This inspection took place on 05 and 06 December 2017 and was unannounced.

The Burnham Nursing and Residential Centre 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.

The Burnham Nursing and Residential Centre is registered to provide personal care and accommodation for up to 71 older people. At the time of our inspection 43 people were using the service. Accommodation was provided over three floors but at the time of the inspection only two floors were occupied. The upper floor had undergone an extensive renovation and redecoration programme and was ready to be occupied.

Following the last inspection in August 2016 we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; Safe, Effective, Responsive and Well led, to at least good.

At the last inspection we found people were not always safe. Risks to people were not well managed and there were times when there were not enough staff to keep people safe. Staff who administered medicines did not have an up to date competency check. Some staff did not know how to report concerns to the local authority if they had concerns about a person’s safety.

At this inspection we found there were systems and processes in place to minimise risks to people, care plans showed risk had been assessed and clear guidelines were in place for staff to follow. This also included a robust recruitment process and making sure staff knew how to recognise and report abuse.

There was sufficient staff to safely meet the needs of people living in the home. People’s opinions on staffing levels varied with some people still concerned about the use of agency staff. However the registered manager confirmed a recruitment programme was on-going and they had employed permanent staff to provide continuity of care. Records showed that there were adequate numbers of staff available to meet the assessed needs of people in a timely manner.

At the last inspection we found the service was not always effective. Staff did not have a clear understanding of the Mental Capacity Act 2005 (MCA). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. We also found Staff were not always aware of people's food allergies or need to avoid specific drinks.

At this inspection we found staff had received training in the MCA and could discuss how they recognised people’s ability to consent to care. People received effective care from staff who understood their needs. Staff were able to tell us about people’s specific likes and dislikes. People told us they thought staff were well trained and understood them well. The registered manager and staff were very pro-active in arranging for people to see health care professionals according to their individual needs.

All staff attended induction training before they started to work in the home. All staff said they had plenty of opportunities for training and the organisation also promoted dementia awareness training for all their staff.

At the last inspection we found the service was not always responsive. People’s care plans were inconsistent and care staff did not have access to people’s care plans. People or their relatives were not involved in developing their care plans.

At this inspection we found people received care that was responsive to their needs and personalised to their wishes and preferences. People were able to make choices about all aspects of their day to day lives. Care staff had access to care plans that were clearly written and included plenty of guidance and information

The Burnham Nursing and Residential Centre is located in a residential area and provides care and support for up to 54 people over the age of 65 who require personal care and/or nursing care. The home has a specialist unit to provide care for people living with dementia. There were two floors in current use, Sandpiper on the ground floor and Nightingale on the first floor. Both floors had a mix of people, those who require nursing care and those who require personal care. There were 43 people using the service at the time of the inspection.

This inspection was unannounced and took place on 10 and 11 August 2016.

The registered manager had recently left and two temporary managers were in post, having taken over in March 2016. 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.

Most people we spoke with were concerned about staffing levels in the home. Although we observed staff to be rushed and people told us they waited sometimes, they were happy with the care they received and interacted well with staff. Experienced staff had built good relationships with people. The managers had developed links with the community.

Although staff received training, some staff we spoke with did not understand their responsibilities around safeguarding. Staff received training for other topics, such as manual handling, but had not received support via supervision through a time of significant change.

There had been a number of changes in the management team since our last inspection. This had led to a period of inconsistency. Everyone we spoke with felt the new, temporary managers were making positive changes and the service was improving.

People, and those close to them, told us they were not involved in planning and reviewing their care and support after their initial meetings when they moved in to the home. Care staff did not have access to people’s care plans because they didn’t have access to them, so relied on information being passed to them from the nurses.

People’s views on meals were mixed. Cooks had not been made aware of everyone’s dietary needs, allergies and preferences. People were not involved in menu planning.

The quality assurance processes in place to monitor care and safety and plan ongoing improvements were not fully effective. There were systems in place to share information and seek people’s views about the home. Complaints and concerns were not always used to improve the service. A number of compliments had been received.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because:

• people, relatives, visitors and staff all said there were not enough staff,

• care and treatment was not always provided in a safe way,

• some people were subject to unauthorised restrictions,

• staff had not been supervised regularly,

• people did not received person centred care

• the quality assurance processes in place to monitor care and safety and plan ongoing improvements were not fully effective.

You can see what action we told the provider to take at the back of the full version of the report.