We inspected Burlam Road Care Home on 14, 21 October and 3 November 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting. At the last inspection in September 2014 we found the Burlam Road Care home was not meeting the requirements of two regulations. These breaches of regulation related to having sufficient staff on duty to meet people’s needs and to ensure the staff were appropriately trained.
Prior to the inspection the registered provider sent us an action plan detailing how they would achieve this and had increased the staffing levels at the inspection. We had monitored that these staffing levels were not reduced.
Burlam Road Care Home provides nursing and personal care up to 44 people with a range of physical health needs. It is a three-storey home, purpose built 25 years ago, with a garden area and car park.
The home has not had a registered manager in post since January 2015. 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. We made the registered provider aware that they were breaching their conditions of registration.
The provider has employed a new manager and they came into post mid-March 2015. The manager has commenced the process to become a registered manager. We confirmed with our registration team that the application has been accepted and is now being processed.
At this inspection we reviewed the action the provider had taken to address the above breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that the provider had ensured improvements were made in these areas and these had led to the home meeting the above regulations.
However we found that some changes were being proposed to the operational structure of the home and although people in the local area were aware of these the registered provider had not formally discussed this with the staff, people who used the service or their relatives. Also the registered provider had not notified us of these proposed changes.
People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. We found that one nurse and six care staff were on duty during the day and overnight there was one nurse and four care staff. In addition ancillary staff such as cooks and domestic staff were on duty throughout the week. The manager and clinical lead worked weekdays. The manager closely monitored dependency levels to ensure this staffing level remained adequate to meet people’s needs and we found they increased the numbers of staff when needed.
We found that the registered provider had invested a lot of money in the service in order to improve the environment and provide staff with computerised systems for both monitoring the service and ensuring they remained up to date with their training. We found that the new monitoring systems had just been introduced and staff were learning how to use them. We found the guidance, particularly for collecting information for calculating the staffing levels, needed to be clearer.
We also found that although the manager was taking action to make sure staff adhered to the requirements of the Mental Capacity Act 2005 and the associated Code of Practice, and we confirmed that staff had been given access to this information. However, we found that relevant guidance and paperwork had been removed from the upstairs unit. The manager investigated this issue and found that prior to a nurse leaving they had taken the documentation. The manager took appropriate action to escalate this matter with the registered provider senior management.
Staff had received Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards training and understood the requirements of the Act. The manager had a very good understanding of the legislation and were ensuring staff worked within the law to support people who may lack capacity to make their own decisions. The manager recognised that staff needed additional support to ensure they had the skills and knowledge to consistently work with the Mental Capacity Code of Practice.
People we spoke with told us they felt safe in the home and the staff made sure they were kept safe. We saw there were systems and processes in place to protect people from the risk of harm.
People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.
People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. Care plans contained comprehensive and detailed information about how each person should be supported. We found that risk assessments were very detailed. They contained person specific actions to reduce or prevent the highlighted risk.
People told us that they made their own choices and decisions, which were respected by staff. We observed that staff had developed positive relationships with the people who used the service. Where people had difficulty making decisions we saw that staff gently worked with them to find out what they felt was best.
The interactions between people and staff were jovial and supportive. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity.
We saw that the activities coordinator engaged people in a wide range of meaningful occupation and this was tailor made to each person’s preferences.
People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.
We saw that the provider had a system in place for dealing with people’s concerns and complaints. People we spoke with told us that they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.
Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
Staff had received a wide range of training, which covered mandatory courses such as fire safety as well as condition specific training such as dementia and Parkinson’s disease. We found that the provider not only ensured staff received refresher training on all training on an annual basis but routinely checked that staff understood how to put this training into practice.
Regular surveys, resident and relative meetings were held and relatives were able to share their views about the staff performance. This had led to two staff members being nominated for the provider’s national award. Both had won awards for showing a caring a compassionate attitude.
We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.
The provider had developed a range of systems to monitor and improve the quality of the service provided. We saw that the provider had implemented these and used them to critically review the service. This had led to the systems being effective and the service being well-led.
We found the provider was breaching one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also highlighted that the provider did need to ensure notifications were submitted in line with the requirements of The Care Quality Commission Registration Regulations 2009. This related to be open with people or otherwise called the duty of cadour. You can see what action we took at the back of the full version of this report.