Burdon Grange Care Home

Burdon Grange Care Home is a nursing home in one adapted building that provides accommodation for people who require nursing and personal care. There is also a separate flat that provides accommodation for two people. The service is registered to accommodate up to 31 people who have complex physical and nursing needs. At the time of our inspection there were 26 people using the service.

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

Not all risks in relation to the management of medicines were managed safely and we found omissions in some clinical records that may expose people to risk. Some medicines were not being stored safely and variable dose medication was not accurately recorded. The providers current policy was not comprehensive in some areas.

The current governance systems in operation had not identified the areas of concern we found during the inspection. Whilst it was not evident this had resulted in impact or harm to people, people were at risk of not receiving care in line with their assessed needs.

Not all staff were positive about the leadership of the service. Some staff told us they felt communication from the registered manager could be improved and that this would make a positive difference to the people they supported and increase team cohesion.

People were well supported by staff that were caring and treated them with dignity and respect. Staff knew people well and understood their needs. We received positive feedback from people and their relatives during the inspection.

Risks of abuse to people were minimised. Staff had received safeguarding training and the service had appropriate safeguarding systems and processes. Staff understood safeguarding reporting processes. There were effective systems that ensured the service and environment were safe. Health and safety checks, together with effective checks of the environment were completed.

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. There were systems in place that ensured people who were deprived of their liberty were done so with the appropriate legal authority.

People were supported by staff who had the skills and knowledge to meet their needs, however some staff told us they would like a more comprehensive continual training package. There was no effective system to monitor staff supervision and appraisal and not all staff were positive about the support they received.

There was a system to investigate and respond to peoples’ concerns and complaints. People and their relatives commented positively about the registered manager and the quality of care their family member received. No concerns were raised about the quality of care provided.

The service continually looked to learn and improve care provision for people. They were involved in trials of new systems and methods to improve peoples’ lives. The service worked well with other professionals and we received very positive feedback from healthcare professionals we contacted about both the care provided and the standard of leadership at the service.

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 Outstanding (published 14 March 2020).

Why we inspected

The inspection was prompted in part by notification of a specific incident as a result of which two people using the service died and another was seriously injured. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about the management and assessment of risk. This inspection examined those risks.

We also 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.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from Outstanding to Requires Improvement based on the findings of this inspection.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Burdon Grange is a nursing home in one adapted building providing personal and nursing care to 31 people at the time of the inspection. The service can support up to 31 people.

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

People, relatives and professionals gave consistently positive feedback about the care provided at Burdon Grange. Comments included: “I think this is an outstanding home. The care is fantastic. The staff are kind, caring and keep us safe. My health has improved since I moved here. The physio has really helped my back.”

There was a strong, visible person-centred culture. This was evident from all staff within all roles. From care staff, domestic staff and management. The person-centred culture was embedded at all levels. A staff member commented: “It's about enriching people's lives.”

People were truly respected and valued as individuals, with staff thinking ‘outside of the box.’ For example, one person suffered a close family bereavement and due to having such a proactive, compassionate and kind relationship with staff they felt able to talk to the registered manager and key worker. The service ensured the person received the right professional support to work through their grief.

Staff were exceptional at anticipating people’s needs. We observed this throughout the inspection. For example, sensory stimulation is a very important part of the care provided to people living at Burdon Grange to aid their well-being.

Staff were highly motivated to ensure people received care which was compassionate and kind. The atmosphere in the home was warm and friendly. We saw people had developed strong relationships with staff, and it was evident that this was an important ethos of the service.

Staff created an inclusive, comfortable and safe environment where people were encouraged to overcome obstacles. Promoting people's independence through enhanced communication and technology was central to the service provided at Burdon Grange.

Staff had an excellent understanding of people's individual needs which protected their values and beliefs in a way the person wanted to receive care and support. The approach to care and support meant there was a multi-professional process which aimed at maintaining continuity, independence and autonomy for the person.

Professionals consistently praised the care provided at Burdon Grange. Comments included: “Management are proactive, there appears to be a strong focus on providing opportunities for individuals to partake in many different and varied activities.”

The service supported people to learn new skills and maintain their independence. For example, adult education was introduced at Burdon Grange to compliment the external courses which are facilitated in local centres.

A number of extensive methods were used to assess the quality and safety of the service people received and continuous improvements were made in response to the findings.

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 provided safe care to people. One person commented: One person commented: “I feel safe living here.” Medicines were safely managed on people’s behalf.

Care files were personalised to reflect people’s personal preferences. People were supported to maintain a balanced diet. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

There were effective staff recruitment and selection processes in place. People received effective care and support from staff who were well trained and competent.

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 9 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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

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.

Burdon Grange provides accommodation for people who require nursing and personal care. They are registered to accommodate up to 30 younger people who have complex physical and nursing needs. Previously they were also registered for the regulated activity of personal care, (providing support to people in their own home) but had recently removed this from their registration.

There was a registered manager running 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.

People benefitted from a team of staff who were skilled and understood the complex needs of each person. There was a varied activities programme which included various trips and outings into the local community and places of interest.

Care and support was well planned which enabled staff to ensure people received personalised care. People’s safety was considered in every aspect of their care and support. Risks were well documented. Medicines were safely managed. The provider operated safe recruitment processes to ensure only staff who were suitable to work with vulnerable people were employed. Staff knew who they should report any concerns about possible abuse to. They were confident their concerns, ideas and suggestions were listened to and acted upon.

People were supported by a staff team with a range of skills and qualifications. The service employed a part time physiotherapist and occupational therapist to help nursing and care staff provide the right care and support to people. There were sufficient staff available on each shift to ensure people’s needs and wishes were being met. People were confident in staffs’ ability to provide effective and person centred care.

People’s privacy and dignity were fully respected. Staff supported people in a kind and compassionate way. We observed staff supporting people in a way which ensured their dignity and respect was being considered.

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. Where possible, consent was gained before providing care. Staff were skilled at understanding people’s non-verbal cues. Not all staff knew who was subject to a deprivation of liberty safeguard (DoLS). They did understand about ensuring how to maximise people’s choice and acting in people’s best interests. Since the inspection the provider had given assurances that systems were being put in place to ensure all staff had information about who was subject to a DoLS and what the impact of this was on the ways staff should work with the person.

People were supported to eat a well-balanced diet and they had access to health professionals to make sure they kept as healthy as possible. People said “We are given a huge range and choice of meals.”

The environment was kept clean and safe. We have made a recommendation about individual evacuation plans for people in the event of a fire. Systems were in place to audit the environment, records and care and support provided. People’s views were sought in a variety of ways to help improve the service and ensure their voice was taken into account when planning for the future with such things as activities, room decors and menus. People, staff and visiting professionals believed the management team to be open and inclusive. There was a positive culture of striving to continually improve. The registered manager and provider acted swiftly to any feedback from CQC and others to help improve safety and the running of the service.