• Mental Health
  • Independent mental health service

Burston House

Overall: Good read more about inspection ratings

Rectory Road, Burston, Diss, Norfolk, IP22 5TU (01379) 742600

Provided and run by:
Partnerships in Care Limited

All Inspections

7th to 15th November 2023

During a routine inspection

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Model of Care and setting that maximises people’s choice, control and independence.

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

SUMMARY

Our rating of this service stayed the same. We rated it as good because:

  • People’s care and support was provided in a safe, clean, well equipped, well-furnished and well-maintained environment which met people's needs.
  • People were protected from abuse and poor care. The service had sufficient, appropriately skilled staff to meet people’s needs and keep them safe.
  • People were supported to be independent and had control over their own lives. Their human rights were upheld.
  • People received kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs. People had their communication needs met and information was shared in a way that could be understood.
  • People’s risks were assessed regularly and managed safely. People were involved in managing their own risks whenever possible.
  • If restrictive practices were used, there was a reporting system in place and there were comprehensive reviews to try and reduce the use of these practices.
  • People made choices and took part in activities which were part of their planned care and support. Staff supported them to achieve their goals.
  • The service provided care, support and treatment from trained staff and specialists able to meet people’s needs. Managers ensured that staff had relevant training, regular supervision and appraisal.
  • People and those important to them, including advocates, were actively involved in planning their care. A multidisciplinary team worked well together to provide the planned care.
  • People were in hospital to receive active, goal-oriented treatment. People had clear plans in place to support them to return home or move to a community setting. Staff worked well with services that provide aftercare to ensure people received the right care and support when they went home.
  • Staff supported people through recognised models of care and treatment for people with a learning disability or people with autistic spectrum conditions. Leadership was good, and governance processes helped the service to keep people safe, protect their human rights and provide good care, support and treatment.

19 – 20 February 2019

During a routine inspection

We rated Burston House as good because:

  • Patients were fully risk assessed on admission to the hospital. Staff developed care plans and positive behaviour support plans for patients, all in easy read format, and included risk reduction. We found these to be thorough, informative and personalised to the patient. Physical health care, nutrition and hydration needs were met. Staff supported patients to live healthier lives.
  • The hospital delivered a range of psychological therapies suitable for the patient group. The interventions were those recommended by and delivered in line with, guidance from the National Institute for Health and Care Excellence. Staff knew the patients well and supported patients to understand and manage their care, treatment, and conditions. The patients we spoke with said they felt happy, relaxed and calm at the hospital, and that staff cared for them well.
  • Family and carers told us that staff were friendly, helpful and informative and communicated well. Carers and family members felt they could contact the hospital at any time. The hospital provided support through the onsite social worker. On admission they received an admission booklet with details of services offered this included information on the Mental Health Act.
  • Staff at the hospital felt respected and supported by managers. We observed a positive culture and close working teams during our visit. Staff felt that they really made a difference and the culture at the hospital was person centred care which gave real job satisfaction. Staff, patients and carers had access to up to date information about the work of the hospital and services they used. Patients could meet with members of the organisations leadership and give feedback on service they received.

However:

  • The hospital did not ensure medication audits were actioned. We found out of date stock medication and first aid box supplies. There were inconsistencies in the recording of opening dates of medication across the hospital. There was a lack of oversight by managers to ensure those concerns identified by audit were acted upon.

19-20 December 2016

During a routine inspection

We rated Burston House as good because:

  • Since our last inspection September 2015,the provider had addressed the ligature risks identified during that inspection. A fire alarm from a corridor that staff could not clearly see had been removed, a toilet brush and hand towel dispenser for the seclusion room was removed. Anti-ligature equipment was in place. Observation mirrors were installed on Kestrel ward for the use of staff observations.
  • There was a range of experienced and qualified staff on duty. The same agency staff were used for continuity of care. Agency staff had received the same restraint training as permanent staff. Agency staff received further training from the provider.
  • Staff assessed patients in a timely manner and updated risk assessments and physical health care checks regularly. Patient’s care plans were individualised and holistic. Staff used a positive behaviour support plan. This had been approved by the British Institute for Learning Disabilities.
  • Staff used an easy read section 17 leave planning form; this had pictures to help patients record their feelings before and after they had leave. Staff were developing easy read Mental Capacity Act and Mental Health Act rights paperwork. Staff were working additional shifts to support patients to have Christmas leave. Patients’ said they enjoyed going on leave and felt supported by staff to do so.
  • Patients were involved in creating some easy read leaflets with staff support.
  • Patients had weekly community ward meetings where they could discuss issues and give feedback. Each ward had a patient representative. This person attended a patient representative forum. This group met regularly with senior staff and management.
  • There was a wide range of activities available for patients. Patients said they enjoyed cooking, art, gardening, community visits and the gym. Staff were seen engaging in activities with patients.
  • Managers had clear systems in place with the local authority for safeguarding patients. Staff knew who the safeguarding leads were and how to report any incidents.
  • Managers tracked and shared learning from incidents across the local hospitals within the same company.

However:

  • The average length of stay was four years, this figure included patients admission within the service.
  • Some patients said that one to one sessions with staff, were affected by staff movements to other wards.
  • Whilst staff said they had regular supervision, there were some gaps in managerial supervision records.

24-25 September 2015

During a routine inspection

We rated Burston House as ‘good’ because:

  • Clinical areas were clean and equipment was well maintained. Controlled drugs were stored securely and recorded in the register. Medication was appropriately prescribed and administered.
  • The service employed appropriately trained staff and covered vacancies by using regular agency staff. A full range of mental health disciplines and healthcare workers delivered care and treatment and the service provided psychological therapies for patients. Newly appointed healthcare workers took the national care certificate. This qualification is aimed at providing health and social care workers with the knowledge and skills needed to provide safe, compassionate care. The management also encouraged health care workers to complete the diploma in health and social care. Two senior healthcare workers completed mentorship training so they could support new starters
  • We reviewed 12 records and saw that patients received a comprehensive and timely assessment of their needs after admission and risk assessments were up to date and regularly reviewed. Care plans were comprehensive and holistic with evidence of patient involvement. Staff completed patients’ physical health checks and continued to monitor these.
  • Patients were appropriately safeguarded and managers had systems for tracking and monitoring safeguarding referrals. The provider had a service wide approach to learning from incidents, allowing for lessons to be learnt across the organisation. There were appropriate systems for managing complaints and information was available to patients on the wards. The service involved patients in decisions about the service and staff recruitment.
  • Staff participated in regular supervision and received appraisals. Staff received training in the application of the Mental Health Act 1983(07). Patients told us they knew their rights under the Act.
  • The provider gave financial assistance to families and carers to support family contact and the service had effective links with the community.
  • Patients were positive about the support they received from staff. We observed interactions with patients and saw that staff responded to patient needs showing discretion and respect. Staff were passionate and enthusiastic about providing care to patients with complex needs and demonstrated good understanding of care and treatment requirements.
  • There was a weekly timetable of community and on-site occupational activities.
  • The hospital had a ‘ward to board’ dashboard for monitoring services against agreed targets and was a member of the quality network for forensic mental health services. This provided peer led reviews to enable services to compare themselves with other similar units and national standards. A peer review had taken place in March this year, the results of which were positive.
  • Staff felt supported to raise concerns without fear of victimisation and told us that morale and job satisfaction was good.

However:

  • Seclusion records indicated medical staff did not review the use of seclusion in accordance with the Mental Health Act 1983(07) code of practice and their own policy.
  • We saw items in the seclusion that could pose a risk to patients or staff, for example a plastic wall mounted paper towel dispenser, toilet brush and bin in the seclusion room toilet. Screws on the inside of the seclusion room door were protruding. This posed a risk to patient safety.
  • A fire alarm bell, on Kestrel ward, situated in a blind spot, presented a ligature risk.
  • On Eagle ward there were omissions in the monitoring of refrigeration of medications. This meant that medicines might not have been stored at the correct temperatures to maintain their quality. However, this had been rectified, appropriate monitoring was now in place and there were no current concerns.

4 February 2014

During a routine inspection

During our inspection we spoke with eight people who used the service. They told us that they were well looked after and received the treatment they needed. They told us that plans were discussed with them about their future, and that where possible they were able to makes choices in their day to day lives.

One person told us they used the on-site gym regularly. They said, "This has been good for me, I have lost weight and feel better." Another person told us they enjoyed a dog walking activity in a local village. People we spoke with told us that they felt safe and that staff helped them if they had any concerns.

We looked at the medication procedures in place which we found needed some improvements.

Other records we examined included care records, staff records and maintenance records. These were very clear and showed that the appropriate information was available and actions were being taken.

16 January 2013

During a routine inspection

During the inspection, we spoke with six people who used the service and one of their relatives. We also spoke with three members of staff.

We were told that people were well cared for and treatment was provided in line with their expectations. One person told us that their care and treatment was explained to them so they knew what would happen and why and another said that they talked about their care with a staff member regularly.

People told us that staff treated them well. One person said, "They (the staff) talk to you and listen." They added that, "Staff are very fair with me." Another person explained how the staff met their cultural and dietary needs.

Care records contained details of the person's needs and detailed how those needs were met and the expected outcome. The records detailed how identified risks were managed, and strategies that were in place to deal with difficult behaviours.

We discussed safeguarding procedures with management and staff. The provider's procedures ensured that everyone was aware of actions to take if they witnessed or were told about abuse. Staff we spoke with were familiar with these procedures and confirmed that they received adequate training.

Procedures were in place to ensure that the service monitored the quality of the care and treatment provided.

5, 6 October 2011

During a themed inspection looking at Learning Disability Services

We spoke with 12 patients to obtain an overview of how they felt about the treatment and support they received and if they felt safe and secure living at Burston house. Comments included, 'All the staff look after me very well, there is no one I don't like' and, 'My support worker discuses with me, about the support I need, and helps me plan what I want to do'.

One patient told us, 'I speak to my support worker regularly, who helps me put my feelings into perspective'. Patients said that the staff treat them in a friendly way and talk to them with respect and kindness.

We spoke with one patient who is due to move into the community, they told us that they are looking forward to being discharged from the hospital, but felt apprehensive about the move. This person's parent told us, they are very pleased with the support from Burston House, and that their relative, 'Is looking after himself better, they have learnt how to cook and they, 'Hold high hopes for their relatives future'.

Patients said that they had been given a leaflet about abuse and were able to speak with staff if they had concerns. One patient told us, that the ward is noisy at times and that staff keep them safe if any trouble happens, especially when patients get angry and threatening to the other patients. They said that this makes them feel happy and well looked after.

Patients told us that they are aware of what restraint is and why the staff members may have to do this and under what circumstances. One patient said that 'if you play up then you will be restrained, it's your own fault.' Our observations indicated that the homes restraint policy was appropriate and its use was proportionate.

We spoke with three parents who told us that they were happy with the service provided and commended the staff for their professionalism and care. They said they were kept informed about their relative's progress and all commented on the vast improvement in their relative's lives and mental health since they had been admitted to Burston House. One of the parents told us the support their relative had received had been 'fantastic'.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.