Burntwood Lodge

Burntwood Lodge is a residential care home providing personal and nursing care to six people with a learning disability. The service accommodates everyone in one converted house.

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.

At the time of our inspection, six people were living at the service.

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

People were well cared for by staff who had a good knowledge of them and knew how they communicated individually. People were given the opportunity to engage in activities and pastimes of their choice, as well as access external pursuits, such as attending a day centre or going on holiday.

People lived in an environment that was suitable for them, clean and hygienic and checked for its safety. People’s care was responsive to their needs and staff’s knowledge of people was evident in the way they provided care and attention.

People were kept safe as staff were aware of how to report concerns and followed guidance in care plans in relation to any risks to people. People received the medicines they required and healthcare professional input was sought and provided to help ensure people stayed healthy.

People were provided with sufficient food and drink to keep them well-nourished and people were supported and encouraged to make their own decisions about their care.

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.

Relatives and professionals gave positive feedback about the service, telling us it was well managed and they were asked for their views or their guidance was followed. The registered manager ensured they engaged with professionals outside of the service to learn new ways to maintain the good level of care as well as improve the service for the people living there.

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 (report published 27 March 2017).

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.

There was a 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 and associated Regulations about how the service is run. The registered manager assisted us during our inspection.

At our last inspection in February 2016 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action in relation to the person-centred care and good governance. Following the inspection the provider submitted an action plan to us to tell us how they planned to address these concerns. We carried out this inspection to check if the provider had made the changes required. We found that improvements had been made in all areas and the regulations were now being met.

People lived in a homely environment and were cared for by staff who knew them well and had developed relationships with them. People were spoken to in a respectful way and encouraged to do things for themselves or spend their time as they wished. Staff supported people to eat a good range of foods and those with a specific dietary requirement were provided with appropriate food.

People had access to external health services and professional involvement was sought by staff when appropriate to help maintain good health. Medicines were stored appropriately and recording of medicines was completed to show people had received the medicines they required.

People were encouraged to take part in activities and staff were consistently reviewing activities and thinking of new ways to keep people stimulated. We found support plans were more person-centred than at our last inspection and staff were continuing to review these and add information that was meaningful to individuals. There were a sufficient number of staff on duty to enable people to either stay indoors or go out to their individual activities.

Staff met with their line manager on a one to one basis and staff said they felt supported. Staff said the registered manager had good management oversight of the home and there was a good culture within the team. Staff received a good range of training. Staff met together regularly as a team to discuss all aspects of the home.

Risks to people’s safety were identified and control measures were in place to minimise the risk of harm. Staff recorded all accidents and incidents and took relevant action to minimise the risk of them happening again. Staff were knowledgeable about their responsibilities to keep people safe and were aware of reporting procedures should they suspect potential abuse. Appropriate checks were carried out to help ensure only suitable staff worked in the home.

Staff were following the legal requirements to make sure that any decisions made or restrictions to people were done in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

Quality assurance audits were carried out to help ensure the care provided was of a standard people should expect. Any areas identified as needing improvement were made by staff. If an emergency occurred, such as a fire, people would be evacuated following guidance in place for staff.

A complaints procedure was available for any concerns. This was displayed in a format that was easy for people to understand. People, their relatives and external stakeholders were encouraged to feedback their views and ideas into the running of the home.

This was an unannounced inspection which took place on 11 February 2016.

There was a 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 and associated Regulations about how the service is run. The registered manager assisted us during our inspection.

The home was not consistently well-led because the registered manager had allowed clinical waste to be disposed of in the general waste bins. Records held in the home were not always up to date or contemporaneous.

Staff undertook quality assurance audits to ensure the care provided was of a standard people should expect. Although we found actions identified were not always acted upon.

Staff had identified and assessed individual risks for people. Accidents and incidents that occurred were recorded however information was sketchy and not contemporaneous.

Medicines were managed in an appropriate way and people received the medicines they had been prescribed.

Care records for people were not always written in a person-centred way and although staff knew people, they were not all able to tell us about people’s background because there was no information available. People had the opportunity to participate in activities, however activities where not always individualised or meaningful for people.

Staff said they felt supported by the registered manager and provider and told us they met with their line manager on a one to one basis to discuss training or any aspect of their work. Staff were aware of their responsibilities to safeguard people from abuse and were able to tell us what they would do in such an event. Staff had access to a whistleblowing policy should they need to use it. Appropriate checks were carried out to help ensure only suitable staff worked in the home.

Good relationships had been established between staff and people. People lived in a homely environment and staff treated people with care and respect.

People were supported to make their own decisions, from the food they wished to eat to what they wanted to wear or how they spent their time. Staff supported people to keep healthy by providing a range of food. People had access to external health services and professional involvement was sought by staff when appropriate to help people maintain good health.

Staff had followed legal requirements to make sure that any decisions made or restrictions to people were done in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

There were a sufficient number of staff on duty to support people when they needed it. People did not have to wait to receive attention from staff.

Staff received a good range of training which included training specific to the needs of people living at Burntwood Lodge. This allowed them to carry out their role in an effective and competent way. Staff met together regularly as a team to discuss all aspects of the home.

If an emergency occurred or the home had to close for a period of time, people’s care would not be interrupted as there were procedures in place. There was a reciprocal arrangement in place with a neighbouring home should people need to be evacuated.

A complaints procedure was available for any concerns. People and their relatives were encouraged to feedback their views and ideas into the running of the home.

During the inspection we found some breaches 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 the report.

We carried out this follow up visit to check that the provider had taken the necessary action to ensure that staff had undertaken recent training.

We found on this visit that the registered manager had reviewed the training requirements and had ensured that staff attended appropriate courses. We also found that the registered manager had updated the training records to ensure they were accurate. This meant that we found the provider compliant.

As part of our inspection we spoke with three staff and the registered manager. We also spoke with two relatives of people who lived in the house as well as two professionals who provided support outside of the service. We spoke with three people who lived in the home. However due to their complex needs we were unable to gain a good understanding of their views, so we used observation to inform our judgements.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

We found the building was generally well maintained and we were told that a programme of redecoration was in progress. We found during our inspection that people were cared for in an environment that was safe, clean and hygienic.

We noted that the provider had ensured that where people lacked capacity to give their consent a mental capacity assessment had been carried out. We also noted that 'best interest' meetings were held when appropriate.

We spoke with relatives who told us that they felt their family member was safe at Burntwood Lodge. One relative told us, 'I feel as comfortable as I can be that they are safe there.'

Is the service effective?

It was evident from our observations and from speaking to staff that they had a clear understanding of people's needs. The people who used the service that we spoke with indicated to us the staff looked after them well. One relative told us, 'I think they go a long way to find out what my relative is thinking. It's such a long time that they (relative) have been noticed in that way.' One professional that we spoke with told us, 'They know their needs.'

Is the service caring?

We saw that people were supported by kind and attentive staff. We saw that people were supported to do things such as pour a cup of tea or put together a jigsaw. One relative told us, 'I think my relative is looked after beautifully.'

Is the service responsive?

People who used the service had a keyworker who regularly reviewed the needs of the person. One member of staff said, 'The keyworker's are the 'eyes' of the people who live here. We spot any changes.' The relatives that we spoke with told us that staff kept them informed and were good at communicating with them. They also told us that if there was any medical problems with their relative, staff called the doctor.

Is the service well-led?

Staff that we spoke with told us that they were asked for their comments and suggestions on how to improve the service. We heard from relatives that they felt that the new owners were very proactive. One relative told us, 'Overall, they do a good job.' We saw that the service held 'residents meetings' to involve people who used the service.

This service has recently transferred ownership to a new provider and we noted they had made improvements to the environment and staffing, which gave more support resources to care and activities.

We saw staff were attentive to people and had a good knowledge of their needs and communication methods.

People told us they had enjoyed their meal and the food was good. They also said the staff offered them choices of food and they could have a snack or a drink at any time.

One person showed us food they liked from the pictorial menu. They also told us they liked to do the shopping and help in the kitchen.

We saw that staff did offer choices and seek consent before offering care and information was included in formats and languages people would understand better so the person's consent would be better informed. However where people did not have capacity the provider did not always act in accordance with legal requirements.

We saw that people were supported to be able to eat and drink sufficient amounts to meet their needs.

We noted that there had been an increase in maintenance works recently. For example, overgrowth to the side of the building that was parallel to a path used by school children had been cleared, so as to provide visibility and deter crime in that area.

However, we found that the service was putting people at risk by leaving a shed open containing hazardous materials; by not risk assessing the need for window restrictors and acting accordingly; by not providing adequate security to the building; by not ensuring the grounds were free from hazards so they could be safely used; and by not providing an adequate legionella and safe water temperature management system.

We found that the registered person was not notifying the Commission of all incidents that they are required to, and particularly those incidents that cause injuries or which change the structure of a person's body or require treatment, for example injuries from falls resulting in hospital attendance.