Archived: Burrswood Care Home

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.”

After the inspection we made a compliance action requiring the provider to tell us what they were going to do to ensure that at all times, sufficient numbers of suitably qualified, skilled and experienced staff were provided. Following the inspection the provider sent us an action plan telling us what steps they were going to take to make the necessary improvements.

During this inspection we found that improvements had been made. Sufficient staff were provided to meet the needs of the people who used the service. All four units had sufficient skilled and experienced staff on duty.

People we spoke with told us, 'No problems here. I am quite happy' and 'There is nothing to be bothered about'. One person spoke very highly of the staff's kindness and attitude and told us they felt there were enough staff to look after them safely

Staff told us they felt there had been a big improvement in the staffing provided. Comments made included; 'Things have greatly improved. It is 100% better' and 'The new manager is certainly on the ball when it comes to sorting out staffing. She is definitely putting things right. She is fantastic'.

We considered all the evidence we had gathered under the outcome we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service caring?

' Is the service effective?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on observing how people were being cared for, speaking to people using the service, speaking to staff and looking at records.

Is the service safe?

There were not enough staff on duty to meet the needs of the people using the service. People who were at risk of falling out of bed and were calling for help were left for long periods of time until staff could assist them.

Inadequate staffing resulted in medicines not always being given at the time they were prescribed. The health and welfare of people living in the home is at risk of harm if their medicines are not given at the times they are prescribed.

One person we spoke with, who had a pressure ulcer and was waiting to go to bed at 23:45 hours, told us, 'I am ready for a rest'. We were made aware they had been sitting in their chair for a long period of time. Prolonged periods of pressure on the body can put the health and welfare of people at risk of harm.

Is the service caring?

The staff we spoke with had a very good understanding of the needs of the people they were looking after. We saw staff worked hard to try to meet people's needs. The staff were kind, patient and attentive.

Is the service effective?

A discussion with the staff showed that people's needs and preferences were assessed and discussed before they were admitted to the home. Following the assessment a care plan was put into place to show how those needs and preferences were to be met. We were made aware that, due to inadequate staffing, some people were denied choice in some aspects of their care; such as rising and retiring to bed.

Is the service responsive?

Management did not respond to the concerns expressed by staff when it was identified there were not enough staff on duty to meet people's needs

Is the service well led?

Management did not take into account people's care needs when making decisions about the number of staff required to ensure people's needs were met.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that, at all times, there are sufficient numbers of suitably qualified, skilled and experienced staff on duty to meet people's needs.

The people we spoke with told us they were happy with the care they received and that they were looked after well. They also told us they chose the times they went to bed or woke up in the morning and that the staff respected their wishes.

We found that people were asked for consent and the provider acted in accordance with people's wishes. People received care in a way that met their needs and preferences.

The people we spoke with told us they felt the home was clean and safe. We found the environment and equipment in the home to be clean, safe and well maintained.

The people we spoke with told us they were happy with the staff. They told us the staff were friendly and helpful. Two people told us they felt more staff were needed, especially during busy periods, such as mornings and lunch times. We found that there were enough qualified, skilled and experienced staff and the provider was in the process of recruiting additional staff to fully meet people's needs.

The people we spoke with told us they had no concerns about the services they received and were confident they could speak to the staff if they had any concerns. We saw that there was an effective complaints system available, in case anyone wished to raise a complaint.