19 June 2019
The inspection: We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team: The service was inspected by one inspector, one specialist advisor (a registered learning disability nurse) and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service, in this instance older people with dementia.
Service and service type: Burton, Bridge and Trent Court are three buildings covered by one CQC registration. The provider is registered to accommodate and provide personal and nursing care for up to 85 younger or older people who may have mental illness or dementia that may be combined with a physical disability and/or sensory Impairment.
Notice of inspection: This inspection was unannounced on the first day and announced on the second.
What we did: We visited Burton, Bridge and Trent Court on 2 and 3 May 2019. The service had a registered manager. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of care provided. The registered manager was available throughout our inspection.
We reviewed information we had received about the service since they were last inspected by us. We looked at details about incidents the provider must notify us about, such as allegations of abuse, and we sought feedback from the local authority and other professionals who work with the service. We assessed the information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
We spoke with seven people who lived at the home. Some people were not always able to share their views, so we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also spoke with four relatives/friends who were visiting. We spoke with four nurses (one a modern matron), two senior care assistants, three care assistants, one activities coordinator, an occupational therapist, psychologist (who was part of a clinical psychology team), registered manager and nominated individual/provider. We also spoke with a visiting GP. We used this information to form part of our judgment. We looked at eight people’s care records to see how their care was planned and delivered, this including their medication records. Other records looked at included three recruitment files to check suitable staff members were recruited and received appropriate training. We also looked at records relating to the management of the service along with a selection of the provider’s policies and procedures, to ensure people received a good quality service.
19 June 2019
About the service: Burton, Bridge and Trent Court are three buildings covered by one CQC registration. The provider is registered to accommodate and provide personal and nursing care for up to 85 younger or older people who may have mental illness or dementia that may be combined with a physical disability and/or sensory Impairment. Bridge Court was not occupied at the time of our inspection and there were 43 people living in Burton and Trent Court.
People’s experience of using this service: People and relatives told us they had a positive experience in respect of the care and support they received. They told us they received support from staff in a timely way and were not kept waiting for assistance.
We saw people looked comfortable in the presence of staff and people told us they felt safe at the home. Staff were knowledgeable about potential risks to people and were able to tell us how these would be minimised.
People were supported by staff who were caring and expressed empathy and compassion towards people who lived at the home. We saw staff consistently respected people and promoted their privacy, dignity and independence.
People received effective person-centred care and support at the point this was provided and based on their individual needs and preferences. Staff were knowledgeable about people’s needs and preferences and the staff fostered good relationships with the people. Some people’s records needed improvement to reflect people’s involvement and how the person-centred care we saw was planned. The provider was aware of this with plans underway to revise all care plans.
People were supported by care staff who had a range of skills and knowledge to meet their needs. Staff understood their role, felt confident and well supported. Staff received supervision and felt well supported by the provider. People's health was supported as staff worked with other health care providers to ensure their health needs were met.
People were supported by staff to have choices, and the provider’s policies supported this practice. There was a lack of evidence of people’s involvement or that of appropriate persons in do not resuscitate agreements where these were completed by external professionals without the provider’s involvement. These needed reviews to ensure these decisions were in the person’s best interests.
We saw staff responded to people’s needs effectively and their preferences were known and respected by staff.
People and their representatives knew how to complain. Staff knew how to identify and respond if people were unhappy with the service. People were able to communicate how they felt to staff, and said staff were approachable and listened to what they had to say. Relatives told us when they had raised concerns these had been addressed appropriately.
People, relatives and staff gave a positive picture as to the quality of care people received and said management and staff were approachable.
Quality monitoring systems were in place, and the provider had used external professionals to carry out audits to assist them in identifying how to improve the service, and people’s experience. The provider was very clear with us the service needed to improve but had identified what most of these improvements were, and had a clear improvement agenda in place. The provider told us changes were being made, with evidence of this seen, but was ensuring the pace of change allowed people and staff to be involved so changes were successful and sustainable.
Rating at last inspection: The rating at our last inspection was ‘Requires Improvement’ (report published 18/05/18).
Why we inspected: This was a scheduled inspection based on the previous rating for the service.