About the service:

Burton Closes Hall is a care home that provides personal care and nursing for up to 58 people. The accommodation is established over two buildings. However, the provider has taken the decision to only use one building. This building is set over two floors. There are communal spaces on the ground floor and access to a secure outside space. There are bedrooms on both floors with bathing facilities. At the time of the inspection there were 26 people using the service.

People’s experience of using this service:

The provider had completed audits to support the quality of the home, however some areas had not been addressed swiftly to reduce the impact on the person. Other areas which had been identified had not been followed up to ensure any changes were embedded. People’s views had been obtained, however no action had been taken to consider how to address any required outcomes or how to share the information.

People using the service were not always supported to have meaningful activities in relation to their hobbies or interests. The environment did not provide orientation guidance for people living with dementia or information in different formats.

There were enough staff to support people’s personal needs, however there were not always enough staff to support the opportunities for interactions or required paperwork.

There was a choice of meals and dietary requirements were catered for. However, the provider recognised that further work was required in this area to make the meal times a more social experience.

Staff had been recruited appropriately to ensure they were suitable to work with people. There was an established group of staff who knew people well. This enabled them to provide care which was personal and supported people’s daily choices and preferences.

People’s dignity was maintained, and consent obtained before care was provided. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People’s health care was supported with established partnerships from a range of professionals. Information about people’s care was only shared with those relevant or at the persons permission. Relatives were made welcome at the home.

Any risks had been assessed and measures put in place to reduce the risks. Medicines was managed safely and in line with current guidance. People were protected from the risk of harm with staff having training in safeguarding and understanding the importance of reporting any concerns.

Staff had received training for their roles, which enabled them to develop their skills in providing care which was in line with current guidelines to ensure safety and good practice. Lessons had been learnt from events.

Care plans were detailed and reflected the individual’s needs to support their care, this included any religious or cultural needs. There were regular services provided from the local religious denominations.

There was a complaints policy which was used to address any concerns raised. The providers rating was displayed on their website and within the home as required. We had received notifications of events and incidents and this enabled us to reflect on the action the provider is taking to ensure people’s ongoing safety.

Rating at last inspection: Requires Improvement (Published June 2018)

Why we inspected: The inspection was prompted in part by notifications and concerns raised by relatives and health and social care professionals. At this inspection we found the service continues to be ‘Requires Improvement.’

Enforcement: We found one breach 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 the report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to

We inspected the service on 6 March 2018. The inspection was unannounced. Burton Closes Hall Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Burton Closes Care Home accommodates up to 34 people in one adapted building. At the time of our inspection 34 people lived at Burton Closes Care Home.

At the time of our inspection there was no registered manager in post, however the manager had applied for registration and was registered on 4 April 2018. They were present at the inspection. The service is required to have 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 2008 and associated Regulations about how the service is run.

There was enough staff available to meet people’s basic needs. The service was reliant on agency staff and people were not always happy with this. Care was not always personalised and people did not have their needs and wishes beyond basic needs met.

Staff had been trained in safeguarding and understood how to raise any concerns. Recruitment processes were in place to ensure any new staff would be subject to pre-employment checks on whether they were suitable to work at the service.

Appropriate arrangements were in place for medicines management and these followed procedures designed to ensure safe medicines practice. People were offered their medicines as prescribed.

Processes were in place to ensure risks and people’s health needs were assessed, managed, monitored and responded to. The premises had been adapted in ways to make sure it was suitable for people using the service. However this was not always successful leaving some people cramped in small communal areas and others isolated in very large communal areas.

People’s needs and choices were promoted in a way that prevented and reduced the impact of any discrimination. People’s communication needs were assessed and people were supported to communicate effectively with staff. The Accessible Information Standard was being met. Staff knew how to support people to make decisions and ensure their rights were respected, working in line with the principles of the Mental Capacity Act 2005.

Due to the high use of agency staff people were not always supported to have maximum choice and control of their lives.

Staff in post were trained and were well supported. Staff were caring in their interactions with people. However care was not always delivered in a manner that promoted people’s dignity and independence. People were not offered the opportunities to pursue their different interests and hobbies and contact with the local community was poor.

People felt able to raise any issues or concerns. There was a complaints process in place to manage and respond to any complaints should they be made. The service had received many compliments.

The manager was aware of the issues to be addressed and had started to make progress on recruitment and more stimulation for people. The provider and the manager had audits and checks in place to provide assurances for the governance of the service. Policies and procedures had been updated to reflect the needs of the service.

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.

At our last visit to Burton Closes Hall on 24 September 2012 we found that there were not enough qualified, skilled and experienced staff to meet people’s needs.

We did not speak to people using the service for this follow up review. We undertook focused observations of staff interactions with a group of four people during our visit, using our Short Observational Framework for Inspection (SOFI). We observed that people’s needs were generally met and people interacted positively with members of staff.

We reviewed the staffing rota’s for all three units in the home for the six weeks before our visit. We found that staffing levels in all three units had improved and that the numbers of staff on shift at any one time had become more consistent.

We did not speak to people using the service for this follow up review. We undertook focused observations of staff interactions with a group of three people during our visit, using our Short Observational Framework for Inspection (SOFI).

We saw that in general, staff interacted positively with people living at Burton Closes Hall however we saw that staff do not always have the time they need to meet people’s needs. We found that staffing levels of care staff working in two areas of the home were inconsistent and that there were insufficient numbers of staff to meet people’s needs and ensure their health, safety and welfare.

We saw that menu’s in the home had been reviewed and that there was an increased choice of food available. We saw that the menu changes had been discussed with people living at Burton Closes Hall.

We found that the provider had taken appropriate action following our last inspection to ensure that they were regularly assessing and monitoring the quality of service people were receiving. We saw that a number of audits had been completed for areas such as infection control and medications. Appropriate action plans had been put in place following the audits and were being addressed by the provider and the home manager.

At our visit we were not able to speak with a significant number of people using the service due to their conditions and frailty. We sought to gather evidence of people’s experiences of the service by way of the complaints log and the provider’s recorded methods of obtaining feedback. However, we found those systems were not being fully utilised to provide us with that information.

We used the Short Observational Framework for Inspection (SOFI). This is a specific way of observing care to help us understand the experiences of people who could not talk with us. From this, we saw staff interacting positively with people. Adopting a relaxed pace with them, whilst recognising and supporting their individual reality.

We saw many instances where staff approaches with people were sensitive and mindful of their rights. Such as in supporting people with their daily living choices and preferences and in promoting their dignity and independence.

This told us that people’s rights to dignity, choice and independence were often recognised and that staff sought people’s views. However, we found where inconsistencies occurred, including where people’s rights and choices were not always best assured. For example in methods for enabling people’s access to key service information, in the variety and choice of food menus, in assessing people’s best interests and for the recording of people’s views and concerns they raised.

All people we spoke with said they said they were comfortable in their own rooms and felt they were provided with the equipment they needed to ensure their safety. Two people described mostly suitable arrangements for their health care needs, including for the purposes of their routine health screening and for their medicines.

Three people said they would be confident to raise concerns in the event of their witnessing or being subject to any form of abuse. Two confirmed they felt safe in the home.

Two people told us that staff was mostly around when they needed them. Two people said that sometimes there was not enough staff. One of them added that staff were, ‘Kind and caring.’ One person felt that sometimes staff did not listen and act on what they said. Another person told us, ‘We are well looked after here.’

Burton Closes Hall Care Home provides accommodation for people who require nursing and personal care. It is also registered to provide treatment for disease, disorder or injury and diagnostic and screening services.

This inspection took place on 10 and 12 November 2015. The first day was unannounced.

Our last inspection of 11 and 16 March 2015 found the provider was not meeting four regulations. These were in relation to safe care and treatment, cleanliness and infection control, the management of complaints and assessing and monitoring the quality of service provision. We issued warning notices in relation to safe care and treatment and cleanliness and infection control. At this inspection we found that the actions we required had been met.

There was a registered manager at the service at the time of our inspection. 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.

Risk of infection was well managed and risk of people acquiring infections had reduced. Cleanliness of the home had improved and staff followed infection control procedures. Damaged equipment had been replaced. We found there were additional areas that the provider needed to improve to ensure the level of cleanliness was maintained such as ensuring cleaning schedules included dust removal.

The service was following the guidance in people’s risk assessments and care plans and the risk of unsafe care was reduced. People’s records were up to date and indicated that the required interventions had been undertaken. The records had also been updated to reflect changes in people’s care needs. Referrals to external health professionals were made in a timely manner.

Systems to monitor the quality of the service had improved. Identified issues were resolved in a timely manner and the provider had obtained feedback about the quality of the service from people, their relatives, external health professionals and staff.

The management team provided good leadership and staff morale had improved as a result of training, guidance and support, the acknowledgement of hard work and good practice and giving people responsibility for their roles.

Although there appeared to be sufficient staff available to meet people’s needs, there were specific periods of time in the communal areas where staff were not available. We were therefore not assured that there was always someone available to assist people in a timely manner.

Complaints were mostly well managed and there had been improvements since our previous inspection in March 2015. The provider had looked into repeated complaints about one person’s care and welfare but despite written responses outlining what action would be taken, some of the issues raised continued. The complainant therefore remained dissatisfied with the provider’s response. Responses to other complaints had reached a satisfactory conclusion.

People told us the care staff were caring and kind and that their privacy and dignity was maintained when personal care was provided. People were involved in the planning of their care and support.

People told us they enjoyed their food and we saw they were assisted to eat in a sensitive manner.

Consent to care and support had been sought and staff acted in accordance with people’s wishes.

People were able to take part in hobbies and interests of their choice.