Burton House

Burton House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

It provides services for adults with a learning disability and autism. Burton House is registered to provide support for six adults and at the time of the inspection three people lived in the home and four other people accessed the home for respite care at various times.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

The outcomes for people using the service reflected the principles and values of Registering the Right Support, by promoting choice, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Thorough recruitment and staff induction was in place to ensure that staff were suitable to work and provide support within the home. Staff work across all U&I Care Ltd services so that they get to know everyone.

Care and support were delivered on an individual basis and the occupants of the home decided their daily routines. Care, support and activities were planned around individual likes and dislikes. People were encouraged to participate in activities which were meaningful to them for example education, work placements and sports. People were given opportunities to experience new activities with varying degrees of success.

We found people were supported to connect with other people using the U&I Care Limited services to avoid social isolation. People also attended events at community activities, social clubs and discos. The time spent engaging with these activities was dependant on their preferences and well-being at the time.

People told us they felt safe. People’s responses and interactions showed us that they felt comfortable with the staff members supporting them. The service worked hard to promote inclusivity and people’s diversity was embraced.

Staff supported people to make their needs and wishes known, and what worked best to ensure they had a good day.

Recent changes to the management structure were seen as a positive move and supported clear lines of accountability. We considered that this would help with issues we had identified at the last inspection regarding robust planning and review, overview, record-keeping and governance to support consistent safety and quality of care.

Staff told us they were proud to work for U&I Care Limited. There were processes in place for staff to access support at any time and we were told by staff they felt supported by the management team. Records clearly showed that staff received formal supervision, appraisal and regular training.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 08 May 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection was unannounced. The inspection was conducted by an adult social care inspector.

At the last inspection of this service in 2015 the home was rated good. During this inspection breaches of legal requirements were found and home was rated 'Requires Improvement.'

Burton House is a care home for six adults that provides support and short breaks to young adults with autism/ learning disabilities and complex needs. Burton House is run by U&I Care Limited. It also provides day service support for a small number of people, which we do not regulate. The home is located in a residential area of Warrington. People staying at the home are supported by staff on a 24 hour basis. Each person has their own bedroom and shared communal areas. There are large well maintained gardens at the back of the house and parking at the front of the building.

Burton House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection there were two people living at the home permanently, and four people accessing the short break services.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.' Registering the Right Support CQC policy.

A registered manager was 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.

Staff recruitment checks highlighted that information was missing from a selection of files from staff who worked at Burton House. This did not demonstrate that robust recruitment checks were being undertaken by the provider when staff were starting working at the service. We checked the provider’s policy with regards to the recruitment and selection of staff and found the provider was not always adhering to their own procedures.

Quality assurance systems were in place and reviewed on a regularly basis. We saw support plans contained updates which had been hand written by staff if there was a change in support. The service had regular internal audits on service provisions as a whole which resulted in a red, amber , green (known as RAG) rating. Despite these audits taking place, some further improvements were needed to ensure the quality assurance procedure was effective as some issues we found in relation to best interests and staff recruitment had not been highlighted.

We saw that applications to deprive people of their liberties (DOLs) were being appropriately applied for. However, there was limited information with regards to decision making in general. Additionally, there was conflicting information within support plans with reference to what decisions people could make, and what required best interest involvement. We could not see any documented evidence of best interest involvement within the support plans viewed as the records were unclear. We have made a recommendation about this.

Medications were stored and administered safely by staff who had been trained to do so. Medication was clearly signed in and out by staff and the person’s family member if they were only at the home for a short stay period. There was no plan in for place for how to give medication which is needed as and when required (PRN) medication. We have made a recommendation regarding this.

Incidents and accidents did not always evidence that remedial action had been taken and followed up by the registered manager. We could not be sure what steps had been taken to prevent future reoccurrences. We have made a recommendation with regards to this.

Staff spoken with were able to explain the correct procedure for reporting actual or potential abuse. Staff had been trained in safeguarding adults, although more training was in the process of being implemented. There was a safeguarding adults policy and procedure and a whistleblowing policy in place at the service.

Risk assessments contained sufficient detail to enable staff to keep people safe from harm. Risk assessments were reviewed regularly by the staff, and any changes were incorporated into people's support plans. Consideration was given within the content of the risk assessments to people's diverse needs and behaviours.

We saw there were enough staff at the home on the day of inspection to ensure that people were supported with their assessed needs. There were different levels of support required for some people, and other people had one to one activity plans. We checked the numbers of staff against the activity planner and saw that each person was receiving the correct level of support.

The home was clean and tidy. Cleaning products were safely stored securely, and there was hand washing facilities available in the home.

We spoke to the house manager about the opportunities for lessons learned and how they have demonstrated this in the home, as we wanted to be sure the service was using opportunities to learn from their own practice to improve outcomes for people. We were given an example if this.

Staff were trained in a range of subjects and had received an induction prior to them commencing work at the home. We spoke to the registered manager at length regarding the training provided regarding autism awareness. Due to the complexities of some of the people at Burton House the autism training offered to staff was not as thorough as expected. The registered manager was looking at introducing new more robust training.

People at Burton House were well supported with their food and fluid intake. We saw most people were supported to make their own meals and snacks, which they did as part of their planned activities.

People had access the GP and out of hours services if they were unwell.

The home was furnished to a good standard. There were accessible 'quite areas' for people to use in line with their needs to enable them to have their own space.

We observed positive interactions between people who used the service and the staff. Staff demonstrated through our conversations with them and by us observing them supporting people that they knew people very well.

Our conversations with family members and people at the home who were able to talk with us, confirmed that staff were caring and kind in their approach. Support plans were not always signed by people or their families, however some were signed and family members confirmed they had been involved in their relatives support plan.

There had been no formal complaints at the home, however we reviewed the organisations complaints process. People we spoke with confirmed they knew how to make a complaint.

People's support plans were respectfully written and there was an appropriate amount of depth and person centred information within each one we viewed. Consideration was given to people's background, routines and behaviours and these were all incorporated and strategized within their support plans.

Staff were trained and had some knowledge of end of life care. The registered manager assured us that more training would be incorporated into the staff training programme to ensure that all staff had a awareness of end of life care, and people's choices regards to this.

All of the staff, family members, and people who lived at the home we spoke with spoke positively about the registered manager.

Our conversations with the registered manger showed they were clearly passionate about providing good support and outcomes for people, and this was evidenced in some of the support plans we viewed. The registered manager was present during our inspection.

The rating for the last inspection was clearly displayed in the communal areas of the home and on the providers website.