Burrswood Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The provider had been proactive in promoting a culture of safety. People felt safely supported and relatives confirmed, their relation was safe. Staff could confidently describe safeguarding processes and were supported to raise any concerns they had without fear of blame or reprisal. The management team were open and honest and continually identified learning to embed good practice. Accidents and incidents were recorded and reviewed to reduce repeat occurrences. Risks were assessed and staff provided care and support in the least restrictive way. People at risk of falls had strategies in place to reduce the risk of falling and injuring themselves. People who may become distressed were supported in a person-centred and positive, risk-based way which had been proven in reducing levels of agitation. People were supported safely with weight management, ensuring their skin integrity was cared for and where they were at risk of choking. The environment was safe and internal and external checks were completed as required. Staff were recruited safely and were supported with a robust induction, training, and supervision. The home was clean and infection control processes were followed. There had been vast improvements in the safe management of medicines. We identified some low-level concerns which were rectified immediately.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us, there had been huge improvements in openness, and they felt concerns and incidents were now reported and investigated with outcomes shared. A relative told us, “Yes, they keep me informed. I have a good relationship with the staff, they are easy to talk to and the let us know. I believe [Name] is well looked after with the right sort of care.”

The management team had been proactive in learning from the last inspection, and it was evident they had worked to improve the culture of safety, honesty, transparency, and good practice. The registered manager told us, staff were open to reporting anything concerning or which hadn't gone quite right as there was a positive culture of learning rather than blame. Staff told us they felt well-supported to speak up and share concerns. Staff now felt with the new management team in place, there was less emphasis on blame and more emphasis on learning from events. From speaking with the management team, they wanted to continually improve, continue to embed current practices, and continue to work in partnership with other health and social care professionals, residents, families, and the Care Quality Commission to achieve the best outcomes for the people living at the home. Staff told us they were able to reflect on accidents and incidents with the management team which allowed them to understand what they could do differently if a similar accident or incident should occur again.

Reporting process for accidents and incidents were in place and staff were aware of how they should record information. A route cause analysis was completed for some incidents to mitigate repeat occurrences and to share learning.

People told us they were referred onto other health support services if required. A relative told us, the care plans had been developed when the person was in hospital, and they involved the doctor from the ward which meant there was continuity of care once the person moved into the home.

Staff told us, they reported any concerns in relation to people’s health to more senior staff. This resulted in other professionals such as GP’s or social workers being contacted, and further health care and support being planned in the person’s best interests.

Partners told us the management team were proactive when people were moving between care services. Partners had received positive feedback from a hospital following an admission from the care home regarding the high levels of information which had been shared in the best interests of the person.

We saw where risks were identified, appropriate referrals were made to the speech and language team, falls teams, and district nurse support among other services. Where people had a planned or emergency admission to hospital, appropriate care information, medicines records and care assessments were submitted with the person to inform the hospital of their immediate needs.

People and their relatives were confident any concerns they had would be acted upon immediately. This had given relatives the confidence, the home was being well-managed and safeguarding concerns were addressed and shared with the relevant authorities. People told us they felt safe living at the home and while being supported by the staff. A relative told us, “I feel [Name] is safe when I leave. [Name] is in capable hands.”

The registered manager felt staff were being more open and transparent about concerns and they were keen to work in a no blame culture and learn from incidents. Staff now felt they could raise concerns to the management team without fear of reprisals. Staff were able to explain the safeguarding processes and were able to describe signs and symptoms of what may constitute abuse. Staff were aware of those people who didn’t have the capacity to make decisions and were able to describe who had a deprivation of liberty in place to provide care and support in the person’s best interests.

We observed people being offered choices and being supported to make decisions as to where they spend their day, meal choices, if they joined in activities or wished to spend time alone. It was evident staff knew people well. We observed strategies being deployed to reduce levels of agitation.

Safeguarding concerns were being reported and logged as per local and national policies and guidance. The local authority safeguarding team felt the home were proactive in reporting concerns and sharing investigation outcomes. Safeguarding policies were in place. Staff received training in safeguarding vulnerable people. The provider had worked with the local authority safeguarding team since the last inspection to implement and embed safeguarding arrangements.

People were involved in managing risks. Relatives told us, people were supported to reduce the risk of falling with the use of monitoring equipment and falls mats. Relatives told us, they were aware if their loved one received a modified diet and were confident staff knew how to support people who were at risk of choking. One relative told us, “[Name] had fallen out of bed. They (staff) took [Name] to hospital and dealt with it well. They put a monitor on the bed, so they know if [Name] does try to get out and they check.”

Staff told us they had been encouraged by the management team to develop new strategies to manage risk, especially for those people who were at risk of distress and agitation. Strategies had been put into place to support people to have wider access to the home which allowed them to walk with a purpose and become less distressed. Staff told us, they had been able to communicate with people to understand why they were distressed. Staff were aware of people’s individual risks and could describe strategies to reduce risks to people.

We observed people being supported with specialist moving and handling equipment in a safe and person-centred way. Staff communicated with the person all the way through the transfer. We saw staff using prescribed fluid thickener for those people at risk of choking and it was recorded when it had been administered. We observed people who were at risk of becoming agitated, spoken to in a kind and meaningful interaction and supported to redirect their attention to another activity.

Risk assessments were in place and recorded the risks people were exposed to. Information in risks assessments captured how risks should be reduced. Staff were aware of the risk assessments in place and were able to read them via the electronic care planning system. Risk assessments were reviewed monthly or more often if required.

People told us they were supported in a safe environment. One person told us, they felt safe as the doors were locked and unauthorised people could not access the home. Relatives spoken with confirmed their relation was safe while living at Burrswood Care Home.

Staff were aware to report any concerns with the environment or equipment immediately. The home had a dedicated maintenance team who were able to rectify minor concerns promptly. Staff were aware they should check equipment to ensure it was in full working order prior to using it. Staff were aware of who had monitoring equipment in place such as bed sensors and falls mats and ensured they were regularly checked. Staff ensured nurse call alarms were in reach of people when they were in their bedrooms. Staff had taken part in fire drills and were aware of procedures to follow in the event of the fire alarm sounding.

The environment was safe and free from risks such as slips, trips and falls. We observed staff check fall’s mats were in place for when people were in bed. Staff ensured nurse call alarms were in reach. We observed staff using moving and handling equipment safely and storing hoists and slings suitably.

Internal and external checks of the environment were completed by competent people at regular intervals. Where improvements had been identified, these were actioned promptly. All equipment including fire fighting systems, nurse alarms, emergency lights, gas and electrical safety had been regularly serviced in accordance with manufacturers instructions. Internal safety checks completed by the maintenance team included portable appliance testing of the electrical equipment and the checking of water temperatures. Processes were in place to support the home in situations such as a power loss. Electronic care planning systems were backed up to a cloud and written records could be used to record care interventions.

People told us, there was enough staff on duty. Comments included, “Oh yes, day, nights and weekends, I never have to ring my bell.” and “There appears to be (enough staff). If I ring my bell, they come quite quickly.” We received mixed feedback from relatives about staffing levels. Comments included, “They could do with more staff, the staff do more and above.” and “I don’t think the patient to staff ratio is enough. There is a senior and there should be 4-5 staff members on each unit.” Another relative told us there had been some staff changes and staff generally cover any sickness between them. We did not see any evidence staffing levels impacted upon people’s care and support. People and relatives felt staff were experienced and had the correct training.

Staff told us, staffing levels were manageable. There was a plan in place to increase staffing levels when the home reopened to admissions. Staff told us they were regularly provided with training and supervision and were encouraged to develop their skills and obtain additional qualifications. Nurses had been provided with additional clinical training and some staff had been given additional responsibilities to help them to progress. The registered manager told us they were looking to continually develop the staff team.

We found staffing levels during our visit to be satisfactory. Staff were responsive to people’s needs. Staff were regularly checking on people in their rooms and we found staff to be attentive and to be supporting people effectively. We observed a staff member speaking with a person in their first language which reduced the individuals’ anxieties. We observed staff knew people well. We observed the registered manager knew everyone by their preferred name and was able to communicate with people in a person-centred manner. People were relaxed and happy in their environment.

Staff were recruited safely. All pre-employment checks had been completed. Staff received an induction and training to support their job role. Training records confirmed the training staff had obtained. Rotas showed a consistent staff team were on duty at all times. Dependency levels were reviewed monthly to ensure the correct numbers of staff were on duty. Staff received supervision from their line managers and were involved in daily huddles and staff meetings to share information in the best interests of the people they were supporting.

People and relatives told us, the home was always clean and house-keeping staff worked each day. People confirmed staff used personal protective equipment such as gloves and aprons when required.

Staff told us they had access to personal protective equipment (PPE) such as gloves and aprons. Staff were able to describe when they should use PPE and how they disposed of it. Nurses told us they used the appropriate waste facilities for dressings and sharps. Staff told us, they were aware of how they should report any illness which may cause an outbreak in the home.

The home was clean, tidy, and free from malodours. House-keeping staff worked alongside cleaning schedules to ensure the environment was clean. Kitchen areas were clean, and the home had a 5-star food hygiene rating. Staff were disposing of waste in the appropriate bins. We observed staff accessing, using, and disposing of personal protective equipment appropriately.

Cleaning records were completed to show what areas had been cleaned and when. House-keeping staff worked across the home, 7 days a week. All staff received training in infection, prevention, and control. Staff had their competency checks to ensure the were following appropriate hand hygiene routines. Licensed contractors were appointed to regularly dispose of waste. Kitchen records were fully completed.

People told us, they received their medicines when they should. One person said, “Yes, I do. The staff discuss it with me if they are changing my medication. I always get it at the right time.” A relative told us, “I do see evidence that they administer [Names] medication as required and painkillers if and when needed.”

Staff told us they were confident in using the electronic medicines record keeping system and had received appropriate medicine’s training to enable them to give people their medicines safely. Staff worked with healthcare professionals to make sure people were not over medicated and ensured people got their medicines on time. People always had an adequate supply of their medicines.

Since our last inspection significant improvements had been made in the safe management of medicines. Medicines were all accurately accounted for and were given as prescribed. However, some medicines were not always administered in line with the manufacturers’ directions. The management team updated these records immediately. Homely remedies had been introduced into the home so everyone could be treated for minor ailments without delay. When medicines need to be given covertly (hidden in food or drinks) some information was available from health care professionals to help staff give medicines in this way, but more information was required to ensure they were always given safely. Records about the use of creams and thickeners had improved however there were inconsistencies and gaps in the records, and they could not always show they had been applied/given safely. Following this, the management team provided additional training to staff around recording. The protocols for assessing when people needed their medicines which had been prescribed ‘When required’ had improved.