Burton Cottages

Burton Cottages is a residential care service providing personal care and accommodation for eight autistic people. The service can support up to nine people. The building was split into two cottages that were joined in the middle by an office. Four people can live in one cottage and five in the other.

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

A new manager had been appointed in January 2021 and was recently registered with CQC. He told us there was a lot of work required to improve the service. There were staff vacancies, sickness and a high use of agency staff. There were often not enough staff on duty in the afternoons to meet people’s needs. The building needed refurbishment. There was limited assessment of people’s ability to make decisions around their care needs.

The organisation had systems to monitor the service and they held regular meetings with the registered manager and the regional area manager to monitor progress with their action plan. However, we found that when areas were signed off as having been addressed, there was a lack of monitoring to ensure that progress had been maintained.

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 always support this practice.

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

The model of care and the layout of the setting had been maximised to ensure people had a choice in where to spend their time. However, some areas lacked personalisation and the building was in need of redecoration. There was a lack of dignity in that there was a mixture of ceramic and melamine crockery and no assessment of who needed each so people had no choice and were given melamine when they could use ceramic. There was a lack of clear guidance to ensure some people’s needs were met in a person-centred way. The registered manager told us following the inspection that a referral had been made for one person to assess their capacity to understand an aspect of their care needs. We were reassured there was a programme of redecoration in place.

Right care:

There were staff vacancies, staff sickness and a high use of agency staff. The service tried to ensure that people received support from staff who knew them well as individuals. Most of the agency staff used were staff who had worked at the service regularly and knew people well. People's care and support needs were assessed and reviewed regularly. Improvements were being made to ensure that care was more person-centred but further work was required to achieve this.

Right culture:

People were supported to pursue their own interests. Some attended day centres throughout the week. Staff supported others to take part in activities of their choice to meet their individual needs and wishes. This included swimming, using the local shops, walking trips and drives to places of interest. It was not evident people had as many choices in the afternoons or evenings for activities due to staff levels.

Surveys completed by the organisation following our inspection showed a mixed response. Staff were unhappy with the sickness and shortage of staff but very happy with the support they received from the registered manager. Relatives also raised issues with the use of agency staff and with the phone not being answered at weekends. However, relatives also felt that communications with their relatives’ keyworkers was good, and they were very thankful for the support and care provided during the pandemic.

The service was clean and tidy throughout. Enhanced cleaning had been instigated as a result of the pandemic, staff had received additional training and the service had a visiting procedure that complied with government guidance.

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 20 December 2019). There were no breaches of regulation. At this inspection the service remains requires improvement and we found multiple breaches of regulation. This is the third time the service has been rated requires improvement.

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. This enabled us to review the previous ratings.

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

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.

Burton Cottages residential care home provides accommodation and personal care for up to ten people who have learning disabilities and some associated physical and/or sensory disabilities. There were seven people using the service at the time of inspection. The building was split into two cottages that were joined in the middle by an office.

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.

Right support:

• Although Burton Cottages is registered for 10 people, it can only accommodate nine people. The model of care and the layout of the setting maximised people’s choice, control and independence. The building is divided into two units and both are run separately. Staff supported people to meet their individual needs and encouraged them to be as independent as possible.

Right care:

• Care plans provided guidance to ensure staff could care for people in a way that suited their individual needs and wishes. We observed that staff were caring in their approach and people were very content in their surroundings.

Right culture:

• The ethos, values, attitudes and behaviours of leaders and care staff ensured people led confident, inclusive and empowered lives. Day centres were closed due to the pandemic but activities were organised to ensure that people spent time doing things that made them happy. For example, people were encouraged to make choices about how they wanted to spend their time and this was arranged with them. Some people liked to spend time on computers, some liked to take walks or train trips.

People were kept safe by staff who had received training in how to safeguard people from abuse and who knew the actions they needed to take to protect people from the risk of harm.

Staff were seen to engage well with the people they were supporting. Care plans provided detailed advice and guidance to staff to ensure people’s individual needs were met in a person-centred way.

Burton Cottages was clean and tidy. There were robust procedures to ensure infection prevention and control (IPC) measures were fully implemented and government guidance and best practice followed.

Robust systems were in place to monitor the service and there was a focus on continuous development to improve quality outcomes for people. Management maintained good oversight of the service. Feedback from relatives was very positive and they appreciated the lengths staff had taken to keep them updated throughout the pandemic.

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

The last rating for this service was Requires Improvement (published 21 December 2019).

We undertook this targeted inspection because we had some concerns about safeguarding notifications received since the last inspection and because there was no registered manager. 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.

The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections 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 found no evidence during this inspection that people were at risk of harm from these concerns.

Follow up

We will continue to monitor information we receive about the service until we return to visit.

Burton Cottages residential care home provides accommodation and personal care for up to ten people who have learning disabilities and some associated physical and/or sensory disabilities. There were eight people using the service at the time of inspection. The building was split into two cottages adjoined in the middle.

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. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home. It was registered for the support of up to 10 people. Eight people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area.

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

The provider and manager had good oversight of the service. There were a series of audits which helped the provider and manager to identify where improvements were needed to continue to develop the service. Through this process a number of areas related to record keeping had been identified as needing improvement. We also identified a number of areas where record keeping could be developed further to demonstrate more clearly the actions taken. For example, in relation to daily records, fire records and recruitment records. Whilst best interest meetings had been held when needed, the assessments that determined the need for these meeting and the actions taken to try to support a person to make a decision had not been carried out.

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.

People received support from staff who knew them well as individuals. Where agency staff were used these were mainly staff who had worked at the service regularly and knew people well. People’s care and support needs were assessed and reviewed regularly. This meant people received care that was person-centred and reflected their needs and choices.

People were supported to maintain their own interests and friendships. Most attended day centres throughout the week. Staff supported others to take part in activities of their choice to meet their individual needs and wishes. This included shopping trips, horse riding, swimming, trips to theatre and pubs, and trips to places of interest.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. The home was clean and tidy throughout. There were enough staff working to provide the support people needed, at times of their choice. Recruitment procedures ensured only suitable staff worked at the service.

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 safely.

Staff received training that helped them to deliver the care and support people needed. This included specialist training in autism and positive behavioural support to meet people’s complex needs. They attended regular supervision meetings and told us they were very well supported by the manager. A staff member told us, “I feel I can go to the manager or any of the seniors if I need support about anything, personal or work related. I have been supported in that respect, we are always there for each other here.”

People's health and well-being needs were met. Where appropriate, staff supported people to attend health appointments, such as the GP or dentist and attended appointments for specialist advice and support. People's nutritional needs were assessed. They were supported to eat a wide range of healthy, freshly cooked meals, drinks and snacks each day.

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 was a detailed complaint procedure, and this was displayed so anyone wanting to raise a concern could do so.

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 Requires Improvement. (16 November 2018).

The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

Why we inspected

This was a planned inspection based on the previous rating

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.

The care 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 who used the service can live as ordinary a life as any citizen.

Burton Cottages provides accommodation and personal care for up to nine people who have learning disabilities and some associated physical and/or sensory disabilities. There were seven people using the service at the time of inspection. The building was split into two cottages adjoined in the middle. People had their own bathrooms attached to their bedrooms. There were also communal facilities if people did not want to use their own bathrooms. There was a kitchen, lounge and dining-room in each cottage for people to relax in. There was also a large garden, however this required some maintenance.

This is the service’s first inspection. They were previously registered under a different provider; however, the same people were living at the service and most staff had continued their employment with this provider.

The service had a registered manager. 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.

Although quality audits were completed regularly, they had not identified several shortfalls in record keeping. There were inconsistencies within care documentation and fire safety procedures. There was not a consistent overview of maintenance issues raised and whether actions had been completed. Incidents were not consistently reported to relevant safeguarding teams when people came to harm. Mental capacity documentation did not reflect the views of the person or how the decision was made that they lacked capacity. Some people whose support needs involved restrictive practises, did not have mental capacity assessments specific to these.

The building was not always clean and staff did not always demonstrate understanding of infection control when supporting people. The provider had not ensured sufficient safety checks such as applications to the Disclosure and Barring Service, photo identification and information about previous training, skills and knowledge were completed for agency staff. Permanent staff did have such checks completed.

There was not consistent oversight of complaints, which meant lessons learned, actions taken and feedback given was not always identified. People did not always receive information in their preferred communication method. We have made a recommendation regarding this.

People had assessments of risk which enabled them to do the activities they enjoyed and remain safe. Numerous safety checks were completed by the management team and external professionals to ensure the building was safe for people to live in. Medicines were administered safely by trained, competent staff and there were suitable staffing levels to meet the needs of people.

Staff had their skills and knowledge increased through regular training and supervision. There was a robust induction process, that staff felt helped them with their understanding of people and their routines. People’s nutritional needs were met and any changes to support needs were discussed with health and social care professionals to improve quality of life.

Interactions between people and staff were warm and demonstrative of strong relationships being built. Relatives and professionals were unanimous in their view that staff were kind and caring. People’s privacy, dignity and independence were promoted at all times. Staff had a good understanding of end of life care and had provided support to ensure this was dignified and included people’s wishes.

Everyone we spoke to was positive about the registered manager and their commitment to people and the service. Although there were areas for improvement in records, they felt the service was well-led and an open, transparent and supportive culture was promoted.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.