Burman House is a residential care home for 32 older people. The service also provides short term and respite care. Peoples care and support is provided in purpose built accommodation, over two floors, although only the ground floor was in use for accommodation. At the time of our comprehensive unannounced inspection of 17 April 2018 there were 26 people living at the service.

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.

Burman House is registered to provide accommodation and personal care for up to 32 people.

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.

At this inspection, our medicine management inspector assessed if people’s medicines were being managed safely and if arrangements were in place to protect people against the risks associated with the unsafe use and management of medication. This follows our previous inspection in October 2014 when we identified shortfalls in the way people’s medicines were being managed that had placed them at risk.

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.

This inspection was conducted by a pharmacy inspector. The focus of the inspection was to answer one key question; is the service safe in respect of the management of people’s medicines. During the inspection we spoke with one member of staff, the registered manager, the deputy manager and the regional director of the provider who was also present during the inspection.

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.

The inspection team was made up of one inspector. We set out to answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

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 who used the service had high praise for the standard and quality of the service they had received at Burman House. They also said that they enjoyed living there. One person said that it was, “Very good. I could not find anywhere better to live than here”.

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.

People who used the service had their support, care and treatment provided only when they gave their consent. Arrangements were in place to improve members of staff’s level of understanding of the Mental Capacity Act 2005.

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.

All people that we spoke with said that their support and care needs were safely and appropriately met by respectful staff who were skilled and knowledgeable to do their job.

People said they were satisfied with the standard of their support and care. One person summarised this by saying, "Everything is lovely here, (including) the staff and the food. What more can you ask for?"

People also told us that they were given opportunities to make choices about how they spent their day, including the time they chose to get up and when they wanted to go to bed.

People we spoke with said they liked their room and said they felt "Safe". They told us that this was due to both the security of the premises and because how they were treated by the staff.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. Before our visit on 06 June 2012, we spoke with a member of the local authority, who told us that they had no concerns about the standards of care and service provided at Burman House.

During our visit, we spoke with a visiting health care professional who told us that people who used the service had experienced a good standard of care and treatment.

This inspection took place on 9 and 10 June 2015 and was unannounced. Burman House is a residential care home providing personal care and support for up to 32 older people, some of whom may live with dementia. On the day of our visit 32 people were living at the service.

The home had a registered manager who has been in post since January 2012, although they were not working in the position at the time of our inspection. An interim manager had been put in place to oversee the running of the home. 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 felt safe living at the home and staff supported them in a way that they liked. Staff were aware of safeguarding people from abuse and they knew how to report concerns to the relevant agencies. Individual risks to people were assessed by staff and reduced or removed. There was adequate servicing and maintenance checks to equipment and systems in the home to ensure people’s safety.

There had been an increase to the number of staff members available and there were enough staff available to meet people’s needs.

Medicines management had improved and these were safely stored and administered, and staff members who administered medicines had been trained to do so.

Staff members received other training, which provided them with the skills and knowledge to carry out their roles. Where they had not received training, they were given enough guidance and information to properly care for people. Staff received support from the manager, which they found helpful.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service was meeting the requirements of DoLS. The manager had acted on the requirements of the safeguards to ensure that people were protected.

Staff members understood the MCA, they presumed people had the capacity to make decisions first and supported them to do this. However, where someone lacked capacity, records to show best interests decisions were not available.

People enjoyed their meals and were given choices about what they ate. Drinks were readily available to ensure people were hydrated. Staff members worked together with health professionals in the community to ensure suitable health provision was in place for people.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. There was a friendly atmosphere and people lived in an entertaining environment where there was much laughter.

People’s needs were responded to well and care tasks were carried out thoroughly by staff. Care plans contained enough information to support individual people with their needs. Records that supported the care given were completed properly.

A complaints procedure was available and people were happy that they did not need to make a complaint. The manager was supportive and approachable, and people or their relatives could speak with her at any time.

The home effectively monitored care and other records to assess the risks to people and ensure that these were reduced as much as possible.