Burbank Mews

Burbank Mews is a residential care home providing personal care to up to 12 people in 6 bungalows. The service provides support to autistic people and people with a learning disability. At the time of inspection 8 people were using the service.

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

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

The service supported people to have the maximum possible choice, control and independence. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful life. The service worked with people to plan for when they experienced periods of distress so their freedoms were restricted only if there was no alternative. People were supported in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

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.

Right care

Staff promoted equality and diversity in their support for people. Staff understood and respected people’s religious and cultural needs and supported them accordingly. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People could take part in activities and pursue interests that were tailored to them. Staff supported people to try new activities that enhanced and enriched their lives. Staff and people co-operated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff placed people’s wishes, needs and rights at the heart of everything they did. People and those important to them, including advocates, were involved in planning their care. The service enabled people and those important to them to worked with staff to develop the service. Staff valued and acted upon people’s views. People’s quality of life was enhanced by the service’s culture of improvement and inclusivity.

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 15 March 2021). At that inspection we found improvements had been made, and the provider was no longer in breach of regulations 12 (safe care and treatment), 17 (good governance) and 19 (fit and proper persons employed). At that inspection we only inspected the key questions safe and well-led as they had previously been rated inadequate (report published 3 August 2020).

During this inspection we inspected all key questions and the remaining breaches of regulation, which included regulations 9 (person-centred care), 11 (need for consent) and 18 (staffing). At this inspection we found significant improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Burbank Mews provides personal care for up to 12 people with a learning disability and/or autism in six bungalows. At the time of inspection seven people were using the service.

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

Medicines were managed safely and effectively. Risks were identified and managed appropriately. There were effective processes to ensure lessons were learnt as the analysis of accidents and incidents had improved significantly. The premises were well maintained, clean and tidy. Recruitment procedures were robust. There were enough staff to meet people's needs and people were protected from the risk of abuse.

Quality monitoring systems were effective. Staff said the management team had made improvements and things had improved significantly. The service did not have a manager registered with the Care Quality Commission (CQC) at the time of this inspection, although an application had been submitted.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right Support, Right Care, Right Culture. Staff ensured they continually maximised people's choice, control and independence in a safe and inclusive environment, whilst also following national infection prevention and control (IPC) guidance. Each person had their own individual, person centred COVID-19 care plan and risk assessment which promoted their rights, privacy and dignity

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.

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 inadequate (published 30 April 2020 and updated report published 31 July 2020 after representations had been concluded) and there were multiple breaches of regulation. The provider completed an action plan after the last comprehensive inspection to show what they would do and by when to improve person-centred care, the need for consent, safe care and treatment, good governance, staffing and fit and proper persons employed.

We served a warning notice on the provider and required them to be compliant with regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 30 April 2020. On 29 July 2020 we completed a targeted inspection to check whether the requirements of the warning notice had been met, and found they had.

This service has been in Special Measures since 30 April 2020. During this inspection the provider demonstrated improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements regarding safe care and treatment, good governance and fit and proper persons employed. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements, as these key questions were both rated inadequate previously.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Burbank Mews on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections, even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

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.

Burbank Mews is a residential care home providing personal care for 12 people with a learning disability and/or autism in six bungalows. Nursing care is not provided. At the time of inspection eight people were using the service.

The service is larger than recommended by best practice guidance. However, the provider had arranged the service in a way that ensured people received person-centred care and were supported to maximise their independence, choice, control and involvement in the community.

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

The management had made improvements to the service. All the requirements of the warning notice had been met.

The systems to manage people’s medicines had been improved and medicines were now being given safely.

Staff recruitment procedures had been updated so staff were employed safely.

Accidents and incidents were now being analysed to look for trends and patterns. Staff were involved in discussions about how to improve the support to reduce the likelihood of incidents reoccurring.

People's weight was being monitored and assessment tools were used to guide staff about what actions should be taken following changes to people’s weight.

Staff had written guidance about how to support people with specific health care needs. Staff were knowledgeable about how to support people with these needs.

People were supported by a team of staff who knew them well. People told us they felt safe and liked the staff that supported them. Staff were caring, respectful and ensured people were treated well.

Care plans had been reviewed regularly and had been updated to reflect people’s current care needs.

The service had implemented mental capacity assessments and undertaken best interest decisions. 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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, 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.

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

Rating at last inspection

The last rating for this service was inadequate (published 30 April 2020).

Following our last inspection, we served a warning notice on the provider. We required them to be

compliant with Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 30 April 2020.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Burbank Mews provides personal care for up to 12 people with a learning disability and/or autism in six bungalows. Nursing care is not provided. At the time of inspection eight people were using the service.

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; however, the principles and values were not always being upheld. We expect that services that uphold these principles and values ensure that people living with learning disabilities and/or autism are supported to live meaningful lives that include control, choice and independence. We found this was not always happening in practice.

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

The service was not well-led as we identified six breaches of regulation. The provider had failed to have enough oversight of the service. Systems to monitor the quality and safety of the service and support continuous improvement, both at registered manager and provider level, were not effective.

People did not receive consistently safe care and medicines were not always managed safely. Staff recruitment procedures were not thorough. Accidents and incidents had not been analysed thoroughly to look for trends so lessons could be learned.

Staff training and supervisions were not up to date. People’s weight was not monitored effectively and care plans specific to people’s health needs were not always in place.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service was not working within the principles of the Mental Capacity Act 2005. Mental capacity assessments and best interest decisions had not always been carried out when they should have been.

The service didn’t always consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support as people’s views had not been sought and we could see how they had been involved in care planning.

People told us they enjoyed living there and liked the staff who supported them. Most staff knew people’s needs well and people seem relaxed and happy in the presence of staff. Most staff were caring, respectful and ensured people were treated well.

Some staff did not always engage with people in a meaningful way and spent time doing other things. Some staff did not regard the people they supported as equals, so did not fully respect their equality and diversity.

Care plans had not been reviewed regularly, were not always up to date and were not always consistent.

There was a lack of consistency across each of the bungalows in terms of staff approach and record keeping. There was evidence of the service making appropriate referrals to other health professionals, but staff did not always follow this advice consistently.

Quality monitoring systems were not robust or effective and did not drive improvement. The result of this was people did not always receive good quality care.

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

Rating at last inspection

The last rating for this service was good (published 13 July 2018).

Why we inspected

The inspection was prompted in part due to concerns we received about the increase of safeguarding incidents, the quality of care records, excessive use of agency staff and staff training not being up to date. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to person-centred care, the need for consent, safe care and treatment, good governance, staffing and fit and proper persons employed. Please see the action we have told the provider to take at the end of this report.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We last inspected the service in April 2017 and rated the service as ‘Requires Improvement’ overall. We found the provider had breached Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing. This was because training records showed not all staff had completed training relevant to their job role and staff had mixed views whether they had received enough training to perform their job role effectively. During this inspection we found significant improvements in this area and across the service as a whole so the overall rating has improved to ‘Good.’

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

Burbank Mews provides personal care for up to twelve people with a learning disability and/or autistic spectrum disorder in six bungalows. The 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. On the day of our inspection there were seven people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

People who used the service appeared comfortable in staff's presence. Relatives told us they were happy with the care provided at Burbank Mews.

Staff had completed training in safeguarding vulnerable adults and understood their responsibilities to report any concerns. Thorough recruitment and selection procedures ensured suitable staff were employed. Risk assessments relating to people's individual care needs and the environment were reviewed regularly. There was a positive approach to risk management.

Medicines were managed safely and administered by staff trained for this role. Each person had an up to date personal emergency evacuation plan (PEEP) which provided staff with information about how to support them to evacuate the building in an emergency situation such as a fire or flood.

Staff training in key areas was up to date. Staff received regular supervisions and appraisals and told us they felt supported.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to have enough to eat and drink and attend appointments with healthcare professionals.

There was a welcoming and homely atmosphere at the service. People were at ease with staff and relatives said staff were kind and caring. Staff respected people’s privacy and dignity.

Staff supported people to do the things they enjoyed and also encouraged independence with daily living. Support plans contained clear information about the person's level of independence as well as details of areas where staff support was required. Support plans detailed people's needs and preferences.

There was an effective quality assurance system in place to ensure the quality of the service and drive improvement.

Relatives and staff felt the service was well managed. Staff described the registered manager as approachable and said things had greatly improved within the service.

There was a positive culture and ethos at the service which was driven by the management team. Staff were positive about the service and their contribution to supporting people to lead full and rewarding lives.

This was the first inspection of this service. It was registered with the Care Quality Commission on 15 June 2015.

Burbank Mews is a residential service for up to 12 people with learning disabilities and/or other needs such as autism, mental health issues and physical needs. The accommodation comprises six bungalows, each with two en-suite bedrooms, a communal kitchen/dining room, living room and a garden. At the time of our inspection there were seven people living in the six bungalows.

The service did not have a registered manager as the registered manager left in November 2016. The provider’s operations manager was currently managing the day to day running of the service. 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.

During this inspection we found a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because training records showed not all staff had completed training relevant to their job role. Staff had mixed views whether they had received enough training to perform their job role effectively.

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

Medicines were not always managed safely as people’s prescribed creams were not always dated on opening. The temperature of the rooms where medicines were stored was not always checked regularly to ensure they were within recommended limits. A number of medicine errors had occurred in recent months which had been dealt with appropriately. Daily management checks were now in place to monitor medicines administration.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Further staff training on this had been arranged.

The provider's quality assurance processes had not always been effective in identifying and generating improvements for the service. An action plan was now in place and progress was being made in a number of areas.

Staff understood their safeguarding responsibilities and told us they would have no hesitation in reporting any concerns about the safety or care of people. Staff said they felt confident the operations manager would deal with safeguarding concerns appropriately.

A thorough recruitment and selection process was in place which ensured staff had the right skills and experience to support people who used the service. Identity and background checks had been completed which included references from previous employers and a Disclosure and Barring Service (DBS) check.

Risks to people's health and safety were recorded in care files. These included risk assessments about people’s individual care needs. Regular planned and preventative maintenance checks and repairs were carried out and other required inspections and services such as gas safety were up to date.

People and relatives spoke positively about staff. Staff supported people to be independent and to do the things they enjoyed. People were at ease in the presence of staff.

Support plans detailed people’s individual care needs and preferences. People’s needs were reviewed regularly. Relatives told us they were involved in care planning.

Arrangements were in place to deal with complaints. One complaint had been received since the opening of the service; this had been dealt with appropriately and to the satisfaction of the person concerned.

Feedback from people who used the service and their relatives was sought regularly. A formal satisfaction survey was due to be launched in the coming weeks.

The provider’s operations manager was currently managing the day to day running of the service and had been since 4 January 2017. A new service manager, who was due to apply to the Care Quality Commission to become the registered manager, was due to start by the end of April 2017.

The operations manager and chief executive officer said it had been challenging opening a new service but they felt things were improving now. Staff also said it had been challenging but spoke positively about the improvements the operations manager had made.