Background to this inspection
Updated
7 April 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This was an unannounced inspection and took place on the 7, 8 and 9 March 2016. The inspection team comprised of two adult social care inspectors and a pharmacist inspector.
Prior to our inspection, we contacted the local authority commissioning and safeguarding teams and also the local clinical commissioning group (CCG) to seek their views about the service. We also considered information we held about the service such as notifications sent to us by the provider of any incidents or any events within the home.
We asked the provider to complete a Provider Information Return (PIR) prior to this inspection. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
We spent time talking with thirteen people who used the service and seven relatives. We spoke with the registered manager, the new regional manager, the finance manager, the clinical service manager, three house managers, two nurses, three senior care staff and ten care staff which included three staff who covered nights.
We also spoke with the maintenance person, the housekeeping supervisor, the new chef, a housekeeper and a hostess. We looked around parts of the building, observed how people were being supported and cared for, looked at twelve people’s care records, staff training records and rotas as well as information about the management and conduct of the service.
Updated
7 April 2016
This was an unannounced inspection carried out on the 7, 8 and 9 March 2016. We last carried out a routine inspection on 8, 9 and 27 April 2015 when we found four breaches in the regulations that we reviewed which related to, staffing levels, medicines management, control and prevention of infection and provision of food and drink. At this inspection, we found that breaches had been met or plans were in place to make improvements.
Burrswood House Residential and Nursing Home is registered to provide accommodation and support for up to 125 mainly older people. The home is a purpose-built, two storey building which comprises of four separate houses.
On the first floor, Dunster House provides general nursing care and Crompton House provides residential social care. On the ground floor, Peel House provides nursing care for people who are living with dementia who also have complex mental health needs and Kay House, which provides residential care to people living with dementia care.
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 2008 and associated Regulations about how the service is run. The registered manager was present throughout our inspection.
We saw improvements had been made in relation to medicines management, infection control and staffing. We saw that improvements had been made to food and nutrition arrangements with further improvements being agreed with the regional and finance managers during our inspection.
We found that all four houses were clean and clutter free and no malodours were detected. A person who used the service said, “They clean my room every day and do my laundry. They do a good job.” Relatives said, “[Relative’s] bedding is always clean. They are always cleaning,” and “It’s a lovely home. It’s been painted and always clean and tidy.”
There had been a reduction in staff sickness levels and therefore the use of agency care staff had ceased. This helped to ensure that people were provided with consistent care, treatment and support by staff who knew them well. Staffing arrangements at the home had improved by changes being made to the rota and an increase in staffing at busy times of the day. Additional staffing was also agreed to help support people who needed additional help to eat their meals.
People told us, “The food is very good,” “It’s lovely,” “I like the sweets,” and “If we don’t like it then we can have something else. They make sure my wife when she visits can have a meal with me in the dining room. You can have anything you want at the drop of a hat!”
The staff we spoke with told that they had received safeguarding adults training. They were all able to inform us what they would do should they find that abuse was taking place. Staff members said, “I know the Speak Up number and I would use it” and “I would not hesitate to speak to [the house manager and registered manager] and they would definitely take action.”
We saw that the required checks had been made when employing new staff. This helped to ensure that people were kept safe from potential staff who were unsuitable to work with vulnerable adults.
A major refurbishment program had been completed to make improvements to the home. This included people’s bedrooms being redecorated, new carpets being fitted and new bedroom furniture. There was also a new lighting system, new radiators and a new ‘nurse call’ system had been fitted. Further work was planned to take place to improve the dining experience of people who lived with dementia on Peel House and Kay House. A quiet lounge with a seaside theme was also in progress of being developed on Peel House.
A pre-admission assessment was undertaken with the person and their relatives if appropriate before agreement was reached to provide care and support was reached. This helped ensure the person’s needs could be met by the service. At the time of this inspection, the registered manager had agreed to stop new admissions to Peel House. This was so that the new house manager, a registered mental health nurse, could review all the people who lived with dementia and had complex needs that on occasion challenged the service.
The registered manager and staff we spoke with were able to demonstrate their understanding of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. When necessary applications had been made to the local authority, to lawfully deprive people of their liberty so that their rights were protected. Staff were aware that some people’s capacity could fluctuate and this was reflected in their records.
People received the care and treatment they needed from a range of healthcare professionals. The service was taking part in a research project with a local university in the prevention and management of pressure ulcers.
We found that the atmosphere at the home was relaxed and friendly and interactions observed between people who used the service and staff were pleasant and polite. We saw there was plenty of fun and good humour. One person said, “If I have to be anywhere I would be here.”
People who used the service said, “It is brilliant here. They have got me on my feet,” “Every one of these girls are brilliant. [The house manager] is fantastic, very caring”, “I get on with the staff. They are very kind” and “I am so happy here. I am so grateful for what they have done. I love them they are like my family.”
People’s care plans and monitoring records were regularly reviewed and updated so that people’s current and changing needs were clearly reflected.
We looked at what activities were provided by the service. One person said, “We had a guitarist recently. He was brilliant.” Other people told us that they preferred to keep to themselves. One person said, “I like to watch football in my room on Sky with my friend.”
A relative told us, “There are garden parties and there is always a cake for people’s birthdays. They have a cinema man comes in. It was Seven Brides for Seven Bothers last week and music man before Christmas and singers booked for April.”
Systems were in place to show the service was under constant monitoring and review.
People who used the service spoke positively about the registered manager and the house managers. They said, “[Managers] have always got time for you” and “[The registered manager] is brilliant. All the improvements she has made here.”
Relatives we talked with spoke highly about the registered manager, who with the support of the staff, had made many improvements since she had been at the home. Relatives described the registered manager as, “First class”, “On the ball”, “The buck stops with her” and “5*.” Some relatives we spoke with talked about the atmosphere at the home. They said, “Two of our relatives have stayed here. It feels like a community. We are made to feel welcome by staff from the minute we enter the home to wherever we visit.”