Burnham House

Burnham House is a residential care home providing personal care to people with learning disabilities and/or autism. At the time of the inspection there were six people living at the service. The service can support up to eight people.

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

The service didn’t always apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons. People had lack of choice and control around the décor of their home.

We found that individual risk was not always assessed, and people were not protected from the risk of harm associated with the maintenance of the service or the spread of infection.

Systems had been established to safeguard people from the risk of abuse. Medicines were being managed in a safe manner. There were enough staff working at the service and pre-employment checks were carried out on prospective staff. The service learnt from accidents and incidents to provide safe care and support.

The service did not always consult with people using the service about the adaption of their home.

Assessments were undertaken to determine people’s needs before they moved into the service. Staff received training to support them in their roles. Staff were provided with ongoing support through supervisions and appraisals and received a thorough induction, to enable them to provide effective care and support. People’s nutritional needs were met, and they told us they enjoyed the food. People were supported to access relevant healthcare professionals. 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.

People told us they were treated in a caring manner by staff. People were involved in the planning and reviewing of their care. Staff understood how to support people in a way that respected their dignity, privacy and promoted their independence.

People received individualised care that met their needs. The care plans were person centred and discussed people’s protected characteristics. People were supported to engage in their local community and participate in activities of their choice. Information was provided to people in an accessible format. People told us they felt able to make a complaint and were confident that complaints would be listened to and acted on. Staff were equipped with the skills to provide end of life care to people.

The governance systems in place did not identify the shortfalls we found during our inspection.

People and staff spoke positively about the service and said it was managed well. There were processes in place to manage and monitor the quality of the service provided. The management team had regular contact with people using the service and their staff. The registered manager kept up to date with best practice to ensure a high-quality service was being delivered.

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 for this service was good (published 9 February 2017). The service is now rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service is registered to accommodate eight people with learning and physical disabilities. People are accommodated in a detached house which is suitably adapted to meet people’s needs. At the time of our inspection, the home was providing care and support to seven people.

The provider of the service is Consensus Support Services Ltd. The home has 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 2008 and associated Regulations about how the service is run.

People were safe at the service and were cared for by staff who were knowledgeable about safeguarding people and knew how to report concerns.

Medicines at the service were managed safely by staff who were trained and assessed as competent to administer medicines as prescribed.

The recruitment process was robust, to make sure that the right staff were recruited to keep people safe. Personnel records showed that appropriate checks were carried out before they began working at the home.

Staff understood how to gain consent from people who used the service. The principles of the Mental Capacity Act 2005 were followed when people could not make specific decisions themselves.

Staff were supported through regular supervision and received an annual appraisal of their practice and performance.

There were sufficient qualified and experienced staff to meet people’s needs. Staff received the support and training they needed to provide an effective service that met people’s needs. The staffing levels were flexible to support people with planned activities and appointments.

People received the care they needed. Care plans were person centred, but needed to be regularly reviewed and updated where relevant when people’s needs changed.

People were supported to have a varied and nutritionally balanced diet to promote their health and wellbeing.

People were supported to see specialist healthcare professionals according to their needs in order to ensure their health and well being were adequately maintained.

People were looked after by staff who understood their needs, were caring, compassionate and promoted their privacy and dignity.

A pictorial complaints procedure was available. People’s relatives were made aware of the complaints procedure and they knew who to speak with if they had any concerns.

Systems were in place to evaluate and monitor the quality of the service. However, improvements were needed to ensure there was continued monitoring of the progress made, where actions were identified.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found.

Is the service safe?

We met all of the seven people who used the service and observed how they were supported by the staff. After the visit we spoke to four people's relatives and one social care professional. We saw that staff treated people with respect and dignity. Relatives told us that they were satisfied with the service provided. They said people were safe there. One relative told us 'yes I always feel that X is safe there.'

We found that staff were properly recruited and checked to ensure that they were suitable to work with vulnerable adults.

People's individual files indicated the risks to the person and how these could be minimised to ensure that they were supported as safely as possible.

The home had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). There were not any DoLS in place. Staff had received MCA and DoLS training and were aware of the process to follow when in some circumstances decisions needed to be made in a person's best interest.

Is the service effective?

Care and treatment was planned and delivered in a way that was intended to ensure

people's safety and welfare. A relative told us 'X has come a long way since they moved into Burnham House and their behaviour continues to improve.'

Each person had a current health action plan which included a record of medical appointments and outcomes and any other health issues. There was a stable staff team and they were able to recognise if people were unwell or in pain and took the necessary action.

People's care needs were assessed and detailed plans of care developed from these. Staff had a good understanding of how to meet people's individual and assessed needs and of individual preferences.

Is the service caring?

Relatives we spoke with were satisfied with the care provided by the staff team. One relative told us 'they take care of all X's needs and X is happy there.' Another said 'I am sure that they are doing what they can for X.'

We saw that staff supported people in a caring and respectful way. They offered people choices and talked to them about what was happening or what they needed to do.

People's preferences and diverse needs were recorded and care and support was provided in accordance with this. Their religious, cultural and social needs were identified and addressed. One person went to church and another was not given any pork or pork products to eat. People were also supported to be part of the wider community. For example some people attended local colleges.

Is the service responsive?

Care staff we spoke with were knowledgeable about the needs of people they supported and how to meet them. They told us how they identified if a person was unwell or unhappy and the action that they took if this occurred. For example, one member of staff said 'if X is not well they are very quiet or want to stay in their room. We then need to go through all the possibilities and take them to the doctor.'

The service was responsive to people's changing needs and wishes. We saw that care plans included information about people's likes, dislikes and preferences and were evaluated monthly to ensure that they had correct information about people's needs and how these should be met.

Is the service well led?

The service had a registered manager in place and a clear management structure. Staff we spoke with said they felt the home was well managed and that they received the support and guidance that they needed to carry out their duties and to meet people's needs. One member of staff told us 'the home is well managed. The manager makes sure that it is run well.'

The provider had a number of different quality assurance systems in place to enable them to effectively monitor the quality of care provided. For example, a senior manager visited monthly to monitor the quality of the service and to check that any identified issues had been addressed.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Staff were aware of issues around mental capacity and how to work with people who may not be able to consent to some aspect of their care and support.

People experienced care, treatment and support that met their needs and protected their rights. They were able to follow their interests and accessed a wide range of meaningful activities.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

A relative told us, 'it's brilliant, my sister settled in immediately. It's the best place she's been in'. Staff said how they loved [working in] the team. They said people were achieving what they had aspired to.

The standard of support and care provided was good. People's diverse needs and interests were respected and people were supported to be as independent as safely possible. People were supported to remain safe.

Whilst the staff felt well supported and worked together well, the provider did not have an adequate supervision and appraisal system in place.

The provider was not ensuring timely repair of appliances and replacement of worn out furnishings.