Burman House

Burman House provides residential care for up to 25 older people some were living with dementia. At the time of our inspection there were 13 people using the service. Burman House is a single storey building. There were a number of fully accessible lounges, a large dining room and although rooms were not ensuite there were sufficient bathrooms and toilets.

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

People spoken with were happy at the service and felt safe. They were supported by staff who were familiar with their needs and there were consistent numbers of permanent staff.

Effective recruitment procedures were in place to ensure only suitable staff were employed to work with people using the service. Staff were sufficiently trained and supported by the management team who told us they liked to recognize and acknowledge when staff were working well and praise their staff team.

People’s care needs and any risks associated with their care were clearly documented and we observed staff following the care plans and providing safe care. Assistive technology was used appropriately to enhance people’s care and alert staff to when people at risk of falls were mobilising. This helped to reduce the number of falls.

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.

We observed high standards of cleanliness throughout the home and staff had a good understanding about how to reduce the risk of cross infection. Domestic staff vacancies were being recruited to and there was to be an overlap to ensure deep cleaning could be undertaken.

There was clear guidance as to how people liked to take their medicines and any risks associated with their health and how medicines were prescribed to help manage their symptoms. Where medicines were prescribed as required there was clear guidance in place and staff were medicine trained and assessed as competent.

All relatives spoken with were happy with the service and felt their family member was safe. The management team were knowledgeable and supportive of their staff. Audits helped to ensure that the service was being managed appropriately and equipment was tested and safe to use.

There was a positive working environment where staff and people using the service appeared to get on well and enjoy each other’s company. People received person centred care.

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 Good (published 16 May 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of Safe and Well-led.

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 has remained Good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last inspection of 3 May 2016, the service was rated Good. At this inspection, we found the service remained Good.

There was a Registered manager in post, however they had recently applied to cancel this registration. This was because they had recently been appointed to another Registered manager position at one of the providers other registered locations. 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. At the time of our inspection, a registered manager from one of the providers other locations had recently started in the position of manager at Burman House, and had applied to the Care Quality Commission (CQC) to become the Registered manager.

People received support to take their medicines safely. Staff knew how to keep people safe from the risk of harm. Actions had been taken to reduce risks to people’s safety. There was enough staff to keep people safe and meet their needs. People’s medicines were managed safely.

Staff were competent to carry out their roles effectively and had received training that supported them to do so. People were supported to eat freshly prepared meals, and their individual dietary needs were met. People were able to access and receive healthcare, with support, if needed.

A programme of refurbishment was underway, which included redecoration and replacement of flooring. This had enhanced the environment positively, and improved safety for people with limited mobility.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were kind and compassionate in the way they delivered support to people. People were treated with dignity and respect. Staff ensured that people were able to have visitors, and enabled people to maintain relationships with relatives and friends who did not live nearby.

People and their relatives were confident that they could raise concerns if they needed to and that these would be addressed. People were able to access a range of activities which they enjoyed.

The manager ensured that the home was well run. Staff were committed to the welfare of people living in the home.

Further information is in the detailed findings below.

We carried out an announced inspection of this service on 3 May 2016 following concerns about how medicines were managed.

At the time of this inspection 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. The registered manager is also a director of the company who are registered as the provider of the service.

This report only covers our findings in relation to the key question of whether the service provided safe care. We previously carried out a comprehensive inspection on 6 October 2015 at which we rated the service. You can read the report from 6 October 2015, by selecting the ‘all reports’ link for ‘Burman House’ on our website at www.cqc.org.uk. We have not changed the rating for the key question of safe in this report and will return to carry out a comprehensive inspection at the home at which we provide an update rating.

We found during this inspection that the provider was effectively managing medicines and administering them in a way which reduced the level of risk.

There was information to support staff with individual’s medicine requirements, however some of these were found to be out of date and in need of renewal.

Staff had received training around medicines however some individual’s competencies had not been observed for a period of time and was in need of renewal.

We looked at how information in medication administration records supported the safe handling of their medicines. Overall improvements were found in the quality of record-keeping that enabled people's medicines to be accounted for, which assured us they were being administered as prescribed., However, we found a number of medicines that had not recently been administered because they had been unavailable at the home and had not been obtained. We noted there to be improvement in the information available about people's medicines for staff to refer to when administering them their medicines. Although, we also noted that some risk assessments about people's medicine administration were in need of more frequent reviews. We noted that staff handling and administering people's medicines had received training and had been assessed as competent to undertake medicine related tasks.

Below is a summary of what we found.

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

Is the management of people's medicines safe?

The management of people's medicines was not safe. There were gaps in some of the records of medicine administration so we could not be assured people's medicines were being given to them as intended by their prescribers.

There was a lack of written information about the use of people's medicines for staff to refer to when administering medicines to people. This meant that there was a risk that staff could give them to people incorrectly.

Records did not confirm that medicines requiring refrigeration had been stored at appropriate temperatures. Therefore it was not clear that they were safe to use.

We noted that staff handling and administering people's medicines had received training and had been assessed as competent to manage people's medicines.

Below is a summary of what we found.

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

Is the service safe?

People told us they felt safe and we found that procedures were in place that protected people from abuse. One person said, 'I feel safe and have no problems.' Staff told us they enjoyed their work and were appropriately trained. Risk assessments were reviewed and updated regularly to ensure that people's needs were met safely.

Is the service effective?

We observed a good rapport between staff and people who used the service. The five staff we spoke with demonstrated a good understanding of people's individual needs. Care plans were up to date and a range of health care professionals were accessed when required. One person told us, 'Everyone looks after you and if you want anything, you have just got to ask.'

Is the service caring?

We saw that people were supported by staff who were kind and respectful. One person commented, 'The staff are really nice. They are all so kind.' Care records showed that people's individual choices were noted and followed. One relative told us, 'X is kept lovely and clean.'

Is the service responsive?

People received an assessment prior to living at Burman House and care records included detailed information about people's needs and preferences. We saw that care was provided in a way that was intended to ensure people's safety and welfare. Staff were not rushed and spent quality time with people during the day.

Is the service well led?

The provider had a number of systems in place to ensure that the quality of the service was regularly assessed. For example, people and staff were asked for feedback about aspects of the service every year and at regular meetings. Staff demonstrated knowledge of their roles and responsibilities. There was evidence that the provider took action to improve the service when this was required.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

People received an adequate standard of personal care and were provided with social activities to maintain and promote their sense of well being.

The safety of people who used the service was promoted due to the improvements made to written information that guided members of staff in how to appropriately meet people's individual support and health care needs.

There were improvements made to ensure that people were safe from the unsafe usage of their prescribed medication. This was due to improved competency and supervision of members of staff. Improvements also had been made regarding the recording of controlled medication received into the home.

All of the people who used the service said that they were very happy living at Burman House. However, improvements were needed in assessing and planning support, care and treatment of people's more complex health care needs.

All of the people we spoke with were satisfied with the support they received with their medication. Nevertheless, improvements were needed to ensure that people were protected from unsafe management of medication.

People who used the service said that there were always enough staff on duty at all times. There were a sufficient number and grades of staff available to safely and appropriately meet people's support, care and treatment needs.

All of the people that were spoken with had high praise about the staff. Staff were trained and supervised to do their job. However, improvements in training opportunities could be made to include assessing and care planning and the health management of a person living with (sugar) diabetes.

There were opportunities created for any person to make a comment, concern or complaint. All of the people that were spoken with had no cause to make a concern or complaint because they were very satisfied with the standard of the service provided.