CQC report explained · a residential care home
What the CQC found at Burton House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People told inspectors they felt safe. Recruitment checks, safeguarding procedures, risk assessments, medicines systems, cleaning and incident reviews were all found to be satisfactory.
- Effective?
- Good
- Care was planned around people's needs, choices and goals. Staff received induction, training and support, although some care plan information was recorded even when it was not relevant.
- Caring?
- Good
- Staff knew people's preferences and treated them with kindness, compassion, dignity and respect. People were involved in decisions about their care and activities.
- Responsive?
- Good
- People had individual care packages and regular reviews. They could choose whether to take part in activities, and information could be provided in different ways.
- Well-led?
- Good
- Changes to the management structure and new audits improved oversight. Inspectors said the systems needed time to become fully consistent.
What inspectors found, August 2019
Burton House was rated Good; inspectors found kind, person-centred care and improvements since the previous inspection, with some records still needing tidying.
This was a planned inspection following the previous Requires Improvement rating. Inspection activity took place on 8 May, 6 June, 26 June and 1 July 2019. Inspectors visited the home and office, met the three people living there, and spoke with staff, relatives and professionals.
Inspectors rated all five areas Good: Safe, Effective, Caring, Responsive and Well-led. They found people were supported to make choices, build independence and take part in activities they valued. Staff were described as kind, well trained and familiar with people's needs and preferences.
The provider had improved recruitment, management oversight, care planning and record-keeping since the previous inspection. Inspectors identified some minor areas to improve, including the usefulness of some care plan information, recording portion sizes where weight was a concern, following up some applications, and recording verbal complaints more formally.
Choice and independence
People were supported to make decisions, develop skills and become more independent. Their daily routines and activities were based on their own preferences.
“People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.” from the report
Kind and respectful staff
Staff knew people's interests and communication styles. Inspectors saw staff give people time, privacy and reassurance.
“Staff consistently treated people with a very kind and compassionate manner.” from the report
Meaningful activities
People were supported to attend clubs, community activities, education, work placements and social events. They could choose whether to participate.
“People led their own activities programme and decided whether to participate or not.” from the report
Improved safety systems
Recruitment, safeguarding, medicines, risk management and incident review systems had improved since the previous inspection.
“Thorough assessments had been undertaken of the suitability of staff to work with people supported by the service.” from the report
Care plan information
minorCare plans were detailed, but the standard format sometimes included information that was not relevant to the person. Inspectors said this did not affect the care provided.
“We found that the standardised format of the plans meant that sometimes information was recorded when not required or relevant to individuals.” from the report
Food and drink records
minorWhere weight loss or weight gain was a concern, records would have been more useful if they included portion sizes.
“When recording this information specifically if there are concerns about weight loss/weight gain information regarding portion size would make records meaningful.” from the report
Follow-up records
needs fixingInspectors asked the service to record follow-up action on applications relating to possible deprivation of liberty.
“We asked the service to keep records when they had followed up on application progress with the local authority.” from the report
Verbal complaints
needs fixingVerbal complaints from people were recorded in care planning records rather than in the complaints register. Inspectors said using the register would give managers a better overview.
“Improvements could be made to incorporate any verbal complaints made by people using the service.” from the report
New management systems
needs fixingThe new management structure and audits were working, but inspectors said they needed more time to become consistent.
“The improved structure and the audits in place were effectively monitoring the service but needed time to embed and achieve the necessary consistency.” from the report
- 01How do you make sure care plans contain only information that is relevant to the individual?
- 02If someone is losing or gaining weight, how do you record the food and portion sizes they receive?
- 03How do you record and review verbal complaints made by people living in the home?
- 04How do you track applications and follow-up actions with the local authority?
- 05How are the new management systems and audits being kept consistent?
This was a planned inspection covering all five CQC questions, with visits to the office and home, checks of one person's care records and records for staff, medicines, incidents and quality monitoring. This explanation was written from the published report of 23 August 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, June 2018
Rated Requires Improvement; care was kind and personalised, but recruitment, decision-making and management checks were not reliable enough.
This was an unannounced inspection on 7 February 2018. Inspectors spoke with two people, two relatives and seven staff. They reviewed three people's support plans, staff recruitment files and other records. The provider sent further information on 21 February 2018.
The home was caring and responsive. Staff treated people with kindness, knew their needs and supported meaningful activities and independence. There were enough staff on the inspection day, the home was clean, medicines were generally stored and given safely, and risk assessments were detailed.
However, some staff recruitment checks were incomplete or did not follow the provider's own policy. Records about people's decision-making, best interests and communication were unclear or contradictory. There was no separate plan for one person's as-needed pain medicine, and incident records did not always show what action had been taken.
The overall rating changed from Good at the 2015 inspection to Requires Improvement. The home breached regulations about staff recruitment and good governance. Caring and Responsive were rated Good, while Safe, Effective and Well-led were rated Requires Improvement.
Kind and respectful staff
Inspectors saw warm interactions. Staff supported people with dignity and understood their individual preferences.
“We observed kind, caring, familiar and warm interactions throughout the duration of our inspection.” from the report
Personalised support
Support plans included people's routines, communication needs, preferences and ways to promote independence.
“People received care and support which was personalised to suit their needs.” from the report
Detailed risk planning
Risk assessments gave staff specific guidance on keeping people safe while respecting their choices and dignity.
“Risk assessments were highly detailed and contained information around how to keep the person safe from harm, whilst ensuing their rights and choices were protected.” from the report
Meaningful activities
People had varied activity plans and were supported to take part in the community and complete tasks independently.
“People engaged in activities which were meaningful and they were encouraged to be independent while completing tasks.” from the report
Incomplete recruitment checks
seriousSome staff files were missing references, employment or education details, medical fitness information and clear DBS information. The provider did not always follow its own recruitment policy.
“This is a breach of Regulation 19 of the Health and social care act 2008 (Regulated Activities) Regulations 2014.” from the report
Unclear capacity and consent records
needs fixingSupport plans sometimes gave conflicting information about what decisions people could make. Best-interest meetings and people's communication methods were not always clearly recorded.
“This meant that although some decisions and choices were documented the records regarding capacity and consent were not always accurate or consistent throughout the support plans we viewed.” from the report
Incident follow-up was unclear
needs fixingSome incident records did not show what action the manager had taken to prevent problems happening again. Related information was also missing from one person's support plan.
“So we could not be sure action had been taken.” from the report
Management checks missed problems
seriousThe home carried out regular audits, but these did not identify several issues found during the inspection. This was a breach of the good governance regulation.
“This is a breach of Regulation 17 of the Health and social care act 2008 (Regulated Activities) Regulations 2014.” from the report
- 01Have all staff recruitment files now been completed, including references, employment history, medical fitness information and clear DBS checks?
- 02How do you record capacity assessments, best-interest decisions and the communication methods used by people who are non-verbal?
- 03What written plan is now in place for each person's as-needed medicine, including when it should be offered?
- 04How are incidents reviewed, followed up and added to support plans so that action is taken to prevent them happening again?
- 05What checks now make sure the home's audits identify problems with recruitment, records and care planning?
This was an unannounced inspection of the regulated care home and all five CQC areas; the report notes that the separate day service was not regulated by CQC. This explanation was written from the published report of 8 June 2018 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 Burton House
3 rated inspections over 4 years: the service has held its Good rating throughout.
- August 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2014
Registered with the Care Quality Commission on 24 June 2014.
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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