ensure people received person centred care, and were at the centre of everything. Staff demonstrated their awareness of the manager’s vision and could tell us how they helped people to maintain choice and provide support in a dignified and respectful manner. One staff, member said, “It’s good that the manager wants to help people make their own decisions. Nobody likes to lose control.”

Staff had received training in identifying and reporting abuse. Staff were able to explain to us the signs of abuse and how they would report any concerns they had. They stated they were confident any concerns brought to the manager would be dealt with appropriately. There was a robust recruitment procedure in place which minimised the risks of abuse to people. People told us they felt safe in the home and they all knew who to talk to if they wanted to raise a concern or complaint.

People’s health care needs were fully assessed and care and support was provided on an individual basis. One staff member told us, “Communication is good and the records give us very clear guidance on people’s likes and dislikes.” This meant people’s individual changing needs were considered and catered for in consultation with them or a family member if necessary. Care plans and care practices were monitored to ensure people’s preferences were being followed and improvements were made when needed.

People saw healthcare professionals such as the GP, district nurse, chiropodist and dentist. Staff supported people to attend appointments with specialist healthcare professionals in hospitals and clinics. Staff made sure when there were changes to people’s physical well- being, such as changes in weight or mobility, effective measures were put in place to address any issues. One visiting healthcare professional said the registered nurses were very good at recognising the specific needs people had and referring them to specialist teams.

Everybody spoken with told us they enjoyed the food, they all said the food was good. People were offered choices and the food was nutritious and well presented. People who needed assistance with eating were supported in a dignified and unhurried manner. Some people chose to eat in their room.

There were systems in place to monitor the care provided and people’s experiences. An external audit was carried out by the manager of another home in the organisation as well as the regular audits carried out by the registered manager. Action plans were then put in place to address any issues found. A regular survey was carried out asking people and their relatives about the service provided by the home. Suggestions for change were listened to and actions taken to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.

Inspection carried out on 3 March 2014

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

We visited the home to follow up on five compliance actions issued for the non-compliance identified during our inspections in July, October and December 2013. We were also responding to information of concern we received and statutory notifications received from the provider.

On our arrival the relief manager informed us that 32 people were receiving nursing care and one person was receiving assistance with personal care.

We read nine care plans and checked that these people received care in accordance with their assessed needs. We spoke with two trained nurses, a team leader and three care workers. We were also able to speak with eleven people who lived at the home and a visitor. We found the people who spoke with us were satisfied with their care. They told us “I have been happy with the service in general” and “I can speak to matron if I’m not happy, it’s not 100% here but it’s pretty good.”

People told us they could make choices and we observed this in practice. We heard “I can ask for a drink, staff will get them for me”, “I have choices about when I get out of bed and what clothes I want to wear” and “staff are friendly, quite good, nothing funny about them”

People told us they felt safe and knew who to contact if they had a concern. Comments included: “I would complain to one of the bosses but I haven’t had to make a complaint” and “I feel able to speak up for myself.”

We also observed the interaction between people and staff during our visit and specifically at lunchtime in the communal dining rooms. We saw the majority of staff communicating well with people and they spoke to people in a calm and quiet manner. People were allowed sufficient time to complete their meals at their own pace.

Overall we saw the provider had made significant improvement to ensure compliance.

Inspection carried out on 31 December 2013

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

At our inspection on 16 October 2013 we found that people were not protected against the risks associated with the unsafe use and management of medicines. A warning notice was served. The purpose of this inspection was to check that suitable action had been taken to address the issues raised. We found some improvements had been made, however further action was needed to ensure that people were protected from the risks associated with medicines. One person prescribed several medicines told us their medicines were always available for them. They had no concerns with how their medicines were looked after.

Inspection carried out on 9 December 2013

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

We visited the home to follow up on two warning notices that we had issued to the provider for continued non compliance identified during our inspection on 16 October 2013. We were also responding to information of concern we received, and statutory notifications received from the provider.

On our arrival the relief manager informed us that 34 people were receiving nursing care and five people were receiving assistance with personal care.

We read seven care plans and checked that these people received care in accordance with their assessed needs. We spoke with three registered nurses, a team leader, a care assistant and an activity coordinator. We were also able to speak with people who lived at the service and a visitor.

We found the people who spoke with us were satisfied with their care. One person told us they were “very well” and another person said “I am very comfortable in bed”. We observed good interaction between staff and people who lived in the home. We heard people were spoken with respectfully and offered information and choices before any care was provided. We were told “the staff come when needed, they are very kind.” We saw that people had a call bell within their reach.

The staff we spoke with told us “the management have made a lot of effort to improve things” and “I can see an improvement from three months ago, the management is really trying.” Staff told us they had sufficient information available to them in order to care for people effectively. We observed a manager oversaw the lunch time meal to ensure people received effective support with eating and drinking. There was sufficient staff available at lunchtime to support people.

We found that although improvements had been made toward meeting the requirements of the warning notices the service remained non compliant. This was because we found inconsistencies in how the care was assessed and provided and therefore could not be assured that people always received safe, effective care.

Inspection carried out on 16 October 2013

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

We visited this home to check if the service had implemented the action plan submitted to CQC following the inspection in July 2013. This was to ensure they were compliant with the essential standards of quality and safety.

In September 2013 we followed up on issues of concern regarding staffing and care delivery. After the September inspection we received a significant number of serious concerns regarding the staffing, care and welfare of people who used the service. We referred these concerns to the local authority safeguarding team.

During the inspection we looked at the care people received and how it was planned and delivered. People told us the staff were mostly nice but were “too busy” so care was hurried or interrupted. All the people spoken with told us they liked the home but were not always happy with the care and support they received. The six relatives we spoke with told us they were very satisfied with the service being provided. One relative told us "the staff are good to X, it’s lovely”.

We spoke with 13 members of staff. We saw the home was kept clean and tidy. We found work had been completed to protect people from the risk of acquiring an infection.

We saw improvements had been made which ensured medicines were appropriately and safely stored. We found no improvements in the safe administration of medicines for the health and wellbeing of people.

Systems in place to monitor the quality of the service people received were ineffective.

Inspection carried out on 9 September 2013

During an inspection in response to concerns

We visited this service at 5am to follow up concerns received regarding staff sleeping on duty, poor care and lack of staff to meet people’s needs. During the inspection we spoke with eight people who used the service, two relatives, six night staff, 11 day staff and one health professional.

We found people were cared for by sufficient numbers of staff and their needs were being appropriately met. Care was planned and delivered, in the main, to ensure the safety and welfare of people.

When we arrived at 5am we did not see anyone asleep on duty. All six night staff told us no one slept on duty as the company were very strict about this. The 17 staff spoken with said staffing levels had improved since the last inspection. They said there were enough staff to meet people’s needs.

All eight people we spoke with told us they felt well cared for and that staff were kind and respectful. One person told us “I am very happy to be here and am well looked after”. Another person said “The girls are all really nice I think they do a grand job”.

We looked at eight care records and saw all contained clear guidance for staff. We observed the handover of information during which key changes in care needs were communicated.

Inspection carried out on 15, 17 July 2013

During a routine inspection

We spoke with 12 people who lived at the home and six relatives. All of the people we spoke with told us there were not enough staff to meet their needs. People told us they liked the home but were not happy with the care and support they received. Two relatives we spoke with told us the personal care given was good. The provider showed us ‘thank you’ messages they had received. Comments included: “thank you for making mum's last few days so happy”.

We spoke with 11 carers and nursing staff and six ancillary members of staff. We saw the home was kept clean and tidy. We found people were not protected from the risk of infection because appropriate guidance had not been followed.

The provider had systems in place to monitor the administration of medicines. Where checks identified shortfalls, these had not been addressed. On the second day of the visit we saw some actions had been taken, however we found medicines was not always given as prescribed for the benefit of people.

We observed staffing levels were not always appropriate to meet the needs of people. During our visit we noted call bells ringing for up to 20 minutes before being answered. One member of staff told us they had been on their own for 15 minutes and unable to respond to people who called for assistance.

Following feedback of our findings the regional manager told us they would stop all admissions, until actions had been completed to address the shortfalls identified in this report.

Inspection carried out on 7 August 2012

During a routine inspection

At this inspection we were told that there have been some changes made to the organisation of the home. The home now aims to provide care for 54 people. Care is being delivered on two floors.

The ground floor is called Sandpiper and provides nursing care. On the second floor, called Nightingale there are 23 nursing beds. There is also provision for six people to receive personal care in Nightingale North. Each floor is led by a senior nurse.

We asked twenty people about the way they spent their days in the home and the care they received. Everyone was very positive about their treatment. One person told us "My day is quite regulated but I could do other things if I wanted to. I like to go to bed early so I like to get up early. "

People who were able to get about were encouraged and supported to live a life that was as individual as possible. One person told us they went into town at least every week on their motorised scooter. We saw that they had chosen their furniture and had equipped their room with their own possessions. They told us “this place is fine. It is my home now. I please myself exactly.”

People told us they had no concerns about living in the home. They said that they were well looked after. One person said “We feel safe here.Even at night.”

We could see that interactions between staff and people receiving care were kindly and relaxed. People told us that if they had any concerns or worries there were people they would feel able to talk to.

Inspection carried out on 7 June 2011

During a routine inspection

People told us that they could make choices about the way that they spent their days in the home and the care that they received. One person told us “They are very good to me here. I can say how I want to spend the day.”

People are encouraged to live a life that is as individual as possible. One person told us that they were supported to leave the home in an electric scooter. They said how much their “granny wagon” meant to them and how important it was to get out. “I just go out and buy a pasty…it’s a bit of fun.” For another person the inclusion of their partner in the home on a daily basis meant things had “worked out very well.”

Throughout our visit to the home we heard that people were being asked if they were ready to receive care. We heard that people enjoyed being able to have a lie-in when they felt like it. We were told that people were asked when they wanted to go to bed but could always change their minds and go earlier or later.

Each person had an individual plan of care that included a very detailed personal support plan. We saw that people in bed looked comfortable and relaxed. We were told by someone who had lived in the home for many years “we can make our own decisions and do as we want. I am quite happy here; I get on well with the staff.”

We were told that the food was “very good“” good” and “not bad” and that there was always a choice. The dining room tables were nicely laid and menus were displayed on the tables.

One person told us that food was “wholesome” and that he was encouraged to “eat like he should.”

People enjoyed being able to choose to have some meal in their rooms whilst going to the dining room for others. There were fluids available for people throughout the home. A member of staff told us of the extra efforts taken to ensure people received enough fluids during hot weather.

People told us they had no concerns about living in the home. We could see that interactions between staff and people receiving care were relaxed.

People told us that they were quite satisfied with their bedrooms. People had been able to personalise their rooms to reflect their tastes and needs. Communal rooms are clean and comfortable.

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