Burrswood Care Home

Burrswood Care Home, owned and operated by Advinia Care Homes Limited, is registered with the Care Quality Commission (CQC) to provide personal and nursing care to a maximum of 125 people. 75 people were accommodated at the time of inspection.

Accommodation is divided across 3 separate units. These are described by the provider as Peel (providing nursing care to people living with dementia) Kay (providing residential care to people living with dementia) and Crompton (providing general residential care). A fourth unit, Dunster, had previously provided general nursing care but had recently closed

People’s experience of using this service and what we found

Medicines were not managed safely which placed people at risk of harm. Medicines could not always be accounted for, which meant these medicines may not have been given as prescribed or misused; it was of particular concern that there was less stock of some medicines which can cause people to be drowsy than expected. Medicines that needed to be taken at specific times were not given safely. Some people were given their night time medicines at teatime on 3 days because there were no staff trained to give medicines working on that unit on those nights.

Management of witnessed and unwitnessed incidents, including falls, was not safe. We found multiple examples where people were known to be at risk, but there had been a failure to act to adequately mitigate those risks. Safeguarding referrals had not always been made to the local authority safeguarding team where people had experienced harm. Deployment of staff was disorganised and frequently chaotic. This was most evident on Peel unit where we found a distinct lack of leadership and management. Staff worked to a ‘task-and-time’ regime which meant daily routines were operated for the convenience of staff, and not in a person-centred way to best support people.

The food and drink offer across the home was poor. Choice was limited and food was not always nutritious. The needs of people who required a modified diet due to a medical need were not always met. Some people had food preferences based on their religious or cultural background. However, these preferences had been flagrantly ignored by staff.

Induction, training and development of staff was inadequate. There was a distinct lack of qualified nursing staff with the relevant professional training, skills, and experience to effectively deliver nursing care to people living with complex advanced dementia. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. The environment, décor and design of the home was not in line with national best practice guidance for supporting people living with dementia.

Whilst it was evident some staff were caring and well intentioned, for others, they appeared indifferent and disinterested. Too often we observed staff not paying attention to basic matters of dignity, privacy and compassion. The individuality and diversity of people receiving care and support was not acknowledged or celebrated in any meaningful way. This was particularly concerning for those people who may have protected characteristics.

The provision of activities and opportunities for people to follow their interests was woefully inadequate. There was too much of an inward focus and links with the local community were virtually non-existent.

There had been a systemic failure of leadership and management across all areas. There was a deep sense of mistrust between staff, the registered manager, deputy manager and senior managers acting for the provider. This led to a closed toxic culture amongst staff which led to poor quality care. There were significant failures in governance, audit, quality assurance and questioning of practice. Governance systems were not operated effectively and were not fit for purpose.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 06 September 2022).

Why we inspected

This inspection was planned in response to emerging risk based on information of concern received from relatives, intelligence from local stakeholders, and our own analysis risk. Key themes centred on pressure wound care, staffing levels, management of falls/unwitnessed events and leadership and management.

Enforcement and Follow up

We have identified breaches of legal requirements in respect of safe care and treatment, protecting people from abuse and improper treatment, staffing, person-centred care, meeting nutritional needs, dignity and respect, and good governance.

The overall rating for this service is ‘Inadequate’ and the service is therefore placed in ‘special measures’. Full information about CQC’s regulatory response to the serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We are currently keeping the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements. If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

In the intervening period between our inspection visits and publication of this report, CQC have worked closely with partners from the local authority, NHS and police to ensure the health, safety and wellbeing of people. This activity remains ongoing at the time of this report.

Burrswood Care Home provides personal and nursing care to a maximum of 125 people. At the time of the inspection 75 people were using the service. Burrswood has four separate units, Dunster (general nursing), Peel (dementia nursing), Crompton (residential) and Kay (dementia residential). Most bedrooms had an integral toilet and shower and each unit had their own adapted facilities.

People’s experience of using this service and what we found

Staff safeguarded people from the risk of abuse. Assessments of risk and safety and supporting measures in place helped minimise risks. Staff managed people’s medicines safely. We have made a recommendation about the management of some medicines.

Staff followed infection prevention and control guidance to minimize risks related to the spread of infection.

Staffing levels were sufficient to meet people’s needs and managers recruited staff safely. Staff followed an induction programme, and training was on-going throughout employment.

Staff assessed people’s needs. Care plans included information about support required in areas such as nutrition, mobility and personal care to help inform care provision. Staff made appropriate referrals to other agencies and professionals when required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Peoples’ equality and diversity was respected. People felt staff respected their privacy and dignity and took into account their views when agreeing on the support required. Staff identified people’s communication needs and addressed these with appropriate actions.

Managers worked continuously to improve the culture in the service; they responded to actions identified at the last inspection and to complaints and used these to inform improvement to care provision. The provider was open and honest, in dealing with concerns raised. The management team were available for people to contact and undertook regular quality checks, to help ensure continuously improved standards of care.

The provider and registered manager followed governance systems which provided effective oversight and monitoring of the service. These governance systems and processes helped to ensure the service provided to people was safe.

This was a focussed inspection which looked at the safe, responsive and well-led domains only.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 24 December 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 09 December 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focussed inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Burrswood Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Burrswood Care Home (known as Burrswood) is a nursing and residential care home providing personal and nursing care to 100 people aged 65 and over at the time of the inspection. The service can support up to 125 people.

Burrswood has four separate units, Dunster (general nursing), Peel (dementia nursing), Crompton (residential) and Kay (dementia residential). Most bedrooms had an ensuite toilet and shower and each unit had their own adapted facilities.

People’s experience of using this service and what we found

There was a significant difference in the quality of the care, staffing, care plans and use of electronic medicines system between the two nursing units (Peel and Dunster) and the two residential units (Crompton and Kay).

There was an over reliance on agency care staff and nurses on the nursing units. One nursing unit had not had a consistent unit manager for three years, the other had a new unit manager after having a vacancy for six-months. The agency staff needed guidance as to the support people needed and were unable to write or review people’s care plans. This meant the guidance for staff on people’s support needs was not written for new admissions or reviewed for people already living at the home.

The residential units had a stable staff team and long-standing unit managers. Staff knew people and their support needs. Care plans were written and reviewed.

People received their medicines as prescribed. However, on the nursing units the electronic medicines system tablet stock levels were not accurate. This was due to agency nurses not being able to use the system correctly when booking medicines in. We were told additional training had been arranged for regular agency nurses. The electronic medicines system was accurately being used on the residential units.

The providers quality assurance system was not being robustly used. The system showed audits were being completed; however, the manager, clinical services manager and Advinia quality manager all said that care plan and medicines audits had not been fully completed in September and October 2021 for the two nursing units (Peel and Dunster). Actions identified from the audits were not being completed. A new home manager had recently been appointed and was in the process of prioritising the actions that needed to be completed.

Staff were safely recruited. The home was clean, infection control procedures were in place and the home was following current government guidelines for staff testing and visitors to the home.

People’s advanced wishes for the end of their lives did not contain much detail. A complaints policy was in place. Informal complaints had not been responded to.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 12 January 2021) and there was one breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had not been made and we also found additional breaches of regulations.

The service has now deteriorated to inadequate. This service has been rated requires improvement or inadequate for the last four consecutive inspections.

Why we inspected

We received concerns in relation to staffing levels, people’s care needs not being met and governance at the home. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, responsive and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Burrswood Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to the lack of guidance for staff in how to meet people’s needs, the lack of a robust quality assurance system, the over reliance on agency staff and the long-term lack of unit manager on one unit, the lack of meaningful activities for people to be involved in, the incorrect inventory levels in the medicines system and the lack of detail for people’s advanced wishes.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Burrswood Care Home (known as Burrswood) is a nursing and residential care home providing personal and nursing care to 99 people aged 65 and over at the time of the inspection. The service can support up to 125 people.

Burrswood has four separate units, Dunster (general nursing), Peel (dementia nursing), Crompton (residential) and Kay (dementia residential). Most bedrooms had an ensuite toilet and shower and each unit had their own adapted facilities.

People’s experience of using this service and what we found

There were limited activities for people to participate in. The manager had appointed a new activities officer and had plans to increase activities further.

The risks people may face were assessed and guidance provided for staff to manage these risks. Staff had not completed training in managing behaviours that may challenge others. This was organised following our inspection.

We have made a recommendation for staff guidance and training in supporting people’s anxieties and behaviours.

Positive feedback was received about the new manager from people living at Burrswood, relatives and members of staff. Relatives felt more involved, with improved communication with the home. Staff morale had improved and staff were clear about their own roles and responsibilities.

Regular audits were completed for a range of areas. Action plans were developed for any issues found, with a set timescale and named person to complete each action. Accidents and incidents were reviewed to ensure appropriate action had been taken and lessons learnt to reduce the risk of a re-occurrence.

People received their medicines as prescribed. People’s support needs were monitored to check there was sufficient staffing to meet their needs. Staff continued to be safely recruited. The home was clean throughout, with additional cleaning being completed during the COVID-19 pandemic.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 2 April 2020) and there was one breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 11 and 13 February 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance of the service. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements.

This inspection was also prompted in part due to concerns received about staffing, medicines and governance at Burrswood. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from these concerns.

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements and concerns. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same as requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Burrswood Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to the lack of activities available for people to participate in at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Burrswood Care Home (known as Burrswood) is a nursing and residential care home providing personal and nursing care to 108 people aged 65 and over at the time of the inspection. The service can support up to 125 people.

Burrswood has four separate units, Dunster (general nursing), Peel (dementia nursing), Crompton (residential) and Kay (dementia residential). Most bedrooms had an ensuite toilet and shower and each unit had their own adapted facilities.

People’s experience of using this service and what we found

Staffing levels had been increased. We observed staff levels were sufficient during the day, although they weren’t always effectively deployed. However, we received feedback that there were not enough staff on duty, especially at night. Staff morale was low, although staff were positive about their immediate line managers. The manager was now tackling staff sickness.

There were not enough activities available for people to take part in and be engaged with. We have made a recommendation about reviewing staffing levels.

The home was running out of continence products at the time of our inspection. We have made a recommendation for systems to be in place to ensure an adequate supply of the correct continence products.

Care records had improved and contained information about people’s needs and how staff should meet these needs. Medicines were administered as prescribed. People’s nutritional needs were being met, although we received mixed feedback about the food. We have made a recommendation about ensuring people’s hydration needs are being met.

The manager had recently been appointed. A computerised quality assurance system was now being embedded to give oversight of the service. Action plans were developed from the completed audits.

The home was clean throughout. One unit had been refurbished and one unit was in the process of being refurbished.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and relatives were positive about care staff team. Staff respected people’s privacy and dignity and encouraged people to be as independent as possible.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 4 March 2019) and there were four breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made in medicines management, care planning and staffing. However, there was one continued breach in good governance. The service remains rated requires improvement. This is the second consecutive inspection this service has been rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified one breach of regulations in relation to the governance of the service. There were not enough activities for people to engage in, staffing was not always effectively deployed and the home was running out of continence products.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan and meet with the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Burrswood Care Home is a care home that provides personal and nursing care for up to 125 older people and people living with dementia in four buildings. Accommodation was provided on two levels. At the time of this inspection 110 people were living at the service.

People’s experience of using this service and what we found

At this targeted inspection we found that systems and processes to protect people from the risk of abuse or neglect were robust. There were safe and effective ordering and delivery systems in place and people were given a choice of nutritious food and drinks. Risk was assessed appropriately and subject to regular review. Systems for recording incidents and accidents were extensive and effective.

The building and equipment were well-maintained in accordance with regulations. Staff were recruited safely and deployed in sufficient numbers to meet people’s needs. Effective measures were in place to manage the risk of infection. Staff were given adequate stocks of cleaning materials and personal protective equipment (PPE) to ensure the risk of infection was minimised.

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

Rating at last inspection

The last rating for this service was requires improvement (published 2 March 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve

Why we inspected

The inspection was prompted due to concerns received about the provision of care people received. We undertook this targeted inspection to ensure that the service was meeting legal requirements. To do this we examined risks relating to systems and processes, areas of risk management and safety monitoring and provisions that were in place to ensure people were living in a safe and well-maintained environment. This targeted inspection only focused on specific concerns and did not cover all key lines of enquiry, as a result the ratings for this service have not been changed. The ratings for this service will be reviewed as part of our next comprehensive inspection.

We found no evidence during this targeted inspection that people were at risk of additional harm from the concerns we had received since we last inspected.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Burrswood Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Therefore at the time of this inspection 106 people were living at the home.

Since our last inspection the home had changed ownership from Bupa Care Homes to Advinia Care Homes Limited. Because of the change in ownership this inspection is classed as the first inspection of the home although it has been in operation for many years.

People’s experience of using this service:

We were aware, and people, their relatives and the staff told us, that in the past year Burrswood had been through several significant changes. The home had changed ownership, there had been three registered managers of the service and internal restructuring of the staff team. These changes had affected morale and confidence in most parts of the service.

We found that the new registered provider demonstrated a commitment to continuing to drive forward improvements at Burrswood Care Home. This was being achieved by additional senior management support, face to face practical training and support as well as investment into the home.

At this inspection we found seven breaches in the Regulations relating to staffing levels, the safety of medicines management, people’s individual risk assessments, staff training, care plans, activities, particularly for people living with dementia, quality assurance and record keeping.

The providers quality assurance audits and systems had not identified the shortfalls we found to ensure good governance of the service.

Systems in place did not ensure that people received their medicines in a safe way. The registered provider took immediate action to address our concerns, however we need to sure that improvements are maintained.

People’s care records we saw showed that individual risk assessments were not always in place to help ensure they received safe care and support, for example, monitoring food and fluid intake, choking and moving and handling assessments.

People where supported by staff who had been safely recruited. However, we had concerns about staffing levels afforded to people to ensure they receive safe, responsive and dignified support by consistent staff who knew them well. This was particularly on Peel House nursing dementia unit where high levels of agency staff were being used.

People were not supported by staff who had received training and support to provide safe and effective care. The registered provider was working swiftly to address this matter and had plans to develop training for staff.

People told us they enjoyed their food. However, on Peel House, Kay House and Dunster House the hostesses, who had previously taken time to assist and monitor people with their food and fluid intake, had been removed and not replaced by an additional member of staff as had been agreed. The registered provider told us that this matter would be addressed.

People’s records had not been kept under review. This is necessary to ensure that staff are aware of people’s needs. The registered provider had yet to introduce their care plans and risk assessments. They were aware that a significant amount of work to do to implement the new paper work and plans were in place to ensure that staff were supported to complete this work.

We found that there were not enough activity co-ordinators in place or the resources needed to provide people with meaningful activity to help support their physical and mental wellbeing, particularly on the units were people lived with dementia.

Staff had received training in safeguarding adults and knew what action they should take if they witness poor care or they thought a person was at risk. They were confident that the manager would act to ensure people were kept safe.

People lived in a clean and comfortable environment and enjoyed the food provided.

People said they were always treated with respect and felt well cared for.

Rating at last inspection: This is the first inspection of this service under a new registered provider.

Why we inspected: This was the first inspection of the service under the new registered provider.

Improvement action: Please see the ‘action we have told the provider to take’ section towards the end of the report

Follow up: We will continue to monitor the service and carry out a further inspection within 12 months.