About the service:

Burnt Tree Croft is a care home that provides personal care and accommodation for up to 40 people. At the time of this inspection there were 32 people using the service.

People’s experience of using this service:

• The service met the characteristics of good in most areas. Some aspects of the service required improvement to ensure people remained safe;

• We found medicines were not always managed safely. This meant the provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; safe care and treatment.

• We received mixed feedback about staffing levels. Staff told us they felt there were not always enough staff deployed to meet people’s needs in a timely manner, however people using the service raised no concerns about staffing levels. We have made a recommendation about how the provider calculates the number of staff needed to meet people’s needs;

• People told us they felt safe and were happy with the support they received from staff. Staff understood how to protect people from abuse and were confident the manager would act upon any concerns they raised;

• People told us staff were kind and caring. We observed staff treated people with dignity and respect. Staff knew people well and they provided care and support in accordance with people’s preferences;

• People’s care records were person-centred and staff took time to get to know people when they moved into the service;

• People were encouraged to make their own decisions and their independence was promoted. People took part in reviews of their care and were supported to decide how and where they wanted to spend their time each day;

• 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;

• People were happy with the food provided at Burnt Tree Croft. The service catered for people’s special dietary requirements and staff monitored food and fluid intake levels of people who were assessed to be at risk. We have made a recommendation about how the service monitors food and fluid intake levels;

• People were supported to take part in a range of activities, which they told us they enjoyed. Staff developed the activity programme in accordance with people’s preferences and tailored activities to people’s differing abilities;

• People knew how to raise any concerns with staff. The provider had a suitable complaints procedure in place;

• The provider and registered manager understood the regulatory requirements and monitored the quality and safety of the service on a regular basis, however the provider’s quality assurance system had not identified the issues observed during this inspection in respect of medicines management;

• More information is in the full report.

Rating at last inspection:

At the last inspection the service was rated good (published 19 July 2016).

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

Enforcement:

Please see the ‘action we have told the provider to take’ section at the end of the full report.

Follow up:

We will continue to monitor this service. We plan to complete a further inspection in line with our re-inspection schedule for those services rated requires improvement.

Burnt Tree Croft is registered to provide accommodation and personal care for up to 40 older people, some of whom may be living with dementia. The home is situated in a residential area of Sheffield, close to local amenities and transport links.

There was a manager at the service who was registered with CQC. 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.

Our last inspection at Burnt Tree Croft took place on 2 May 2014. The home was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on 16 June 2016 and was unannounced. This meant the people who lived at Burnt Tree Croft and the staff who worked there did not know we were coming. On the day of our inspection there were 37 people living at Burnt Tree Croft.

People spoken with were positive about their experience of living at Burnt Tree Croft. They told us they felt safe and they liked the staff.

Relatives spoken with had no concerns regarding their relative’s care. They told us they knew staff well and they were always kept up to date with any news.

Healthcare professionals spoken with told us they had no concerns about Burnt Tree Croft.

We found systems were in place to make sure people received their medicines safely.

Staff recruitment procedures were thorough and ensured people’s safety was promoted.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role. Staff understood their role and what was expected of them. They told us they liked their jobs, worked well as a team and were well supported by the registered manager.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves.

People had access to a range of health care professionals to help maintain their health. A varied and nutritious diet was provided to people that took into account dietary needs and preferences so their health was promoted and choices could be respected.

People living at the home, and their relatives said they could speak with staff if they had any worries or concerns and they would be listened to.

We saw people participated in a range of daily activities both in and outside of the home which were meaningful and promoted independence.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. People using the service and their relatives had been asked their opinion via questionnaires, the results of these had been audited to identify any areas for improvement.

At the time of this inspection Burnt Tree Croft was providing care and support to thirty two people, some of whom had a diagnosis of dementia. We spoke with eight people living at the home, one relative and two visiting professionals to obtain their views of the support provided. In addition, we spoke with the registered manager, the deputy manager, a team leader, three care staff, the activities worker, a senior cook and a domestic.

We gathered evidence against the outcomes we inspected to help 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. The summary is based on speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People supported by the service, or their representatives told us they felt safe.

People told us that they felt their rights and dignity were respected.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

We found that risk assessments had been undertaken to identify any potential risk and the actions required to manage the risk. This meant that people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded as required.

The service was safe, clean and hygienic.

Is the service effective?

People’s health and care needs were assessed with them and their representatives, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Staff were provided with training to ensure they had the skills to meet people’s needs. Managers’ were accessible to staff for advice and support. Staff were provided with formal individual supervision and appraisals at an appropriate frequency to ensure they were adequately supported and their performance was appraised.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

We asked people using the service and a relative for their opinions about the support provided. Feedback from people was positive, for example; “they are smashing, can’t do enough for you”, “they give me the help I need” and “they (staff) are very good. I can’t fault them”.

When speaking with staff it was clear that they genuinely cared for the people they supported and had a detailed knowledge of the person’s interests, personality and support needs.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People regularly completed a range of activities in and outside the service. The home had access to a shared adapted minibus, which helped to keep people involved with their local community.

Some people required specialised diets for health or personal reasons. We found the service provided food and drinks specifically requested by people. People told us, “The food is good, we get a good choice” and “they (staff) keep us well fed and watered”.

People spoken with said they had never had to make a complaint but knew how to make a complaint if they were unhappy. We found that appropriate procedures were in place to respond to and record any complaints received. People could be assured that systems were in place to investigate complaints and take action as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

People living at the home told us that they were happy with the care they received. They told us, "it’s smashing here, the staff are lovely" and "the staff go out of their way for you."

Relatives spoken with said that they were happy with the care their loved one received. Comments included, “the staff are very caring” and “I’ve no worries at all. It is homely and friendly here.”

During the inspection we were able to observe people's experiences of living in the home. The interactions between people living at the home and staff appeared positive. Staff spoken with knew the people living at the home well. We found that care and support was offered appropriately to people.

We found that before people received any care or treatment they were asked for their consent and the staff acted in accordance with their wishes.

We found that people's care and welfare needs were assessed and each person had a written plan of care that set out their identified needs and the actions required of staff to meet these.

We found that medicines were being obtained, recorded, handled, dispensed and disposed of in a safe way.

The provider had a satisfactory recruitment and selection procedure in place to ensure that staff were appropriately employed. Staff were provided with relevant training to maintain and update their skills and knowledge.

The provider had an effective complaints system available. A system was in place to respond appropriately to any complaints received.

We spoke to ten people that lived at Burnt Tree Croft. They told us that they liked living at the home, and the staff knew them well and supported them in the way they needed. Comments included; “The staff are smashing, they are very kind.” “The staff are good. They look after me and see that I am alright.” “I am fine here. The staff are champion. I would definitely recommend this home to anyone that needed a bit of help.”

We spoke to four relatives visiting the home. They said that they had no concerns regarding their loved ones care and staff always kept them informed. Comments included; "Without exception the staff are caring. We have no worries at all." "I think (my parent) is very well looked after by people who know them well."