Burton Cottages

Updated 23 July 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

This was a focussed inspection. It was completed to check whether the provider had met the requirements of the last inspection.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of one inspector.

Service and service type

Burton Cottages is a ‘care service’. People in care services 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 had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 72 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

We reviewed the information we held about the service and the service provider, including the previous inspection report and the action plan supplied by the provider. We looked at notifications we had received for this service. We sought feedback from the local authority and professionals who work with the service. Notifications are information about important events the service is required to send us by law. We used all of this information to plan our inspection.

During the inspection

Most people were not able to share their views of the service due to their complex communication and support needs. Therefore, we observed their experiences living at Burton Cottages and staff interactions with them. We spoke with the registered manager, and three staff members.

We reviewed a range of records. This included two people’s care records and everyone’s medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service, including audits, health and safety files and policies and procedures were also reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at staff rotas, training data, surveys and quality assurance records. We were in contact with the organisation’s recruitment team and estates team. We received feedback from six people’s relatives and two health and social care professionals.

Updated 23 July 2021

About the service

Burton Cottages is a residential care service providing personal care and accommodation for eight autistic people. The service can support up to nine people. The building was split into two cottages that were joined in the middle by an office. Four people can live in one cottage and five in the other.

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

A new manager had been appointed in January 2021 and was recently registered with CQC. He told us there was a lot of work required to improve the service. There were staff vacancies, sickness and a high use of agency staff. There were often not enough staff on duty in the afternoons to meet people’s needs. The building needed refurbishment. There was limited assessment of people’s ability to make decisions around their care needs.

The organisation had systems to monitor the service and they held regular meetings with the registered manager and the regional area manager to monitor progress with their action plan. However, we found that when areas were signed off as having been addressed, there was a lack of monitoring to ensure that progress had been maintained.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

The model of care and the layout of the setting had been maximised to ensure people had a choice in where to spend their time. However, some areas lacked personalisation and the building was in need of redecoration. There was a lack of dignity in that there was a mixture of ceramic and melamine crockery and no assessment of who needed each so people had no choice and were given melamine when they could use ceramic. There was a lack of clear guidance to ensure some people’s needs were met in a person-centred way. The registered manager told us following the inspection that a referral had been made for one person to assess their capacity to understand an aspect of their care needs. We were reassured there was a programme of redecoration in place.

Right care:

There were staff vacancies, staff sickness and a high use of agency staff. The service tried to ensure that people received support from staff who knew them well as individuals. Most of the agency staff used were staff who had worked at the service regularly and knew people well. People's care and support needs were assessed and reviewed regularly. Improvements were being made to ensure that care was more person-centred but further work was required to achieve this.

Right culture:

People were supported to pursue their own interests. Some attended day centres throughout the week. Staff supported others to take part in activities of their choice to meet their individual needs and wishes. This included swimming, using the local shops, walking trips and drives to places of interest. It was not evident people had as many choices in the afternoons or evenings for activities due to staff levels.

Surveys completed by the organisation following our inspection showed a mixed response. Staff were unhappy with the sickness and shortage of staff but very happy with the support they received from the registered manager. Relatives also raised issues with the use of agency staff and with the phone not being answered at weekends. However, relatives also felt that communications with their relatives’ keyworkers was good, and they were very thankful for the support and care provided during the pandemic.

The service was clean and tidy throughout. Enhanced cleaning had been instigated as a result of the pandemic, staff had received additional training and the service had a visiting procedure that complied with government guidance.

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 last rating for this service was requires improvement (published 20 December 2019). There were no breaches of regulation. At this inspection the service remains requires improvement and we found multiple breaches of regulation. This is the third time the service has been rated requires improvement.

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. This enabled us to review the previous ratings.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.