Burnham Lodge

Burnham Lodge is a nursing care home providing accommodation for a maximum of 60 people. At the time of the inspection 31 people were using the service which is operated from a large stately home set in vast acreage. Four floors offer bedrooms and facilities, including large communal dining areas, an activities room based in the conservatory and a large day room. Each bedroom has an en-suite with additional toileting and bathing facilities offered per floor.

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

We found risks to people using the service were not always clearly identified and managed. We also identified concerns in relation to the safe management of medicines. We made a recommendation in relation to systems in place to identify and respond to safeguarding concerns. People indicated they felt safe, with comments including, “I do feel safe here, the staff are sensible” and “Yes, I always feel safe living here, I am being looked after very well as far as I’m concerned.”

Staff were safely recruited. We observed positive interactions between staff and people, with some examples of less person-centred care also observed. The service utilised technology, providing staff with hand-held devices with access to people’s care plans, details of care tasks required, and a link to alerts from movement sensors and call bells.

Some people felt they would benefit from improved staffing continuity. People’s comments included, “Some of the carers are very kind and helpful, the carers do change all the time, sometimes it feels like they are never the same for long” and “Some of the staff are absolutely amazing here, although we rarely have conversations, those we have are always short… they simply haven’t got the time.” A relative also commented, “Generally the staff are very good, but she doesn’t like being washed by strangers…if she had regular staff it would make a difference to her.” A second relative commented, “I have no major concerns but he is not stimulated...it’s a fairly quiet atmosphere, some residents seem cheerful.”

We received positive feedback regarding the service’s environment. A relative commented, “The atmosphere is nice, they have amazing gardens and it feels like home.” Other comments from relatives included, “It’s very homely, friendly” and “They get tea and coffee throughout the day. The ambience is good, and the building warm and nicely furnished with a big TV.”

Systems were in place to monitor the quality and safety of the service, however these were not always fully effective and we found some gaps in recording, such as records used to document support given with personal and oral care. The service planned additional staff training to help improve documentation.

Systems were in place to engage with people and their relatives. Some relatives raised concerns regarding the accessibility of communication with the service, with particular difficulties in making telephone contact. Comments from relatives included, “[Registered manager’s name] always provides me with updates”, “The manager is okay, approachable, accessible and will get others to sort stuff out and then let me know” and “There was nothing before but recently they started having [relative] meetings…There was a couple of issues initially and I think they were acted upon but I did not get feedback.” The telephone system was due to be replaced.

People were generally 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 did not always support this practice.

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 Good (published 09 January 2020).

Why we inspected

We received concerns in relation to an increased number of falls resulting in injury and concerns expressed from families in relation to the quality of people’s care and communication with the service. As a result, we undertook a focused inspection to review the key questions of Safe 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.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe 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 Burnham Lodge 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 safe care and treatment and in informing the Commission of information they are required to.

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.

We found the following examples of good practice.

Visitors had their temperature taken and were asked about their health to identify signs of infection. There was clear signage and all visitors wore personal protective equipment (PPE). At the time of our visit the home was closed for non-essential visitors, but we observed a garden visiting area which had been in use. This promoted social distancing and included a canopy for the comfort of residents. The registered manager had also identified where a transparent screen would be used to accommodate safe visiting during winter months.

The home was registered to regularly test staff and people using the service for COVID-19 infection. The service had a good supply of testing kits and acted immediately where test results confirmed a positive result. Systems were in place to isolate affected residents to minimise the risk of infection spread. This included personalised infection control care plans, to ensure individuals were appropriately supported, with a one to one carer if required. People’s social and emotional needs had also been considered, and staff offered one to one activities.

We observed staff wearing appropriate PPE, including the use of face visors where additional eye protection was needed. PPE stock levels were monitored on a weekly basis and staff had received training on infection prevention and control. Audits took place to monitor infection prevention and control across the service.

Safe processes were in place to admit new residents from the community or a hospital setting. This included testing for COVID-19 and a period of isolation on arrival. We have signposted the provider to resources to support them to update their infection prevention and control policy to ensure it reflected their current admissions practice and relevant government guidance for new admissions.

We observed changes made to the service’s environment to help promote social distancing. Seating in dining areas had been arranged to ensure people were seated at a safe distance. Where people used communal lounges, staff encouraged people to sit at a safe distance from one another.

Regular cleaning was undertaken to minimise the risk of infection. In addition to routine daily cleaning, all staff worked together in sanitising areas which could pose a higher risk of cross infection four times daily. This included surfaces, door handles, hand rails and light switches. We observed this activity twice during our visit. We provided feedback regarding items in a fridge which required open-date labelling, the storage of personal belongings in a cleaning cupboard, and a janitorial sink which required sanitisation. All issues identified were quickly rectified before the end of our visit, and we were satisfied appropriate actions had been taken. The premises were generally kept in a clean and hygienic condition throughout and we reviewed completed cleaning schedules.

Further information is in the detailed findings below.

Burnham Lodge provides accommodation for a maximum of 60 people and also offers day care, where people could choose to visit for a day, a week or several weeks. At the time of the inspection 28 people were using the service which is operated from a large stately home set in vast acreage. Four floors offer bedrooms and facilities, including a hair salon, large communal dining areas, an activities room based in the conservatory and a large day room. Each bedroom has an en-suite with additional toileting and bathing facilities offered per floor.

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

The provider had acted to ensure the premises was safe to use for their intended purposes. Risks to people’s health and welfare were assessed and managed appropriately. We found all concerns found at our last inspection in December 2018 had been addressed.

People spoke positively about the caring nature of staff. A relative commented, “(Care is) amazing! Can't ask for anything better. Staff are kind, caring, friendly. They’re always great and address us and [name of family member], very welcoming."

Throughout our visit we observed warm, friendly interactions from staff towards people. People received care and support from staff who knew and understood their care and support needs. People and relatives felt they were able to express their views and staff ensured their privacy and dignity was maintained, and their independence promoted.

People said they generally felt safe. Staff understood the signs of abuse, reporting procedures and had attended the relevant training. A person told us of instances when they did not feel safe. We discussed this with the management team who told us they would look at ways of improving the person’s experience of feeling safe. Recruitment checks ensured people were cared for by staff who were suitable. We found there were enough staff to provide care and support to people. There were safe medicines management and infection control procedures.

The service had participated in a hydration project with the local clinical commissioning group (CCG) which had resulted in improved hydration for people. Staff had the qualifications, competence and skills necessary for the work to be performed by them. Care records documented how people wanted to be cared for but, did not identify all individual needs which related to the protected characteristics identified in the Equality Act 2010. We have made a recommendation about this.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests; as the policies and systems in the service did support this practice. We found the service acted in accordance with the Mental Capacity Act 2015.

People’s care and support needs were assessed to enable staff to meet their specific needs. Care records were detailed and documented people’s preferences for care, such as end of life care. However, this was not always clear when it came to people’s preferences for staff based on their gender. We have made a recommendation about this.

The service did meet the requirements of the Accessible Information Standard (AIS) but management acknowledged they were not familiar with the AIS. Information contained in care records was detailed, documented if people had disabilities or sensory impairments, showed what people’s level of communications were and how staff should support them. People were supported and had the choice to be socially active and they knew what to do if they had any concerns. The provider operated an accessible system for identifying, receiving, handling, and responding to complaints.

People and relatives felt the service was well-led. A relative commented, "Best care anywhere. [Name of family member) didn't want to come to a care home but they (staff) helped them settle. Better than we thought. Quality of life has improved since [name of family member] has been here."

We found the service had robust and effective systems in place to assess, monitor and improve the quality and safety of services provided.

Rating at last inspection and update: The last rating for this service was requires improvement (published 7 June 2019). 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.

Why we inspected:

This was a planned inspection based on the previous rating.

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.

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

This inspection was completed on 17 and 20 December 2018, by two inspectors. The inspection was unannounced, which meant the provider did not have any advanced knowledge of the date of the visit.

Burnham Lodge 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 can accommodate a maximum of 60 people in the premises with 49 bedrooms, and the remainder as day patients. At the time of the inspection 36 people were using the service which is operated from a large stately home set in vast acreage. Four floors offer bedrooms and facilities, including a hair salon, large communal dining areas, an activities room based in the conservatory and a large day room. Each bedroom is en-suite with additional toileting and bathing facilities offered per floor.

The service has a registered manager. However, at the time of the inspection, the registered manager had been on maternity leave for 11 months. The service was overseen by the deputy manager, and a peripatetic management team. 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 were not kept safe. Adequate risk assessments and comprehensive documentation were not in place to ensure people were offered responsive, safe care and treatment. Staff could not always tell us how to safely care for people and meet their needs, and people's care plans and risk assessments contained conflicting and inaccurate information. The inconsistent information meant people were put at risk of harm.

Medicines were not always managed safely. Whilst we found that medicines were stored in people’s rooms, temperatures were not maintained, therefore were at risk of the efficacy of medicines became altered. Furthermore, the method of administration was not in line with best practice guidance, or with the provider's own medicine administration policy.

People were not being kept safe due to a failure in appropriate monitoring and recording of the environmental risks and risks to people. The service did not have robust recruitment processes in place to ensure staff employed were safe to work with people.

Nutrition and hydration records were maintained for all people. However, information was not cross referenced or analysed as required. As a result, some referrals were not made to health professionals to seek further clarity on change in people’s hydration and nutrition.

Staff were not supported with adequate training, with their training not always being in date. Staff did not have training that would help them meet people’s changing needs.

Effective systems were not in place to audit care documentation and identify any shortfalls in the quality and safety of care provided.

People's care was not always delivered in a dignified way. Privacy was not always protected, with bedroom doors being left open for most of the day and night. Care was found not to be responsive to people’s changing needs, and often not effective. People were not always consulted about how they wished to have care delivered, or were not consulted prior to being assisted. This meant that whilst staff had received training in the Mental Capacity Act, they did not practice the fundamental standards of the legislation. Furthermore, people were having their liberty restricted without confirmation from the local authority that this was authorised.

The management completed ad hoc audits. The provider did not have a comprehensive overview of the service. Whilst a management structure existed, this was not effective in ensuring governance of the provision. Information was not always analysed or passed to the correct people, leading to errors in care delivery and poor management. The service, although did not specialise in delivering care to people living with dementia, had a number of people residing at the service with the onset of this condition. The service did not environmentally meet the needs of the people.

During the inspection we identified several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As one domain has been rated Inadequate we will inspect again within six months and if this or any other domain were to be rated Inadequate at the next inspection, the service would be placed into special measures.

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

This inspection was undertaken on the 26 & 27 January 2016 and was unannounced.

Burnham Lodge had a registered manager in place. 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.

Burnham Lodge is a large period property located in Burnham, Buckinghamshire. Burnham Lodge is set over four floors and is a registered nursing home. The home provides care to people who require assistance with personal care and nursing needs. Staffing at Burnham Lodge consists of registered nurses, care assistants and domestic staff.

We found people were receiving good care at Burnham Lodge. People were protected from harm as there were appropriate risk assessments and staff training in place. Medicines were managed in a way which prevented potential harm and promoted people’s rights.

People were cared for by staff who were polite, caring and responsive to their needs. When people requested assistance, staff acted promptly. People we spoke with were complimentary about the staff team at Burnham Lodge.

People’s needs were assessed to ensure their needs were met in a way which promoted their rights, dignity and privacy. Where people required support with their nursing needs, these were done by clinical staff who had the knowledge and skills to promote people’s wellbeing.

We found there to be clear management oversight of the service. Many positive changes had occurred since the new manager came into post which appeared to have a positive impact on the people living at Burnham Lodge.

People were supported to access a range of activities and we observed these to be well received by those who participated. People had free access to the grounds of Burnham Lodge. The home was well maintained and had a homely atmosphere. People told us they were happy living at Burnham Lodge.

We spoke with five people who lived in Burnham Lodge and one relative. One person told us "I am very happy here, I choose what I like to eat and activities I want to take part in." Another person said "The food is lovely, always plenty of it and we have many options to choice from." A third person told us "All the staff here respect me and my choices and my dignity and independence is respected." A relative we spoke with told us "I come very often here, and I have always found the staff respectful and they respect people's dignity and independence."

The home had a policy in place, which clearly set out how mealtimes should be planned to ensure people's choice, dignity and independence were promoted. The manager had introduced dining room audits, to ensure staff respected people's dignity and independence.

We found people could now be confident that important events that affected their welfare, health and safety were reported to the Care Quality Commission so that, where needed, action could be taken.

We found people were involved in making decisions about their care and were offered choices in what they wished to eat and activities they wished to take part in. However, people's dignity was not always respected and promoted. People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found there were enough qualified, skilled and experienced staff to meet people's needs. We found that events which affect people's welfare, health and safety were not being reported to the Care Quality Commission as required.

People said they received their medicines at the right time. We spoke to a person who was managing their own medicines. The person said, 'I am able to take my medication by myself. Staff keep my medication in a safe place and assist me by getting what I want when I request it.'

People said their bedrooms were cleaned daily. A visitor we spoke with said, 'The home is spotless.'

People said staff supported them to maintain their independence.

People described staff as 'most helpful, pleasant, polite and professional.'

We found people received the appropriate care and support that met their needs. People's medicines were safely administered. The environment was appropriately maintained to promote people's safety and wellbeing. The service ensured there was an effective recruitment and selection procedure in place. Staff were appropriately trained, supervised and appraised.