This inspection took place on 6 June 2018 and was unannounced. The last inspection was in February 2017, where we found two breaches of regulation relating to medicines and governance of the service. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led to at least good. At this inspection in June 2018, we found improvements had been made and the service was no longer in breach of regulations.

Burgh House residential home is a ‘care home’. People in care homes receive accommodation and nursing or 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 care home accommodates up to 43 people in one adapted building. At the time of this inspection there were 34 people living in the service.

Short stays were also provided to people who required a period of reablement. The purpose of reablement is to help people who have experienced deterioration in their health and have increased support needs to re-learn the skills required to keep them safe and independent when they return home. The short stay beds were located in a separate unit called ‘Oak Lodge’ on the grounds of the site. Physiotherapists and occupational therapists supported the care and treatment people received during the period of reablement. The average stay for people receiving reablement was two to six weeks. Three people were receiving re-ablement at the time of our inspection.

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 2008 and associated Regulations about how the service is run.

Improvements had been made to ensure people received their medicines safely, and there was evidence of learning from incidents. Additional audits were put in place to monitor medicines systems, which were now overseen regularly by the registered manager.

Care plans had been improved significantly, and contained detailed assessments of people’s health and social care needs, and their hopes and wishes for the future.

A schedule of activities that people enjoyed were provided, and people were supported to pursue their hobbies and interests. However, we did observe that at times during the day some people were sat for long periods with no meaningful interaction from staff. We have made a recommendation that the service ensures it is meeting people’s individual and specialist needs on a day to day basis.

People were supported to remain comfortable, dignified and pain-free at the end of their lives. We found some care plans in relation to people’s end of life care could be more detailed to ensure the full scope of people’s wishes were known. The registered manager told us they were planning to implement the Gold Standard Framework for end of life care to improve current arrangements further.

People were safe because there were effective risk assessments in place, and systems to keep them safe from abuse or avoidable harm.

There was sufficient numbers of staff to support people safely. However, some feedback indicated that at certain times of the day more staff may be needed. However, the registered manager was monitoring this, and would adjust staffing levels accordingly if a need was identified.

Staff took appropriate precautions to ensure people were protected from the risk of acquired infections.

Staff had regular supervision and they had been trained to meet people's individual needs effectively.

The requirements of the Mental Capacity Act 2005 were being met, and staff understood their roles and responsibilities to seek people's consent prior to care and support being provided. They were supported to have m

This inspection took place on 22 February 2017 and was unannounced. Burgh House Residential Care Home provides accommodation and care for up 40 people.

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 2008 and associated Regulations about how the service is run.

This inspection found that there were two breaches the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We identified a breach of Regulation 12 which related to the safety of the arrangements in place to manage people’s medicines. We found considerable medicine stock imbalances that had been caused by several different issues.

We also identified a breach of Regulation 17. This was because the provider’s quality assurance systems had failed to identify the problems with the medicines management arrangements and issues we found in relation to care planning. These needed improvement to ensure that plans were in place to meet people’s individual health and care needs. Care records did not always contain sufficient guidance and information for staff. You can see what action we told the provider to take at the back of the full version of the report.

The service had a strong focus on meeting people’s social and emotional needs as well as their physical needs. This resulted in people having a positive experience of life at Burgh House. Staff went to considerable lengths to ensure that people could live their lives as they chose, that they were content and fulfilled. If any concerns were raised, these were minor in nature. They were looked into and resolved to people’s satisfaction.

There were enough staff to meet people’s needs. Staff were well trained and supported by their colleagues and service managers.

People received a choice of food and people’s preferences and special diets were catered for.

Staff were caring and had developed good relationships with people living in the home and their relatives.

There was pleasant, calm atmosphere in the home. People chatted happily between themselves and staff engaged well with them without being intrusive. There was plenty going on for people to involve themselves in if they wished.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

This inspection was unannounced. This meant the provider was not informed about our visit beforehand. When the service was last inspected on 10 June 2013, we found there were no breaches in the legal requirements for the areas we looked at.

Burgh House Residential Care Home is a home registered to accommodate up to 40 older people. On the day of this inspection 37 people were living at this home. It does not provide nursing care. There is a registered manager for this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

During this inspection we spent time talking to people who lived in the home who told us they felt safe and were well looked after. They all said they could not fault the service they were given and were happy living in the home.

Staff were recruited using safe procedures, they were regularly supervised and had annual appraisals. Most training was provided but some training was still to be given on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to ensure staff had the knowledge to act appropriately when assisting someone who may have limited understanding. Staff rotas were planned to ensure the correct level of staff. The provider had systems in place to ensure that there were enough staff to meet people’s needs and that more staff were available when the needs of the people living in the home were greater.

Care plans were in place to guide staff on how to meet the individual care needs of people. Risks had been assessed. However, some risks, such as monitoring people’s weights had not been completed and where concerns were found the monitoring and action that had not taken place.

Medication management was carried out using safe procedures. We observed administration of medication, recording of administration and safe storage of medication. People were protected against poor medication management.

Infection control procedures were in place to prevent the possible spread of infection with good hygiene practices followed.

People received choices and enjoyed the meals provided. Those we spoke with told us they had ample to eat and drink and had no complaints about the meals provided.

Relatives and visitors praised the home highly and said they could not fault the support, care and involvement the home gave to both the person who lived in the home and their families.

People who lived in the home were encouraged to be involved and active in the day to day life of the home. Many and varied activities were in place and people were asked their views on what activities they preferred.

Regular meetings were held with staff and people who lived in the home to regularly up date and bring about an ongoing improving service.

The manager’s style was open and transparent. Care and support was offered when it was needed. People were encouraged to be involved in the planning of ideas for the home and all staff were supported to develop their skills both for them and the home’s benefit.

A concern that may be seen as a safeguarding issue was acted upon quickly, thoroughly and concluded showing effective procedures were in place to ensure people were safeguarded.

During our inspection we spoke with five people who used the service and with the relative of another who was visiting at the time. We found from talking to people, observing staff during the day and looking at records that people who received any care or treatment were asked for their consent and that the provider acted in accordance with their wishes.

People we spoke with were happy with the care and treatment they received. One person told us, "It is a lovely place to live, everyone is so kind and they seem to know what I need all the time. If there is anything I want I only have to ask and they get it for me." Another person said, "The staff here all help me. I need some help to get washed and dressed but encourage me to do what I can for myself."

We spoke with four members of staff who told us that they were well supported, and we looked at a range of records which showed that the service kept accurate records relating to people who used the service, staff and the premises.

The service demonstrated a good working relationship with other providers both on a care and social basis as well as working together on training.

The 10 people we spoke with during the review told us that they were happy with the care and support provided at Burgh House. They told us that staff looked after them well and tried to keep them cheerful.

They told us that they were involved in the planning and review of their care. A relative of a person who was also spoken with confirmed this.

Two people told us they could make decisions about their care and support, for example one person still had their own car and were able to drive to the local shops.

The people we spoke with told us about the meetings they attended to talk about the service and how the service listened to their views and made changes.

During this visit to the service eight people were spoken with. Five people who live at the service and three visitors.

All the comments confirmed that they were happy and satisfied that Burgh House was an 'open and positive' place to live.

They confirmed that the care they receive is 'second to none' and there are a variety of useful and meaningful activities offered, including learning new skills with the computer.