Archived: Burgess Park

We carried out a comprehensive inspection at this service on 17 December 2015, and rated it as requires improvement. At that time we found two breaches in regulations for safe care and treatment and good governance. We asked the registered provider to send us a plan to tell us what they would do to meet legal requirements. We did not receive the action plan.

We carried out a focussed inspection on the 13 September 2016. We did not look at all of the Key Lines of Enquiry under each key question. We followed up on the breaches of regulations to see if the registered provider had made improvements to the service. At the last inspection on December 2015 we asked the provider to take action to make improvements for safe care and treatment and good governance. We found for safe care and treatment this action has been completed. However, we found the provider was in continued breach of good governance. We also found new breaches of staffing and person centred care. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. You can read the report from our last inspection, by selecting the 'all reports' link for Burgess Park on our website at www.cqc.org.uk.

This comprehensive inspection was carried out on 23 and 31 January 2017 to check that the registered provider had followed their plan and to check that they now met the regulations inspected. During this inspection, we found evidence that the provider had made some improvements. We found that the breach in relation to staffing was now met. We found a continued breach of good governance. We also found new breaches of safe care and treatment and need for consent. We found that further action is required to meet all the regulations we inspected.

There was no registered manager 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. The registered provider was recruiting for a home manager. There is an interim manager at Burgess Park supporting the service whilst a permanent manager is recruited.

People did not receive safe care and treatment that met their needs because staff had not acted to manage them. People's health conditions were not managed well and they were at risk from deterioration of their health. Staff had not always followed health care professional’s advice and recommendations to manage people’s health needs effectively.

People did not have their medicines provided to them in a safe way. We found examples where staff did not administer medicines to people a way that helped maintain their health.

The quality assurance systems in place did not identify the areas of concern we found. The provider’s governance systems and audit systems were not always well organised. People did not receive safe quality care because the governance systems did not identify any concerns with the service.

People and their relatives, gave feedback to the provider about the quality of care they received. However, we found that the quality of care experienced did not match our findings at the inspection.

Assessment identified people’s care and support needs. These were completed with people and their relative. A plan of care was developed in order to provide guidance for staff to meet those assessed needs. However we found that reassessments of people’s needs did not take into consideration new health needs. Risks to people’s health and well-being were not always identified and used to plan their care.

Activities for people did not always meet their preferences or hobbies. The activities provided did not meet the needs of people with dementia or people who do not have English as their first language.

Consent to care was not always obtained by staff. Staff did not have an understanding of how to apply the principles of the Mental Capacity Act 2005 (MCA) to support people effectively in a way that was safe. People are not supported to have maximum choice and control of their lives.

People told us that staff showed them compassion and respect when supporting them. People and staff engaged and knew each other well. We found that staff did not always treat people with dignity in the provision of care.

There was sufficient staff to meet people’s care and support needs. The manager followed the registered provider’s staffing planning tool using the staffing level as recommended.

Training, supervision, and appraisals supported staff in their jobs. Resident experience managers supported staff through identifying their strengths, and to support them with their professional needs.

Food and drink provided met people’s needs and preferences. People told us they enjoyed their meals and they were able to choose meals they wanted from the menu provided.

There was a complaint process in place. This enabled people to make a complaint about an aspect of their care and support needs. People were aware of the process to follow if they wanted to raise a complaint. People and relatives we spoke with shared with us varied views of the service and the care they received.

Staff received support from the manager, the regional manager and three of the provider’s managers who currently provide leadership and management support at the service. Staff told us that the manager was open and transparent. The manager provided opportunities for staff to speak with them and have their concerns listened.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This is because the service is Inadequate in two key questions.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to be providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

This service has now remained in Special Measures for over 12 months. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. CQC is considering the appropriate regulatory response to resolve the problems. We will report on action we have taken in respect of this when it is complete. If the service has demonstrated improvements when we inspect it and it is no longer rate as inadequate for any of the five key questions it will no longer be in special measures.

There was no registered manager 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.

The manager at the service and had made an application to the Care Quality Commission to become the registered manager. During the inspection we were informed that the manager of the service, who had made an application to the CQC to become a registered manager, was supporting a manager at another service three days a week. After the inspection we were informed that the manager of the service had left Burgess Park to become the manager of the other service. We were informed that the deputy manager will be supporting the service in the interim whilst a permanent manager is recruited to the service.

We last inspected this service in December 2015, and rated it as requires improvement. At that time we found two breaches in regulations which included breaches relating to safe care and treatment and good governance. We asked the registered provider to tell us what they would do to meet legal requirements. We did not receive the action plan.

On the 13th September 2016, we carried out a focussed inspection so we did not look at all of the Key Lines of Enquiry under each key question. We followed up on the breaches of regulations to see if the provider had made improvements to the service. At this inspection we found the provider was still in breach in relation to good governance. We also found new breaches in relation to staffing and person centred care.

People did not have sufficient numbers of staff caring for them. During the inspection we saw that there was not enough staff available to support people. We observed that people did not have their basic hygiene needs met and call bells were not answered in a timely manner. Staff we spoke with told us there were not enough staff on duty. The manager of the service did not follow the assessment tool used to assess the level of staff required to meet the needs of people. We are considering our regulator response to this breach of regulation and will report to resolve the problems.

People did not have activities that met their preferences or needs. We observed that one person who did not speak English did not have activities tailored to their needs. We also found that people who were unable to leave their bedroom due to frailty did not have individual social activities as identified in their care records. The service did not develop strong links with the local community to reduce the social isolation of people living in the service.

The quality assurance systems in place were not effective because it did not identify the areas of concern we found. Over the past six inspections at this service since 2013, we have found several breaches of the 2010 and 2014 regulations in all expect one inspection. We found the same or similar breeches in regulations at our inspections during this period where the provider had failed to act on these to improve the care and support people received.

People and their relatives, gave feedback to the provider. Feedback received by the provider showed people reported they were happy with the care and service provided. However this was in contrast to what people told us. Staff provided feedback to the registered provider and they analysed the findings. The regional manager then analysed these which showed staff were satisfied with their job. This was in contrast to what staff told us that there were not supported by the managers of the service.

People and staff told us the manager of the service was not open and approachable. They told us when they wanted to speak with her she was not available at the service. We were informed that the manager was supporting another service manager at another one of the registered provider’s locations. People we spoke with were not aware that the manager was not regularly at the service.

During this inspection, we found that the provider had made some improvements to safe care and treatment. Risks to people’s health and well-being were identified and a plan was in place to manage those risks appropriately. Staff had access to this information and they were able to reduce the recurrence of the identified risk.

Staff had received appropriate training, supervision, and appraisals to support them in their roles. Staff with the support of their line manager identified their professional needs and development and took action to achieve them.

Staff sought consent to care from people they supported. Staff were aware of the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and how to support people effectively. The manager understood their role for caring with people in line with the Deprivation of Liberty Safeguards (DoLS).

People told us they enjoyed the food and drink they had. People chose the meals they wanted from the menu provided. People had their preferences and nutritional needs met because staff understood and met them.

Healthcare services were available to people who required them. People had access to health care services when their health needs changed. Staff made referrals to health care professionals for further advice and guidance to manage their health conditions. Staff followed health professional’s guidance and recommendations for people.

People contributed to the development of their care. People’s assessment identified their needs and a care plan developed to meet them. Staff had guidance from people’s care plans to ensure that care delivered was appropriate. Assessments were carried and care delivered was flexible to meet their changing needs. However, we found people were not supported to follow their interests and take part in social activities increasing the risk of social isolation.

People were aware of the process to follow if they wanted to raise a complaint. The majority of people we spoke with said they were happy with the service.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This is because the service is Inadequate in two key questions.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

This service has now remained in Special Measures for over 12 months. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. CQC is considering the appropriate regulatory response to resolve the problems. We will report on action we have taken in respect of this when it is complete. 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.

Is the service caring?

People were supported by knowledgeable staff who knew the health and care needs of people they cared for. Staff engaged well with people and provided them with opportunities to participate in social activities. People were treated with respect, dignity and kindness.

Is the service responsive?

People or their relatives told us they were asked for their views of the services. Relatives had regular meetings with the registered manager. Some relatives said that senior staff took notice of what they told the manager. An example given was that a request was made for the registered manger to invite senior managers to the residents and relatives meetings. Minutes from these meetings were displayed on the notice board with actions taken.

Is the service safe?

Staff were aware of how to care for people with complex health needs. We saw that staff made referrals for specialist advice if required. For example, to the physiotherapist, GP or tissue viability nurse. Where people required support from two carers, this was provided for people.

Is the service effective?

People had an assessment of their needs before living at the service. Assessments were thorough to establish whether people's health and social care needs could be met at the service. Risks assessments and management plans were developed and implemented to reduce risks.

Is the service well led?

People's personal records including medical records were accurate and fit for purpose. People had regular monthly reviews; copies of the reviews were held on their care records. We found that the registered manager had made notifications to the CQC, appropriately. We were able to track each notification sent with an outcome.

Is the service safe?

We looked at six people's care records and saw that the service had plans in place to manage risks to their health. For example, there was guidance on how to support people who were at risk of developing pressure ulcers. However, staff had not always fully implemented these plans. We found that staff did not always protect people from risks identified from an assessment. For example we observed one person was not supported with daily transfers out of bed.

Two relatives told us that staffing levels were low at the home and it was sometimes difficult to get the attention of care staff. Following change in management a number of staff had left Burgess Park, and ten newly appointed staff were being inducted into the home.

On our inspection there was one nurse on night shift, due to staff absence. We looked at the nurse's rota and saw that two nurses should be on night duty. However, the manager provided staff to cover this absence.

People were at risk of receiving unsafe care because risk management plans were not always been put into action.

Procedures for dealing with emergencies were in place and staff were able to describe these to us.

The provider and staff understood their responsibilities under the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

People had an assessment of their needs before receiving care and support; from this information, individual care plans and an assessment of risk were developed. Assessments included needs for any equipment, mobility aids and specialist dietary requirements. Care plans identified areas of risk and a management plan was developed to minimise them. However, we found that staff did not always implement professional guidance.

Is the service caring?

People told us that staff were kind, supportive and staff were aware of their individual needs and preferences. We observed staff did not always treat people with respect and dignity. We observed one member of staff shouting at a person using the service and another member of staff addressing people as 'sweetheart', 'love' and 'darling'. Staff did not always engage well with people or offer choices; for example we saw a member of staff turn on the radio while people were having breakfast, people were not asked if they wanted the radio on or what radio station they wanted to listen to.

Is the service responsive?

We saw that the provider made arrangements for people with additional health and social care support needs when required. We saw that referrals had been made to health professionals, including GP, tissue viability nurse and speech and language therapist (SALT) for people, meeting their changing care needs.

Staff took action when appropriate to cater to specific needs of people, for example a recommendation was made for an individualised activities plan for one person. We saw that staff implemented this recommendation and we saw that staff engaged the person in activities on a daily basis.

Is the service well led?

People told us they felt able to raise and discuss concerns with staff or the manager as appropriate. Some staff told us they felt supported and listened to by the manager of the service. They said the manager was responsive to any requests and they felt involved in decisions about the care provided to people they supported. Regular team meetings were held and people were encouraged to raise any concerns or issues, and recorded in the team meeting minutes.

There was a residents meeting held with staff, people and relatives of people using the service. People raised issues and a record of the meeting minutes were provided to people. A response to the issues raised and appropriate actions taken by the manager were documented.

Staff received training regularly and new staff completed their induction, all mandatory training was up to date and staff received regular supervision and had an appraisal in place. We reviewed four staff records and we saw that the provider's recruitment process had been followed. We saw documents held on staff records regarding; recruitment and interview process, references, identification, Disclosure and Barring Service (DBS) checks or Criminal Records checks (CRB), as appropriate.

People had appropriate care plans in place and regular review of risks to ensure there was up to date information about how they were to be cared for and supported. For the majority we found that the care provided was in line with that outlined in their care plans. However we found that further improvement was required regarding protecting people from the risk of developing pressure ulcers.

We observed that people had good access to food and drinks throughout the day. The chef was knowledgeable on people's individual dietary requirements.

The service was visually clean and we found that staff were knowledgeable in how to reduce the risk and spread of infections.

People using the service told us they liked the staff and the staff were aware of how to meet their needs. However, we found that at times the service was short staffed which meant that people had to wait for their needs to be met.

A new supervision and induction process had been introduced to support staff. However, we found that not all staff were up to date with mandatory training. This meant there was a risk that staff were not skilled or knowledgeable on how to support people using the service.

The majority of people had appropriate care plans and risk assessments in place. However, at times appropriate pressure sore prevention measures were not in place, which meant that some people were at risk of developing pressure sores.

Some people were not receiving appropriate amount of foods and fluids, and we saw that some people were not woken up to eat and drink which meant they went a long time without food or drink. We saw that fluid charts were not consistently used to monitor the intake and output of fluids and people were regularly not drinking the recommended amounts of daily fluids, which meant they were at risk of dehydration.

We found there were not enough qualified, skilled and experienced staff to meet people's needs. Staff at the service were very busy and told us they were not able to meet the needs of people using the service. We observed that sometimes when people used their call bells or called out to staff for help they had to wait for assistance as there were times when no staff were available to assist them, because they were busy supporting other people.

People told us that they felt well informed and involved in decisions about their care and treatment. Their preferences over food choice, bed times and personal care were respected, and observations showed staff treated them with respect and protected their dignity and privacy.

Care records were up to date and evidenced comprehensive assessment and care planning. People's physical, emotional and social needs were addressed and care plans were developed in discussion with people who use the service. One person told us 'the staff talk to me about what they can do for me but I like to just get on with things and they let me.'

There were appropriate processes for management of medicines. The medication administration record (MAR) charts were completed correctly and observations on the day showed safe administration of medication.

Effective recruitment and selection processes were in place, with accurate pre-employment checks being carried out.

Effective quality checking systems were in place and there was regular monitoring of the quality of service provision through audits and staff meetings. People who use the service were able to feedback about the service through regular 'residents' meetings.