Burnside Court

Burnside Court is a 'care home' that provides care and support for a maximum of 26 older people, some of whom may be living with a dementia and/or physical frailty. At the time of the inspection 24 people were living at the service.

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

Although people who were able to share their views with us told us they were happy living at Burnside Court, and relatives we spoke with did not raise any concerns about the quality of care provided.

We found the service was not always operating in accordance with the regulations and best practice guidance. This meant people were at risk of not receiving care and support that promoted their wellbeing and protected them from harm.

Key pieces of information relating to people's care and support needs were not always being recorded or followed up.

People were not always protected from the risk of avoidable harm. We found where some risks had been identified, enough action had not always been taken to mitigate those risks and keep people safe.

People were not always protected from the risk and spread of infection.

People were not always protected by safe recruitment procedures.

People were not supported to have maximum choice and control of their lives and staff were not supporting people in the least restrictive way possible and in their best interests.

Systems and processes to monitor the service were not undertaken robustly. This meant they were not always effective; did not drive improvement; did not identify the issues we found at this inspection and could not be relied upon as a source to measure quality and risk.

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 27th March 2020). Following that inspection, the provider was asked to complete an action plan to show what they would do and by when to improve. This was not received by the Commission .

At this inspection we found not enough improvement had been made and the provider remained in breach of regulations. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This inspection was part prompted by a review of the information we held about this service. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Effective and Well-led which contain those requirements.

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 COVID-19 and other infection outbreaks effectively.

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 based on the findings of this inspection.

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

Enforcement and Recommendations

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 safe care and treatment, infection prevention and control, need for consent, recruitment and governance at this inspection. We have also made recommendations in relation to management of people’s medicines and staff induction processes. Please see the actions 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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Burnside Court is a residential care home providing personal care to 24 people aged 65 and over at the time of the inspection. The service is registered to support up to 26 people in one adapted building.

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

People told us they felt safe living at Burnside Court. However, improvements were required to ensure people were supported to have maximum choice and control of their lives and to ensure staff supported people in the least restrictive way possible and in their best interests. The policies and systems in the service required improvement as they did not support this practice.

Systems to audit the home were in place to monitor and improve the quality of the care people received. However, systems and processes had failed to identify the service was not meeting the requirements of the Mental Capacity Act 2005.

Since the last inspection risks in relation to the health, safety and welfare of people, risks associated with medicines management and maintaining a clean environment had been addressed. However, we found information associated with particular health risks, and information about people's needs, would benefit from more information to ensure staff have sufficient information to keep people safe, and meet their needs. We made a recommendation to the provider about this.

People said they felt safe at the home. Staff knew how to report any concerns and said these would be acted upon.

People told us they were happy living at Burnside Court and staff were kind and caring. Privacy was supported during personal care and staff had a good understanding of gaining consent before delivering care.

People were supported by staff who had been through a robust recruitment process. People told us, and we saw, there were enough staff to meet people’s needs.

People were happy with the food provided and told us they had enough to eat and drink. People were referred to health care professionals when they needed advice and treatment.

People lived in a home that was pleasantly decorated, well maintained and adapted and designed to meet their needs.

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 (published 26 February 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection whilst some improvement had been made, the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the Mental Capacity Act 2005 and systems and processes to improve the quality of the service at this inspection.

People’s experience of using this service: On the day of the inspection we observed medicines were not being safely administered and people were at risk of receiving the wrong medicine. The inspection took place at the weekend when there was not normally a manager present. We were assured this method of administering medicines was not normal practice but were concerned the lack of oversight at weekends could lead to care practices falling below acceptable standards. The registered manager said they would look at introducing spot checks to monitor care standards more effectively.

Care plans contained information about people’s health and social needs and were regularly reviewed. Risk assessments had been developed across a range of areas. Some people had specific health conditions and there was not always a relevant care plan or risk assessment in place to describe their individual needs and guide staff.

Systems to prevent cross infection were not robust. There were no cleaning schedules in place, slings were shared between people and hand gel dispensers were empty. The registered manager told us this would be addressed.

Staff knew people well and there was a relaxed and comfortable atmosphere. People chatted with each other and staff and some people sang along to the radio. People moved between their own rooms and the shared lounge/dining area as they chose. The office door was normally open and people were clearly used to going into the office to chat with the management team.

People and relatives were highly complimentary of the service and no-one had needed to raise a complaint. They told us the registered and assistant manager were approachable and they would be confident raising any issues.

The service was based in an old style property and accommodation was arranged over four floors. Due to the layout of the premises, the registered manager considered people’s mobility and cognitive abilities when assessing their needs. Some redecoration was being carried out at the time of the inspection. The registered manager said this was a continual process due to the age of the property.

Staff received an induction and regular training and supervision. They told us they were well supported and encouraged to develop their skills. The registered manager did not receive any formal supervision. However, they told us the provider was communicative and supportive. They were pro-active in developing their skills and had systems in place to help ensure they were up to date with any developments in the care sector.

At our previous inspection the service was rated Good (report published 9 September 2016). At this inspection the rating had dropped to Requires Improvement.

Why we inspected: This was a scheduled inspection and was planned based on the previous rating.

Enforcement We identified breaches of the regulations in respect of the administration of medicines and governance. Details of action we have asked the provider to take can be found at the end of this report.

Follow up: We will ask the registered provider to send us an action plan outlining how they will address the concerns identified at our inspection. We will check to see the necessary improvements have been made in accordance with our re-inspection programme. If we receive any information of concern we may re-inspect sooner.

Burnside Court is a residential home in Paignton, Devon providing accommodation and care for up to twenty six people. People living at the home are older people, most of whom were living with dementia. On the day of our inspection, twenty three people were living at the home. Accommodation was provided over three floors, accessed by lifts and stairs. All bedrooms had en-suite facilities. The home had an attractive garden, and a small patio and car parking area.

The home 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 and associated Regulations about how the service is run.

On the first day of our inspection Burnside Court were holding their annual BBQ party. We had the opportunity to speak with people, friends and relatives about the care at the home. Without exception everyone we spoke with had nothing but praise for the kindness and care shown by staff at Burnside Court. There was a real family atmosphere and it was evident that staff considered the people they supported and their families, as friends.

People told us that they were happy and felt well cared for. It was clear to see that people were comfortable living at Burnside Court and really felt they were at home. People’s care was personalised and detailed, and it was evident that staff knew people they were supporting very well. We saw them interacting with kindness and compassion. People and their families described management and staff as caring, respectful and approachable. The families we spoke with had regular contact with the registered manager.

People told us they felt safe, and we found that the registered manager had a number of systems and processes in place to promote safety. Staff received training in and understood their responsibilities in relation to safeguarding vulnerable adults. Staff were knowledgeable about how to recognise and report abuse. We saw risk assessments in place regarding risks associated with people's care. These explained how people's care should be delivered in a safe way and how to reduce any risks involved.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people were deprived of their liberty applications had been appropriately made. For people who were assessed as not having capacity, records showed that their advocates or families and other health professionals were involved in making decisions in their best interests.

Staff had been recruited appropriately to ensure they were suitable to work with vulnerable adults. People who lived at the home, families and staff told us there were sufficient numbers of staff on duty at all times.

Staff knew how to meet people’s needs. Records showed they had a thorough induction and on-going training to help ensure they had the skills and knowledge they needed to provide effective care. We saw staff received regular supervision as part of their on-going development. This provided an opportunity to discuss their work, any concerns and any training opportunities they may have. We saw appropriate records were maintained to show these had taken place.

We looked at the way in which the home managed people’s medicines. Medicines were secured safely and accurate records were maintained. Staff received regular competency assessment checks to ensure the on-going safe management of medicines. Safe systems were in place to manage medicines so people received their medicines at the right times.

People and their relatives were involved in planning and agreeing how they were cared for and supported. Care was planned to meet people’s individual needs, abilities and preferences. The care plans were person centred and contained detailed information, setting out exactly how each person should be supported to ensure their needs were met. Care plans were reviewed regularly.

People told us they were satisfied with the meals. We saw that people were offered a nutritious and balanced diet which met their needs. People had a good choice of food and were served drinks and snacks in-between meals. We observed lunch being served and some people required assistance from staff to eat their meals. This was provided in a caring and unrushed manner.

Risks to people from malnutrition were minimised because people were offered meals that were suitable for their individual dietary needs and met their preferences. For example, where people had been assessed as being at risk with regards to their nutrition, we saw appropriate referrals were made to Speech and Language Therapy (SALT) and pureed diets were then provided. Staff ensured people obtained advice and support from other health professionals when their health needs changed. We saw care plans showed when professionals had been involved in people's care and referrals were made to other professionals when required.

People and relatives were asked for their views about the care provided and informed how to make a complaint or raise any concerns. These were acted on and used to make improvements for people's care when required.

The registered manager’s quality monitoring system included regular checks of people’s care plans, medicines administration and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence.

We made one recommendation to the provider to ensure on-going commitment to the refurbishment of the home.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was safe. There were plenty of staff on duty to meet people's needs. Staff personnel records showed that the home only employed people once all the appropriate checks and safeguards were in place. This meant that the home had taken reasonable precautions to ensure that they only employed people with good reputations.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager was taking advice on how the recent Cheshire Judgement will affect the people living at Burnside.

Is the service effective?

Relatives told us that they were happy with the care that their loved ones received and felt that their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One relative told us "The staff know (my relative)'s every day needs and if I am not happy I say and they sort it out."

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. We observed that people were supported to do things at their own pace and were not rushed. We saw that staff explained to people what they were doing as they did it. That way people were not scared by what was happening. Visitors told us "The girls are really caring, they love the people they are looking after." And "The staff are loving and caring." One member of staff said "I love it here, I like to go and have a chat, I see them as people, it's not just a job here."

Is the service responsive?

People's needs had been assessed before they moved into the home and these were regularly reviewed by the manager. The care files contained information about people's care and support needs as well as information about the things that were important to them. We saw that the home provided various activities to stimulate and entertain people. Families and friends were encouraged to visit and, where appropriate, to bring their pets to visit.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. We saw a customer satisfaction survey had been carried out in March of 2014 and as a result the main communal areas had been redecorated. The manager told us that the home's owner was responsive to requests for essential items of equipment etc. and said that they were "very good." The manager themselves had worked for the home for many years, starting as a carer and progressing to becoming the manager, so they had a good understanding of all aspects of the home.

On this inspection we found that improvements had been made.

We saw that people's care plans had been re-written to include more information about the impact of dementia on each individual and the support they needed. We saw clearer guidance for staff on how to support people, including people in distress. Records and policies had all been updated and reviewed to reflect current practice. The home had also put in place a clearer process for recording decision making and what to do if the person lacked capacity to make decisions themselves. Senior staff had received training and taken advice from specialist practitioners with regard to the Mental Capacity Act 2005 (MCA).

However, on our inspection we found that the service was not considering people's capacity to consent to care and treatment or to put in place best interest decision making processes to protect people's rights. We also found concerns over some poor record keeping, assessment and delivery of care. We found that some polices and procedures were out of date. We found the care planning systems did not identify or give clear instructions to staff on how to manage behaviours that were challenging.

We found the home was clean and free from odours and that people understood how and to whom to raise any concerns about their care or the home.

We looked at five care files. These were well organised and easy to follow and all care plans had been regularly reviewed. The files contained a Residents Profile which had a summary of key details including things that were important to the person, such as 'loves interaction with staff'.

During our visit we saw a care worker giving a person their tablets. Before giving the tablets they told the person that 'the GP had prescribed the tablets and reminded the person that they had their tablets every day'. This helped the person to understand what was happening to them and why.

Staff we spoke with told us that in normal circumstances there was sufficient staff to meet people's needs as identified in their care plan. One carer told us that in normal circumstances they had time to 'play games with the person, do their nails or their hair'.

There are a number of systems in place to assess and monitor the quality of care provided. One relative we spoke with told us that they 'could not think of anything bad to say' and 'were happy with everything they had seen'.