Burdyke Lodge

Burdyke Lodge is a residential care home providing personal care to 15 people aged 65 and over at the time of the inspection. The service can support up to 27 people. People were living with a range of needs associated with the frailties of old age.

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

At the last inspection we identified improvements were needed to ensure there was an effective quality assurance system to identify concerns and drive necessary improvement. At this inspection we found some improvements had been made but these had not always been sustained. We also found that where the need for improvements had been identified action was not always taken in a timely way.

There were not enough staff employed at the home. Staff worked hard to ensure people’s care and support needs were met. However, the staffing levels impacted on other aspects of the service including the cleanliness of the home, activities for people and some aspects of quality assurance.

Environmental risks were not always managed safely. This included some aspects of fire safety and general safety and upkeep of the home. Risks to people were well managed. Staff knew people well and understood how to support them safely. There was a large, well-kept garden where people enjoyed spending time during the warmer weather.

People received care and support that met their individual needs and wishes. Staff understood the care and support people wished to receive. This included their individual choices and preferences. There was a positive culture at the home and staff were committed to ensuring people lived happy lives.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns.

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 requires improvement (published 16 October 2019). There was one breach 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 the provider remained in breach of regulations.

At our last inspection we recommended that the provider ensured staff received appropriate practical training. We also recommended they work with people to improve and develop meaningful activities for everybody. At this inspection we found the provider had not ensured staff received appropriate practical training. We found there had been some improvements to meaningful activities. However, due to current staffing concerns these improvements had not been maintained.

The last rating for this service was requires improvement (published 16 October 2019). The service remains rated requires improvement.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 12 August 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their quality assurance systems.

This inspection was also, prompted in part, due to concerns received about fire safety risks. A decision was made for us to inspect and examine those risks.

We undertook this focused inspection to check they had followed their action plan, to check if they now met legal requirements and to examine the risks identified to us. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well-led sections of this report.

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains Requires Improvement.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the staffing, risk management and the quality assurance systems at this inspection.

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 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.

Burdyke Lodge is a residential care home providing personal care to 19 people aged 65 and over at the time of the inspection. The service can support up to 27 people. People were living with a range of needs associated with the frailties of old age.

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

The provider lacked effective quality assurance systems to identify concerns in the service and drive necessary improvement. Where the need for improvement was identified these were not always addressed in a timely way.

The provider had not always sent us notifications when people had died. Notifications are information about important events the service is required to send us by law.

Staff received training that helped them to deliver the care and support that people needed. However, staff had not received recent practical training in relation to moving and handling and first aid. We made a recommendation about this.

Although there was a range of activities taking place, improvements were needed to ensure people had enough to do each day and activities were meaningful and reflected their individual interests. We made a recommendation about this.

People received support from staff who knew them well, understood their needs and were kind and caring. People’s care and support needs were assessed and reviewed. This meant people received care that was person-centred and reflected their needs and choices.

There was a positive, person-centred culture at Burdyke Lodge. People felt well supported by the provider, manager and staff. One person said. “You won’t find a better place than this.”

Staff understood the risks associated with the people they supported. Risk assessments provided further guidance for staff about individual and environmental risks. People were supported to receive their medicines when they needed them.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions they should take if they identified concerns. There were enough staff working to provide the support people needed, at times of their choice.

Staff received supervision and told us they were well supported by the manager and provider.

People's health and well-being needs were met. They were supported to receive healthcare services when they needed them. People were supported to eat a wide range of healthy, freshly cooked meals, drinks and snacks each day. They were given choices about what they would like to eat and drink.

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

The last rating for this service was good (published 10 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the quality assurance system at this inspection.

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 request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s level of care and support needs varied. People were independently mobile some using walking frames. Many were self-caring and required only guidance and prompting from staff,. A number of people went out alone or with friends and family, whilst others required more assistance with all care needs and remained in bed or in their rooms as they chose.

This was an unannounced inspection which took place on 3 and 8 November 2016.

At the last inspection undertaken July 2015 CQC did not identify any breaches of regulation. However we did make some recommendations about the safe administration of medicines, and ensuring professionalism and dignified care were maintained at all times.

There was a registered manager at the home; however the day to day running of the service was the responsibility of the home manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 manager was also the registered provider. People spoke highly of the home and the way it was run. And staff told us that they felt supported.

Staff had an understanding about how to recognise and report safeguarding concerns. Staff were clear that any concerns would be reported to the home or registered manager.

Risk assessments were completed for identified health and environmental needs. This included specific health related risks for the individual and environmental risks for the premises. Medicines policies and procedures ensured people received their medicines safely. People who looked after their own medicines without support from staff had risk assessments to support this. These were reviewed regularly to ensure medicine procedures remained safe.

Care plans and risk assessments were regularly reviewed and updated. Documentation was personalised and included peoples choices and the involvement of family and next of kin or significant others when appropriate. There was information to inform staff of people’s backgrounds and health needs. People who moved to Burdyke Lodge for a short period of respite care had care information in place. These were updated during the inspection to ensure they contained the level of detail in permanent care folders; however staff knew people and their needs well.

People living at Burdyke Lodge told us that staff responded to them promptly when they needed assistance and they felt staffing levels were appropriate. Staff had received training and support and felt they had the knowledge and skills to provide care for people appropriately.

People had capacity to make decisions and felt involved in decisions and choices about their care. Staff told us how they supported people’s choices and preferences. Management had an understanding of mental capacity assessments (MCA) and Deprivation of Liberty Safeguards (DoLS).

We received positive feedback regarding the meals provided. Meal choices were available and people were supported to eat a healthy balanced diet. People’s weights were monitored regularly to identify any health changes, however when people declined to be weighed, this was not always clear from documentation. Referrals were made to GPs and other health professionals when required to help maintain people’s good health.

Staff were kind, caring and supportive. They knew people well and were able to tell us about peoples likes, dislikes and preferences. Staff spoke to people and we saw light hearted banter between staff and people living at Burdyke Lodge. It was clear that people enjoyed this and they responded positively. People’s dignity and privacy were respected and everyone told us the atmosphere was homely and welcoming.

Activities were scheduled most days. This was predominately provided by visiting organisations, although staff told us they did some activity provision themselves. We saw that people went out or kept themselves busy throughout the day, some sitting to read the newspaper or watch television whilst others chose to remain in their rooms.

There was a homely warm atmosphere and people were encouraged to share their views and give feedback regularly. This included information about living at Burdyke Lodge, feedback on the home environment, staffing and meal provision. A system was in place to assess and monitor the quality of service provided. Some areas needed to be expanded to ensure all areas of auditing were effective. Audit information was used to continually improve and develop the service.

We found that care plans were comprehensive, reflected people's individual needs and provided direction that enabled staff to give people the appropriate care.

We saw that nutritional and well balanced food was prepared in maintained and clean kitchens. People who used the service told us that the food was of a high quality and one person told us 'The food here is really good, I like it and they always go out of their way if I want something special'.

The provider had policies and procedures in place to deal with complaints, incidents and to safeguard vulnerable adults. Staff received appropriate training and were confident about the procedures they needed to follow if they had any concerns.

We found that there were sufficient numbers of skilled staff employed and available at the home to meet people's needs. This was complimented with a clear and robust recruitment procedure that ensured staff were skilled and qualified to carry out their roles effectively.