CQC report explained · a residential care home
What the CQC found at Burntwood Lodge
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found suitable risk assessments, enough staff, safe recruitment, robust medicines arrangements and a clean environment. Staff responded appropriately to accidents and incidents.
- Effective?
- Good
- Staff followed professional advice, supported healthcare appointments, provided enough food and drink, and had up-to-date training. People’s consent and best-interest decisions were considered.
- Caring?
- Good
- Staff knew people well and treated them with kindness, dignity and respect. People were supported to make choices and maintain independence.
- Responsive?
- Good
- Care was personalised and reflected people’s communication methods, preferences and routines. People had access to activities, day centres, holidays and outings, although the manager identified a need for more opportunities.
- Well-led?
- Good
- Relatives and professionals described the home as well managed. Audits and checks were carried out, but some care plans lacked important details.
What inspectors found, October 2019
Burntwood Lodge was rated Good; inspectors found safe, kind and personalised care, with some care records needing more detail.
Inspectors made an unannounced visit on 09 October 2019. They spoke with one resident, three relatives, three staff members and four professionals. They observed care and checked care, medicines, recruitment and management records.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that staff knew people well, supported their choices, followed guidance about risks and medicines, and helped people take part in activities and outings.
The main weakness was that some care records did not include all the information staff needed. This included advice about repositioning, a person’s seizures and people’s life histories. The manager said the records would be reviewed and updated. The previous inspection in March 2017 had also rated the service Good.
Staff knew people well
Staff understood how people communicated and used this knowledge to provide attentive, individual care.
“People were well cared for by staff who had a good knowledge of them and knew how they communicated individually.” from the report
Safe care and medicines
Inspectors found suitable risk assessments, enough staff and strong arrangements for storing and recording medicines.
“People received the medicines they required because medicines practices were robust.” from the report
Kind and respectful support
People were treated warmly and with dignity. Staff supported privacy, choice and independence.
“People were cared for by staff who knew them well and showed them kindness and attention.” from the report
Good links with health professionals
Staff sought and followed professional advice about issues such as pressure sores, choking, seating and nutrition.
“People were supported to access healthcare input when appropriate.” from the report
Positive management
Relatives and professionals gave positive feedback about how the service was run. The home used audits, surveys and outside advice to improve.
“Checks and audits were carried out around the service to help ensure the quality of care remained consistently good.” from the report
Some care records lacked detail
needs fixingSome important information was missing from care plans. This included professional advice about repositioning, a person’s seizures and some people’s life histories.
“However, we did find some information missing from people's care plans.” from the report
More activity opportunities were wanted
minorPeople had activities and outings, but the manager recognised that further opportunities and engagement would be helpful.
“Although people had access to activities, the registered manager recognised that further opportunities and engagement was desirable.” from the report
End-of-life information was basic
minorNo one was receiving end-of-life care during the inspection. Inspectors found only basic information about people’s wishes and the manager said care plans would be reviewed.
“Although no one was receiving end of life, we did note some basic information in people's care plans about their end of life wishes.” from the report
- 01How have you updated care plans to include professional advice about repositioning and information about seizures?
- 02How do you make sure a new staff member can quickly learn each person’s life history, preferences and communication needs?
- 03What extra activities and engagement opportunities have been introduced since the inspection?
- 04How are end-of-life wishes recorded and kept up to date?
- 05What was learned from the recent medicines recording error, and what changes followed?
This was an unannounced planned inspection covering all five CQC questions; the previous inspection in 2017 had rated every area Good. This explanation was written from the published report of 24 October 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, March 2017
Rated Good; inspectors found kind, safe and responsive care, with some records still being improved.
This was an unannounced inspection on 28 February 2017. The inspector reviewed care plans, medicines records, risk assessments, accident records, complaints, audits and staff recruitment files. They also observed care and spoke with the manager, two staff members, two relatives and one health and social care professional.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines practice, suitable training, kind care and activities that had improved since the previous inspection. People were supported to make choices, stay as independent as possible and access health services.
The previous inspection in February 2016 found two legal breaches about person-centred care and good governance. Inspectors found the required improvements had been made and that the regulations were now being met. Some mental capacity records were still incomplete, and daily notes and support plans remained work in progress.
Kind, familiar care
Staff knew people well and treated them respectfully. Inspectors saw that staff understood how people communicated and responded to their individual wishes.
“Staff displayed kind, caring behaviour and it was clear to see that staff knew people well.” from the report
Safe medicines practice
Medicines were stored securely and administration records were completed without gaps or errors. Staff also had guidance for medicines taken only when needed.
“Each MAR held a photograph to ensure correct identification of people.” from the report
More meaningful activities
People were supported to take part in activities inside and outside the home. Inspectors found clear improvement since the previous inspection.
“At this inspection we found things had improved as people were encouraged more to participate in activities.” from the report
Improved oversight
The home used audits, staff meetings and feedback to identify and address improvements. Inspectors found that earlier concerns about management oversight had been addressed.
“Regular audit visits by an external consultancy company took place to check the quality of the care being provided by staff” from the report
Some decision-making records incomplete
needs fixingSome mental capacity assessments and records of best-interest discussions had not been completed or recorded. The manager said this work was continuing.
“However we found that some records had not been completed and discussions around best interest meetings had not always been recorded.” from the report
Care records still developing
minorSupport plans had improved but were still a work in progress. Some daily notes were written in a task-focused way rather than describing the person's experience in detail.
“We found some of the daily notes were written in a task orientated way and spoke with the registered manager about this.” from the report
- 01How have you completed the mental capacity assessments and recorded best-interest discussions mentioned in the inspection?
- 02How do you make sure support plans stay person-centred and reflect each person's current needs?
- 03How do staff record what matters to the person, rather than only listing tasks completed?
- 04What activities and outings are currently available for someone with my relative's interests and abilities?
- 05How are relatives involved when care plans are reviewed or decisions are made for someone who cannot decide for themselves?
This was an unannounced inspection covering all five CQC questions and checking improvements required after breaches found at the February 2016 inspection. This explanation was written from the published report of 28 March 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Burntwood Lodge
3 rated inspections over 4 years: the service has improved, from Requires improvement to Good.
- October 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2016Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2014
Report published without a new overall rating.
- May 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- July 2013
Registered with the Care Quality Commission on 19 July 2013.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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