The Burroughs

The Burroughs is a care home for up to 75 older adults, some who are living with the experience of dementia. At the time of our inspection 67 people were living at the service. The service is managed by Care UK, a national organisation providing care services in the UK.

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

People explained they were well cared for at the service and their needs were met. They liked the staff, who were kind, considerate and polite. There was a wide range of leisure activities being offered and people were able to join these if they wanted. People were offered choices and these were respected.

There was enough to eat and drink and meals were freshly prepared at the service each day. There was a choice at mealtimes and different cultural and specialist diets were catered for. The staff monitored people's weight and made sure they stayed hydrated.

The staff worked closely with other healthcare professionals to monitor and meet people's healthcare needs. Visiting nurses offered daily support to people and the staff made referrals to other healthcare professionals when needed. People received their medicines in a safe way and as prescribed.

There were suitable procedures for recruiting, inducting, training and supervising staff. Staff felt supported and were able to discuss any concerns they had with their manager. There was good communication and team work. Senior staff were involved in training other staff, which included 'experience' training where the staff experienced receiving a number of care interventions so they could understand how it felt to receive care.

There were appropriate systems for safeguarding people from abuse, dealing with complaints, accidents and incidents. The staff had been proactive in working towards reducing accidents and falls.

People's preferences and needs had been assessed. Care plans were developed to describe how they should be supported. The provider operated a 'resident of the day' system where staff reviewed people's needs each month – involving the person, their family and all the departments in the service to identify if any changes were needed to their planned care. The risks to people's safety and well being had been assessed, planned for and monitored.

The building was suitably designed and had some additional features to engage people and help orientate them. Some of the communal rooms had been refurbished to provide a theme, such as a coffee bar and a cinema. The building was clean and free from hazards. Equipment was well maintained and safe to use.

The provider had introduced a number of initiatives to improve the service, such as a 'wish tree' where people could request specific activities and treats.

People using the service, staff and visitors found the registered manager approachable and were able to raise concerns or ask for support if needed. There were appropriate systems for monitoring and improving the quality of the service, including regular visits and checks by senior managers within the organisation.

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.

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 rating at the last inspection was requires improvement (Published 20 February 2019). We identified breaches relating to safe care and treatment and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

The last inspection of the service was on 27 February 2018, when we rated the service 'requires improvement' for all key questions and overall. Following this inspection, we asked the provider to complete an action plan to show us what they would do to improve the service to at least 'good.'

At this inspection we found that they had made improvements, however some aspects of the service required further improvement.

The Burroughs is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is for up to 75 older adults, some people were living with the experience of dementia. The provider does not employ nursing staff and cannot meet the needs of people with complex nursing needs. At the time of our inspection 55 people were living at the service.

The service is managed by Care UK, a private organisation providing health and social care throughout the United Kingdom.

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 provider had not always monitored or mitigated the risks to people's safety and wellbeing. For example, we found risks within the environment, which included areas which were not clean and with access to electrical meters and wiring.

The provider's governance systems had not always identified and mitigated these risks.

Some of the support people received focused on the tasks the staff were performing rather than the needs and preferences of the people being cared for. However, we observed that staff interactions were kind and caring. The staff had a good knowledge of the people who they were caring for.

People liked living at the service. They told us their needs were being met and that they were able to make choices about their care and how they spent their time. People had good relationships with the staff, they trusted them and felt safe.

People were supported to take part in a range of different activities and fulfil their particular 'wishes' for special events. The staff had started to support people to be more involved in helping around the service, if this is what the person wanted, such as laying tables and dusting.

Care plans were sufficiently detailed and included information about the risks people were exposed to, people's preferences and how they wished to be cared for and the medical professionals involved in people's care. People had access to healthcare services and the staff worked with these professionals and followed their guidance. People received their medicines in a safe way. They had enough to eat and drink and made choices about the food they ate.

The staff were well supported. There were enough staff to meet people's needs. The provider's recruitment checks ensured they were suitable. The staff had access to training, support and information about their roles and responsibilities. There were appropriate systems for the staff to share information and work effectively together.

The provider had undertaken some work to promote an environment which supported people from the LGBT+ (Lesbian, Gay, Bisexual and Transgender) community. The staff had taken part in the London Pride march where they highlighted some of the issues for older people identifying as LGBT+. They had also had special events to celebrate diversity and encourage people to discuss their identity in a non-judgemental environment.

The provider had systems for monitoring and improving the quality of the service. There was evidence of improvements and the registered manager had introduced new ideas and initiatives which had helped to make the service better. People using the service, staff and other stakeholders were consulted about their views. The provider listened to people and acted on complaints. They learnt from incidents and accidents so that improvements could be made.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment and good governance. You can see what action we have asked the provider to take within our table of actions at the back of this report.

The last inspection of the service took place on19 April 2016 when we rated the service Good in all key questions and overall.

At this inspection we have rated the service Requires Improvement in all key questions and overall.

The Burroughs is a 'care home'. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide care for up to 75 older people in a single building. Accommodation is provided on two floors. The ground floor is for people living with the experience of dementia. The first floor accommodates older people who may or may not be living with the experience of dementia. The provider does not employ nursing staff. However, local community nurses work closely with the staff and have an office at the service from which they provide any nursing care which people need. At the time of our inspection there were 59 people living at the service.

The service is provided by Care UK Community Partnerships Ltd, part of Care UK, a national organisation providing health and social care.

The registered manager had left the service since the last inspection. There was no registered manager in post. The provider's representatives told us that they had recruited a manager who was due to start work at the service in July 2018 and that this person would apply to be registered with the Care Quality Commission. 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 provider was not always acting in accordance with the Mental Capacity Act 2005 because the assessments of people's capacity were not always reflected in the way their care was planned. People had not always been asked to consent to their care and treatment and the staff did not always understand their responsibilities under the Act.

The provider's systems for identifying and mitigating the risks to people's safety were not effective because they had not always checked that the environment was safely maintained or that risks had been fully assessed and recorded. The systems and processes for monitoring and improving quality had not always been effective in achieving improvements.

We found two breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to consent to care and treatment and good governance . You can see what action we told the provider to take at the back of the full version of the report.

The provider was not always meeting people's needs in a person centred way. For example, people's preferences in relation to personal care were not always being met. People were not always involved in reviewing how they were being cared for.

Some of the staff felt that improvements were needed in the way they worked effectively together as a team to deliver care to people because they felt communication needed to be improved and that not all staff were working the same way.

The provider had not employed a full time or permanent manager for the service. The registered manager of another similar sized home was working part time at both services and this meant that they did not always have enough time to embed the improvements which were needed.

People felt they were safe and well cared for. They liked living at the service and they had good relationships with the staff. The staff were kind and caring. They knew people well and wanted to meet their needs. Care was planned in a person centred way with enough information for the staff so they knew how to support people. People were asked their opinion about the service and felt able to raise concerns or make complaints.

The staff felt supported and had enough training and information to undertake their roles. There were enough staff on duty and they had been recruited in a suitable way.

There were procedures designed to keep people safe and protect them from abuse. People received their medicines in a safe way. The environment was clean and appropriately maintained. People had enough to eat and drink and they were supported to access healthcare services when needed.

The provider had systems for monitoring the quality of the service and identifying where improvements were needed. They undertook regular audits and there was evidence that they had taken action to make improvements when they found these were needed.

The last inspection took place on 22 September 2015 when we found breaches of four Regulations relating to the safe care and treatment of people, the deployment of staff, consent to care and treatment and good governance. At the inspection of April 2016 we found these breaches had been addressed and all Regulations were being met.

The Burroughs is a residential home providing personal care for up to 75 older people. Some people were living with dementia. The home is managed by Care UK, a national organisation. At the time of our inspection 62 people were living at the home.

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.

People told us they felt safe at the service.

There were enough staff on duty to meet people's needs and keep them safe.

The provider had appropriate systems and procedures to safeguard people.

The risks to people's wellbeing and safety had been assessed and there were plans for staff to help keep people safe.

The environment was appropriately maintained and safe.

People had the help they needed to take their medicines.

The provider asked people to consent to their care plan and other aspects of their care.

People were cared for by staff who were well trained and supported.

The staff gave people the support they needed to meet their nutritional needs.

People were given the support they needed to stay healthy.

The staff were kind, polite and caring.

People's privacy was respected.

People’s care needs had been assessed and planned for. People received care which met their individual needs.

There were a range of organised activities which met people's needs.

There was an appropriate complaints procedure and the people felt able to make complaints or raise concerns.

The service was appropriately managed and people found the manager professional and approachable. There was a positive culture and people felt the service was well run.

Records were accurate up to date and clear.

There were systems of audits and quality checks to make sure people were receiving a good service which met their needs.

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

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

People were cared for in a way which met their individual needs. There were enough staff employed and they were suitably trained and supported. People's individual needs had been assessed and were regularly reviewed. People's health and wellbeing was monitored. The risks which people experienced had been assessed and action had been taken to minimise risks. People said they felt safe and other professionals we spoke with told us the staff followed appropriate procedures. There was a record of all complaints and safeguarding alerts and these showed how concerns had been investigated and acted upon. The environment was well maintained and regular checks took place to ensure there were no hazards. We saw the staff made sure people used equipment appropriately so they could move around safely.

Is the service effective?

Generally people's individual needs were met. They told us they were happy and well cared for. One person said, 'they are really good here' and another person told us, 'the staff are marvellous'. They said that the staff knew them well and were kind and respectful. People were able to see healthcare professionals whenever they needed and they were supported to stay healthy. There was a choice of nutritious food and drinks. However, the provider had not always made arrangements for the people who had dementia. For example, there were not enough things for people to do when they did not want to take part in the organised activities.

Is the service caring?

People told us the staff were kind and caring. We saw the staff caring for people in a considerate way. They offered people discreet support and listened to people's wishes and choices. The staff made sure everyone looked well presented and dressed comfortably. They offered them drinks and food at regular intervals. However, some of the staff focussed on the practical tasks they were undertaking rather than the people they were supporting.

Is the service responsive?

People's needs were reassessed on a regular basis and they were involved in planning their own care. These needs had been recorded in care plans and we saw these had been followed. Where people had become unwell or there had been a change in their needs ' this had been recorded and acted upon. People living at the home and other stakeholders were asked for their opinions about the service and these were listened to.

Is the service well-led?

There were systems for monitoring the quality of the service. Where problems had been identified these had been put right. There were suitable procedures for recruiting and supporting the staff. The staff were aware of their roles and responsibilities. One member of staff told us, 'my role is to provide the best care, meeting their individual needs is paramount'. People living at the home and their representatives were consulted about their care and the service. Complaints, incidents and accidents were appropriately investigated and action had been taken when things had gone wrong.

People said they were being well cared for in the service. Comments people made included 'People here are very good (staff)' and 'The food and staff are lovely here.'

One visitor said 'I am very very pleased with the way they look after my (relative)' and another told us 'I feel like one of the family'.I cannot find a single fault.' One healthcare professional told us 'the home is very good and residents are well looked after'.

People's nutritional needs were being identified and met and systems were in place to identify any concerns and get professional input.

The previous inspection visit in February 2013 had identified a need to improve recording and investigation of bruises and unexplained injuries and the management of people's medicines. At this inspection we found action had been taken to improve in these two outcomes.

Staff understood safeguarding and whistleblowing procedures and knew to report any concerns. The service had a complaints procedure in place and people and visitors said they were confident to raise any issues.

Whilst the electronic care records were up to date, some paper care records were not, which could place someone at risk of not having their current needs met.

We found that people appeared well cared for. They said they were happy with the care and support they received. One person said 'they [staff] are very nice girls and look after us well'. A relative said 'They [staff] look after them [people] the best they can considering they [people] have demanding needs'.

People were supported to meet their healthcare needs but the arrangements to manage medicines were not always effective to protect people against the risks associated with medicines.

Staff took into account people's likes, dislikes and preferences when providing care to them. People's care records addressed their needs appropriately and were reviewed at least monthly. However, we found little evidence of people's or their relatives' involvement in the care planning process although staff assured us that this took place.

People's bedrooms were personalised and maintained. Some of the communal areas and fixtures and fittings were not in good decorative order but the provider had a plan to address these issues.

Skilled and experienced staff were provided to care for people. On a few occasions, their numbers might have fallen short of what should have been in place. Management had plans to review the number of staff at the home.

The provider had systems in place to monitor and assess the quality of the service.