Archived: Burnham House

Since our last visit in April 2015 we found the service had made significant improvements.

The service acted in accordance with some aspects of the Mental Capacity Act 2005 (MCA). Mental capacity assessments were undertaken for people who lacked capacity to make specific decisions. Care records showed the service sought consent from people who were not able to make specific decisions in line with legislation.

People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met We found conditions on authorisations to deprive people of their liberty were not being met.

We recommend that the service seek advice and guidance from current legislation in relation to adhering to conditions in DoLS.

There were no calendars to orientate people living with dementia of the date and time.

People and relatives were kept safe from abuse because staff had attended relevant training and knew what to do if they suspected abuse had occurred. Risk assessments clearly outlined potential risks and risk management plans showed what staff should do to minimise those risks. Call bells were responded to in a prompt manner.

We observed there were sufficient numbers of staff to provide care and support to people; this was supported by our review of staff rosters. We noted staffing levels were regularly reviewed to ensure there was enough staff to meet people’s needs.

People received care and support from staff who received appropriate induction; training supervision and appraisal. This was supported by our reviews of staff records and what staff had told us. Staff demonstrated an understanding of how to work with people who were unable to make specific decisions.

People’s meal times were given at the appropriate times and they were supported to have enough to eat and drink. This was supported by care records which showed people’s nutritional and hydration needs were being met.

Admission assessments ensured the service captured essential information about people in order to establish what their care and support needs were. People said staff were responsive to their needs and their social needs were met. People and their relatives knew how to raise concerns and the complaints log evidenced all complaints received were responded to appropriately.

People and their relatives expressed happiness with the service but had concerns about the frequent changes in registered managers. They said they were kept up to date with changes in the service and were able to provide feedback. Quality assurance systems were in place to improve the welfare and safety of people who used the service.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

The service was not safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had submitted one application to their Supervisory Body which received standard authorisation. This was to ensure the person was deprived of their liberty in the correct way and this was done only in the person's best interests and in the lest restrictive manner. This meant people who used the service were only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the DoLS.

We observed staff working practice was not in line with the service's policy and procedures. Although care and treatment was planned it was not always delivered in a way that was intended to ensure people's safety and welfare. We were told by the manager every person in the home had a folder which contained supplementary charts such as, 24 hour food intake chart, fluid intake charts, positioning turning charts, observation charts. The charts had to be completed as soon as care was delivered. We observed a supplementary folder had been taken from a person who was in their room and completed without them being present. Whilst in another room we observed a staff updating a record for a care task they had not completed. This meant the information would not have accurately reflected the care delivered and had the potential of placing the person's safety and welfare at risk.

We visited one person in their room in the morning on day one of our inspection. They showed us two empty drink containers and commented, 'I am meant to get refills of drink throughout the day but his does not happen.' We returned later in the afternoon to the person's room and saw the drink containers were still empty. This meant people could not be confident they would be supported to drink sufficient amounts to meet their needs.

The manager told us the service's infection control lead was the housekeeping manager. When we spoke with the housekeeping manager we found they were not aware of this or the infection control procedures. We observed two staff members were not wearing personal protection equipment (PPE) when changing dirty bed linen. However we were told by one of the staff member's that the correct procedure was to wear one. This had the potential of cross contamination and placed people and staff employed by the service from identifiable risks of acquiring an infection.

Medicines were safely administered. We saw all medicines were kept locked away in trolleys and controlled drugs were kept in a double locked cupboard. This meant medicines were handled safely, securely and appropriately.

People who were identified at risk of dehydration or malnutrition were placed at further risk because 24 hour food and fluid intake records did not accurately reflect what people had drank or eaten.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to care and welfare of people who use the service, meeting peoples' nutritional needs, infection control and records.

Is the service effective?

The service was not effective.

There were no regular social activities arranged for people. This meant peoples' social needs were not being met.

We observed the lunch period in the ground floor dining room on the first day of our inspection. Tables were set before people entered the dining room. None of the people referred to the menus that were available. Instead they asked staff what food was available. We saw some of the people observed had limited communication. This meant although there was accessible information about meals, the written menus did not meet the needs of some of the people they were designed for.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to care and welfare of people who use the service and records.

Is it caring?

The service was not caring.

We observed some positive interaction between staff and the people they supported. People were spoken to in a respectful manner. People gave positive and negative comments about the care such as, 'They are very good and look after me well' and "It was very good when I first came here but I don't get to see staff regularly. They don't have enough time to talk to me.' They proceeded to change the person's bed linen and only spoke with the person when the individual asked them a question. This meant people's dignity were not promoted.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to care and welfare of people who use the service.

Is it responsive?

The service was not responsive.

We observed one person who could not verbally communicate had waited 25 minutes before a staff member brought them their meal. We saw no staff interaction with the person during this time. The staff member returned with their meal, sat down and proceeded to assist them. This meant people were not being supported to eat and drink in a timely manner.

Another person called out to say they were ready for their pudding. We observed even though there were staff within hearing distance, no one acknowledged the person. After calling out a couple of times the person became frustrated to the point they were unable to verbalise what they wanted. Staff eventually acknowledged them but it still took a while before they were given their pudding. This meant people were not treated with dignity and respect.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to care and welfare of people who use the service and meeting people's nutritional needs.

Is it well-led?

The service was not effective.

We found systems put in place to monitor, manage and improve the quality of the service were not effective. There were no processes to ensure identified actions for care audits carried out were followed through. Care audit records were not kept securely. We saw no audits of supplementary folders which contained monitoring records that were not accurate, factual and fit for purpose. Complaints received were not dealt with in line with service's policy and people were not made aware of the complaints procedure. There were no regular social activities to meet peoples' needs. This meant systems put in place to identify, analyse and review risks were not effective.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation assessing and monitoring the quality of service provision.

We returned to the service on 10 July 2013 to check whether improvements had been made.

We found improvements had been made in all of the areas where we had concerns. People's privacy and dignity were now respected by staff. Records of team meetings and staff supervision reflected staff had been reminded of appropriate ways of treating people. The interactions we observed were respectful. Action was being taken to improve activity provision at the service, to provide people with stimulation and opportunities to access the community.

People we spoke with said they were well cared for. One person told us they received 'Very good care.' Another told us staff were 'Very kind and respectful' towards them. Three people commented they were well cared for overall but mentioned some staff were better than others in their approach and how they interacted with them. We fed this comment back to the manager for their attention.

Improvements had been made to ensure people were kept hydrated. Meal times had been reorganised. This helped to ensure people who needed assistance were being given more attention. People's weight was being monitored effectively and any weight loss reported to their GP.

We found action had been taken to make sure people were protected from the risk of abuse. Staff had been made aware of the issues following the last inspection and reminded about acceptable ways of working. We saw records showing staff meetings had been held to raise and discuss issues about care practices. Staff supervision had also been used to reinforce good practices.

There was a range of auditing systems in place to monitor care practice. This helped ensure improvements were made and sustained.

We were satisfied the provider had taken sufficient action to become compliant with the standards.

We saw that people were not experiencing safe and effective care. Some people we spoke to and relatives told us that they were not happy with the standards of care provided. People using the service were not protected from abuse. Some staff and people said that they were spoken to harshly and one person was treated roughly by some staff but was afraid to complain about this. There had been two incidents where resident's possessions had gone missing. Both were reported to the police and had been investigated

There were sufficient staff in place to support people. Not all staff felt there were enough staff to meet the needs of people with advanced dementia and challenging behaviour. Few staff were engaging with people in communal activities. Relatives and one person we spoke to mentioned the lack of meaningful activity taking place during the day. The were not effective systems in place to monitor and assess the quality of the service. We saw a structured quality assurance system and some evidence of positive learning and action taken to improve standards, but not enough to ensure that people were receiving a good quality of care.