About the service: Burnham Lodge is a nursing home providing care and accommodation for up to 20 people. At the time of our inspection 19 people were receiving care.

People’s experience of using this service:

People received good care at the home. People told us they were happy with staff and the care they provided. We saw that people were treated with kindness dignity and respect.

Staff were positive about working at the home and told us they received good support and training to assist them in their roles. Staff told us communication was good and that staffing levels, in the main worked well. We saw that there was a calm and positive atmosphere within the home.

People’s dietary needs were clear in their care plans and where necessary staff referred people to other health professionals. This included for example, dieticians, physiotherapists and speech and language therapists. People’s health was monitored so that action could be taken if any concerns were identified.

People’s care was reviewed regularly so that care plans were up to date and reflective of people’s current needs. People were involved in the review process.

There were activities taking place if people wished to take part in them. People were aware of the activities taking place, even if they chose not to take part in them. People were given information about how to make a complaint, though people told us they had no concerns and would speak with staff if they did.

The service was well led. There was a registered manager in place, supported by registered nurses and senior staff. The service was monitored to provide an opportunity to identify and plan any improvements necessary.

Rating at last inspection: The service was last inspection in March 2018 and was rated as Requires Improvement at this time.

Why we inspected: This was a scheduled inspection, in line with the rating of the service at our previous inspection.

Follow up: ongoing monitoring.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 6 and 7 March 2018 and was unannounced.

We last undertook a comprehensive inspection at Burnham Lodge Nursing Home in August 2017. At this inspection in August 2017 we found the provider to be in breach five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Regulation 9, Person centred care, Regulation 11, Need for consent, Regulation 12, Safe care and treatment, Regulation 15, Premises and equipment, and Regulation 17, Good governance.

Following the inspection in August 2017, we served two Warning Notices for breaches in Regulations 12 and 17. In addition to this, we set requirement actions relating to breaches 9,12, and 15. We also asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led to at least good. The provider told us they would make the required improvements by January 2018.

We undertook a focused inspection in December 2017 to check the provider was meeting the legal requirements for the two regulations they had breached that resulted in them being served Warning Notices. During the focused inspection we found the provider had taken action to ensure compliance with these regulations.

During this comprehensive inspection in March 2018 we found improvements had been made in some areas, we also found areas that still required improvement.

Burnham Lodge Nursing 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.

Burnham Lodge Nursing Home provides residential and nursing care for up to a maximum 23 people. At the time of our inspection, 19 people were living at the home. The home specialises in caring for older people including those with physical disabilities, people living with dementia or those who require end of life care.

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.’

People told us they were happy with the food provided. Our observations of the mealtime experience were mixed, some improvements were required to ensure people had a choice of the meals provided.

Some improvements were still required to ensure people’s rights were fully protected in line with the Mental Capacity Act 2005.

Our observations of people’s involvement in meaningful engagement was mixed; the registered manager had plans in place to improve this. Care plans still required further information to ensure they identified people’s social, spiritual and wellbeing needs.

There were systems in place to assess, monitor and improve the quality and safety of the service provided. These systems were identifying where some improvements were required, however they did not identify all of the shortfalls we found. During this inspection we found some similar concerns to our previous comprehensive inspection.

People felt safe living at Burnham Lodge Nursing Home. People were supported by staff who knew how to recognise and report abuse. Recruitment procedures were in place to ensure staff employed were suitable for their role.

Where risks had been identified to people’s safety, suitable measures were in place to reduce the identified risks. Staff were aware of people’s risk assessments and guidelines.

Staff were recording incidents when they occurred, these were reviewed by the registered manager for any lessons to be learned.

Medicines were administered safely to people, and people were happy with how staff administered their medicines.

We carried out a comprehensive inspection of Burnham Lodge Nursing Home on 17 and 21 August 2017.

Following this inspection we served two Warning Notices for breaches under two separate regulations of the Health and Social Care Act 2008. In addition to this, we also found three further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have set requirement actions relating to these breaches.

We undertook a focused inspection on 6 December 2017 to check the provider was meeting the legal requirements for one of the regulations they had breached that resulted in them being served a Warning Notice. This focused inspection was to ensure the provider had taken sufficient action that ensured people were protected against the risks associated with receiving safe care and treatment and medicines. This report only covers our findings in relation to these areas. At the last inspection ‘Safe’ was rated inadequate. This rating will not change because this was not a full comprehensive inspection. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for 'Burnham Lodge Nursing Home' on our website at www.cqc.org.uk

Burnham Lodge Nursing Home accommodates up to 23 people in one building. At the time of our inspection, 17 people were living at the home. The home specialises in caring for older people including those with physical disabilities, people living with dementia or those who require end of life care.

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.

During this focused inspection on 6 December 2017, we found action had been taken to ensure people received care and treatment in a safe way, risks to people’s safety were assessed and mitigated and sufficient action had been taken to ensure compliance with the safe and proper management of medicines had been achieved.

Where risks were identified to people’s safety, we found measures were in place to reduce the identified risks. Staff were aware of the risks relating to people and they were recording incidents when they occurred.

Clear protocols and guidelines were in place giving staff instruction on when and how ‘when required’ medicines should be given.

Risks relating to legionella bacteria in the water systems and high water temperatures were being managed consistently and safely.

We undertook this inspection of Burnham Lodge Nursing Home on 17 and 21 August 2017. The first day of the inspection was unannounced. We arranged to visit on the second day of the inspection with the registered manager.

Burnham Lodge Nursing Home provides residential and nursing care for up to a maximum 23 people. At the time of our inspection, 18 people were living at the service. The service specialises in caring for older people including those with physical disabilities, people living with dementia or those who require end of life care.

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.

People did not consistently receive safe care. Where risks had been identified to people’s safety, we found suitable measures were not always put in place to reduce the identified risks. Staff were not always recording incidents when they occurred. Staff were not receiving effective clinical supervision.

Medicines were not always stored securely and there were no clear protocols in place giving staff instruction on when and how ‘when required’ medicines should be given. People were happy with the way staff supported them with their medicines and we observed medicines were administered safely.

The home was not consistently clean and there were areas of the home that needed improving. Risks to legionella bacteria in the water systems and water temperatures were not being managed consistently. The provider had a refurbishment plan in place for the home identifying areas for improvement.

There were not always enough staff or activities available to meet people’s social, emotional and wellbeing needs. Staff did not always follow health professional advice or guidance.

People’s rights were not fully protected because the home had not consistently acted in accordance with the Mental Capacity Act 2005 (MCA).

People’s mealtime experience was mixed. People commented positively about the food, and food was prepared to meet their individual needs.

People’s care needs were not always fully assessed and planned for. Some of the care plans we reviewed included contradictory information.

Quality assurance systems were not always fully effective at identifying and addressing shortfalls in the service provided.

People told us they felt safe at Burnham Lodge. Staff knew how to recognise and report abuse and recruitment was managed safely. People’s healthcare needs were met.

Staff received appropriate training to understand their role. New members of staff received an induction which included shadowing experienced staff before working independently.

People and their relatives told us the staff at Burnham Lodge were kind and caring. People were treated with dignity and respect. People or their representatives were fully involved in decisions about their care and treatment, including the care they would like to receive at the end of their lives.

People and their relatives knew how to complaint and felt confident any concerns would be responded to.

People were supported by a staff team who felt supported by their manager and were positive about working in the home. Staff felt able to approach their managers and raise any concerns.

There were systems in place for people, their relatives and staff to give their feedback on the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.