The service was registered to provide accommodation and personal care for up to 15 people. At the time of our inspection on 27 April 2017 15 people were using the service. At the last inspection in November 2015, the service was rated Good. At this inspection we found that the service remained Good.

People continued to receive safe care because staff understood how to protect them from avoidable harm and abuse. People’s medicines were managed safely to ensure they received their treatments at the right time and in the prescribed way. Staff’s suitability to work with people was checked before they were able to work in the home.

The care and support that people received continued to effectively meet their needs. People were provided with choices and when necessary they were supported by staff with their decision making. People were able to choose the food and drinks they enjoyed and were supported to have a sociable mealtime. When necessary people were referred to other healthcare professionals and staff followed the guidance they were provided with.

People’s experience of care remained good. Staff provided kind and compassionate care. People enjoyed the company of staff who protected their dignity and privacy. Relatives were welcomed into the home and supported to spend time with their relations.

Staff continued to respond to people’s needs. People were supported to spend their time as they wanted and staff respected their choices. Staff asked people about information that was important to them to ensure they received care in the way they preferred. People were encouraged to raise concerns or complaints and felt empowered to do so.

The service remained well-led. People and staff were given opportunities to learn about changes in the home which might affect them and were asked to share their feedback. The quality and safety of the service was monitored regularly. The registered manager understood the responsibility of registration with us.

Further information is in the detailed findings below

We carried out an unannounced comprehensive inspection of this service on 03 October 2014. A breach of legal requirements was found. This was because legal requirements were not always followed when people’s liberties were restricted. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 11 (Need for consent) of the Health and Social care Act (Regulated Activities), Regulations 2014. During that inspection we also found that staff did not always take appropriate action when people were at risk of abuse and the provider did not have effective systems in place to regularly assess and monitor the quality of services provided.

We undertook this follow-up inspection to check that they had followed their plan and to confirm that they now met legal requirements, and we found that these actions had been completed. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

We inspected Burleigh House on 30 November 2015 and the inspection was unannounced. The provider is registered to provider accommodation and personal care to a maximum of 15 people. They are not registered to provide nursing care. At the time of our inspection, 15 people used the service.

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 ensured that people who did not have capacity to make certain decisions about their care and well-being had mental capacity assessments in place to guide staff on the decisions that could be made in their best interest. The legal requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of liberty Safeguards (DoLs) were followed when people’s liberties were being restricted for their safety.

People told us they felt safe and protected from harm because staff looked after them well. Staff we spoke with demonstrated a good understanding of safeguarding and abuse and knew what actions to take if abuse was suspected. The provider took appropriate action to report safeguarding concerns to the local authority and to notify us of these.

People had risk assessments and management plans in place which were viewed regularly and updated when their needs changed. Environmental risk assessments were carried out to ensure that people were kept safe when they accessed the environment.

The provider had effective systems in place to regularly assess and monitor the quality of services provided. Risk assessments identified potential environmental risks to people who used the service and action was taken to ensure that the risks were removed or minimised.

People who used the service and professionals who visited the service and staff were very complimentary about the registered manager. They told us the registered manager was always available and approachable. We observed that the registered manager had a hands-on management style. The registered manager notified us of events and incidents they were required to notify us of.

We inspected Burleigh House on 3 October 2014. Burleigh House is a residential home, registered to provide accommodation and personal care to a maximum of 15 people. At the time of our inspection, 13 people used the service.

At our last inspection in April 2014, the provider was not meeting the essential standards of quality and safety. This was because where people did not have the capacity to consent to their care; the provider did not act in accordance with legal requirements. At this inspection, we saw that improvements had been made to ensure that people consented to the care they received. People who used the service and professionals were involved in discussions about people’s ability to consent to their care. We saw that records were maintained to reflect people’s ability to consent to the care they received.

People’s liberties were at risk of being restricted inappropriately. The legal requirements of the Mental Capacity Act (MCA) 2005 were not always followed when people were deemed to lack the capacity to make certain decisions relating to their care and treatment. The MCA and Deprivation of Liberties Safeguards (DoLS) set out the requirements that ensure where appropriate; decisions are made in people’s best interest.

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.

Staff did not recognise and take appropriate action when people were at risk of abuse. The provider did not always carry out necessary risk assessments to ensure people’s safety when they accessed the surrounding grounds.

People told us that they felt safe at the home. We saw that the provider took steps to ensure that people remained safe within the home. There were adequate numbers of staff to provide safe care.

People were cared for by staff that knew them and understood their needs. We saw that the staff knew the people they cared for and understood their individual needs.

People who used the service told us that staff were caring. We saw that people were supported by polite, kind and caring staff. People were encouraged to express their views and be actively involved in making decisions about their care. The decisions people made were respected by the staff.

We found that people’s care needs were assessed; care planned and delivered in a consistent way that met their individual needs. Information and guidance about people’s preferences was used by staff to ensure that people received appropriate and consistent care. People’s concerns and complaints were responded to appropriately.

People who used the service, their relatives and the staff were very complimentary about the registered manager of the service. The registered manager had a hands-on management style and people told us that they encouraged an open and transparent culture in the home.

We identified that the provider was not meeting Regulation 18 of the Health and Social Care Act 2008 Regulations and improvements were required.You can see what action we told the provider to take at the back of the full version of the report.

We spoke with four people who used the service, two relatives, four staff members and one visiting professional to help us understand the experience of people who used the service.

At a previous inspection completed on 2 August 2013 we identified areas of non-compliance with regulations we inspect against. We asked the provider to tell us how they intended to make improvements for the welfare and safety of people who used the service and when.

During this inspection, we checked if the provider had acted to improve the quality of service. We found some improvements had been made but further improvement was required. The provider need to ensure that suitable arrangements were in place for obtaining and acting in accordance with, the consent of people who used the service.

Is the service safe?

People who used the service were treated with dignity and respect. People told us they liked it at the home. One person who used the service told us, “I like it here, it’s very nice and I’m well looked after”. Another person told us, “The lady who saw me made me feel welcomed. It made me feel like people are going to understand you here”. Safeguarding procedures were in place and staff understood how to safeguard the people they supported.

We noted that capacity assessments had been carried out for people judged not to have capacity to make specific decisions. Most staff had had received training on the Mental Capacity Act 2005 or training about Deprivation of Liberty Safeguards (DoLS) and were able to explain the principles.

Is the service effective?

People’s care records were personalised, and the provider ensured that people’s dietary, mobility and equipment needs had been identified in care plans where necessary. People who used the service said that staff spent time with them to understand their individual needs.

The provider needed to make further improvement to ensure that the records for people who should not be resuscitated (DNAR) indicated that other people who are involved in the care of the person had been involved in the decision. The records we saw during the inspection showed that only the doctor had been involved in making decisions about DNAR.

Is the service caring?

People were supported by kind, attentive and friendly staff. We saw that staff were caring and gave encouragement when supporting people. One person told us, “I’m happy with the way they look after X. She’s quite well looked after.” People told us that they did not have to wait for long if they needed assistance from staff. We saw that people were treated with respect and their dignity was maintained at all times.

Is the service responsive?

We saw that people were involved in a range of activities in and outside the service. People told us that they went out for day trips, and we noted that people were encouraged to engage in activities outside the service if they were able to do so independently. People knew how to raise complaints and we saw that complaints were investigated and dealt with appropriately. People told us that staff always responded to their needs in a timely manner.

Is the service well led?

The service worked well with other agencies and services to make sure care was joined up and effective. We saw records to demonstrate that identified shortfalls were addressed promptly. People we spoke with told us that the manager was also available to deal with any concerns. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. This helped to ensure that people received a good quality service at all times.

This inspection was unannounced which meant the provider and the staff did not know we were coming. We spoke with five people using the service, two visitors, two staff and two visiting professionals. Everyone spoke well of the home, one person using the service said, “This is my home. I make my own breakfast and cups of tea. I like it here, the staff are nice and I can please myself what I do.”

We found people using the service were safe because the staff were given clear instructions, support and guidance. People told us they were treated with care and compassion and the staff responded well to their needs or concerns.

We saw information regarding capacity and consent was not always in place. This meant the home could not demonstrate how arrangements to seek people’s consent to care or treatment had been agreed in the person’s best interests.

We saw people received a varied and healthy diet. People using the service spoke well of the food and were suitably nourished and hydrated.

At our last inspection on 3 January 2013 we made one compliance action about the management of medication. This meant the provider had to make improvements. We found that suitable and sufficient improvements had been made which meant medication was managed in a suitable and safe way.

Recruitment records demonstrated there were systems in place to ensure the staff were suitable to work with vulnerable people.

We saw people’s confidential information was stored appropriately.

During our inspection we spoke with seven people using the service, three staff on duty, or who came on duty, the registered manager and any visitors that called during our inspection. People spoke positively about how they were able to make decisions about their care, spend their time and enjoy shared interests and social events.

People told us they were satisfied with the care and support they received and were happy with the staff team that supported them. One person said, “It is very nice, all the staff are pleasant.”

We found the care and support were delivered in a warm and caring manner. Records were informative and up to date.

We looked at the way medication was managed and saw that overall medication systems and practices were safe and suitable, but improvements were needed.

We looked at the number of staff on duty in the afternoon and considered the registered manager should judge whether there were enough staff available to meet the needs of the people using the service.

We found that complaints were dealt with quickly and appropriately and they were being recorded in the complaints register.

Information we hold about the home showed that we needed to undertake a monitoring visit, in order to update our records, and to establish that people's needs were being met. We had also received some information of concern stating the home was dirty, individual’s needs were not being met and the home was understaffed.

We concentrated on these areas to find out how the care was provided and to look at the quality of the service to ensure enough staff were available to meet people’s needs.

We saw that the staff were kind, respectful and unhurried. They gave support with personal care in ways that respected people's dignity and privacy. Staff listened to people and spent time with them, talking and carrying out activities, as well as providing care.

People spoken with told us they felt staff treated them well and respected them. They also commented that they received support from regular staff, which promoted consistency.

People told us the staff were kind and caring, “The staff here are very good, they keep an eye on me. If I need to, I just press the bell and I get assistance.”

Relatives continued to play an active role and support people and provide care. Family and friends could attend social events and were involved in supporting people using the service where appropriate.