Archived: Bursted Houses

The service had a registered manager in post. 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 and associated Regulations about how the service is run.

At this inspection we found a breach of regulations because pressure relieving equipment was not always used safely. Improvement was required because systems were not in place to monitor the use of pressure relieving equipment to ensure it was safely used, and action had not always been taken in response to audit findings to improve the quality and safety of the service. Improvement was also required to ensure the service consistently complied with any conditions placed on people’s Deprivation of Liberty Safeguards (DoLS) authorisations.

People were protected from the risk of abuse because staff were aware of the action to take if they suspected abuse had occurred. Medicines were administered to people as prescribed and were stored securely. The provider followed safe recruitment practices when employing new staff and there were sufficient staff deployed within the service to meet people’s needs.

Staff received an induction when starting work at the service and were supported in their roles through training and regular supervision. People were supported to access a range of healthcare services when required and to maintain a balanced diet. Staff were aware of the importance of seeking consent from the people they supported and worked within the requirements of the Mental Capacity Act 2005 (MCA) where people had been assessed as lacking capacity to make decisions for themselves.

People and relatives told us that staff were caring and considerate. Staff treated people with dignity and respected their privacy. People were involved in day to day decisions about their care and treatment and people and relatives also had involvement in their support planning. Support plans included information about people’s individual needs and preferences.

The provider had guidance in place on how to raise complaints in formats suitable for people’s needs. People and relatives told us they knew how to raise a complaint should they need to do so. Staff spoke positively about the management of the service and told us they worked well as a team. People and relatives’ views on the service were sought through an annual survey and the feedback received by the service indicated they were happy with the care and support they received.

We also identified further breaches of regulations because staff had not received refresher training or supervision on a regular basis, in line with the provider’s policy. Risks to people were not always managed safely and people’s risk assessments had not always been reviewed and updated in response to changes in their conditions. People were not always lawfully deprived of their liberty under the Deprivation of Liberty Safeguards (DoLS) because the provider had not always complied with the conditions places on people’s DoLS authorisations. Following our inspection, the provider wrote to us and told us how they would address these issues.

We carried out this unannounced focused inspection of the service on 01 September 2016 to check that the requirements of the regulations had been met in response to the breaches we had identified and enforcement action we took. This report only covers our findings in relation to the follow up on the breaches of Regulations 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and to improvements made in response to our findings regarding the responsiveness of the service during our last inspection. You can read the report from our last inspection, by selecting the 'all reports' link for 'Bursted Houses' on our website at www.cqc.org.uk.

Bursted Houses provides accommodation and support for up to 23 people across five separate units. At the time of our inspection the service was providing support to 19 adults with learning disabilities.

At this inspection on 01 September 2016 we found that the provider had addressed the breaches of Regulations 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that medicines were safely stored and managed, however further improvement was required because one person had not received a dose of a medicine as prescribed.

Risks to people had been assessed and risk assessments reviewed on regular basis to ensure they remained reflective of people’s current needs. Staff were aware of the areas of risk to people and knew the action to take to manage risks safely. People were lawfully deprived of their liberty where it was in their best interests under the Deprivation of Liberty Safeguards (DoLS) and the provider complied with any conditions placed on people’s DoLS authorisations.

Staff were supported in their roles through training and regular supervision. The provider had systems in place to monitor and mitigate risks to people and staff had taken action to make improvements in response to any issues identified during the monitoring of the service. We also found improvements had been made to ensure people's support plans were up to date and reflective of their current needs and views.

We have revised and improved our ratings for the key questions 'Is the service effective?', 'is the service responsive?' and ‘Is the service well-led?’ to 'Good' in response to the improvements found during this inspection.

Bursted Houses provides accommodation and support for up to 23 people across five separate units. At the time of our inspection the service was providing support to 19 adults with learning disabilities.

A registered manager had not been in place since the end of 2015 although the current service manager was in the process of applying for the position. 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.

At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Medicines were not safely managed. Risks to people had not always been assessed and were not always safely managed. People were not always lawfully deprived of their liberty because conditions placed on their Deprivation of Liberties Safeguards (DoLS) authorisation had not always been met. Staff had not always been supported through regular supervision and training. The systems used by the provider to identify and mitigate risks to people and to drive improvements within the service were not always effective. You can see what action we told the provider to take in respect of these breaches at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There were sufficient staff deployed within the service to meet people's needs and the provider undertook appropriate recruitment checks before employing staff to ensure they were suitable for their roles. People were protected from the risk of abuse because staff knew the action to take if they suspected abuse had occurred.

Staff sought consent from people when offering them support and demonstrated a good understanding of the Mental Capacity Act 2005, although improvement was required to ensure best interests decisions were recorded where people had been assessed as not having capacity to make specific decisions.

People were supported to maintain a balanced diet and to access healthcare services when required. Staff treated people with dignity, kindness and consideration. People's privacy was respected and they were involved in day to day decisions about the support they received.

Support plans were person centred and reflected people's strengths and preferences but improvement was required to ensure they remained reflective of people's current needs and conditions. The provider had a complaints procedure in place and people knew who to talk to if they had any concerns. Relatives spoke positively about the management of the service and staff told us the management team were available to support them when needed.

Care planning and reviews took place regularly with involvement from people who used the service. People's ability to consent to their care had been assessed, and care plans were in place and agreed by people who used the service or their social worker. However there were no independent people involved, such as family or advocacy, in decision making for some people who were unable to make decisions themselves about their care.

We found that the staff understood people's care needs, how to protect them from risk and harm, and how to provide activities for them. People were provided with a choice of suitable and nutritious food and drink.

The provider ensured that safe recruitment practices were adhered to in order to keep people safe. Appropriate procedures were in place to deal with concerns and complaints, and people had been informed of their rights to complain.

People told us that they had choices in their daily lives and others said that people were treated as individuals. They also said that they had no complaints. Other people we spoke to said that they had been kept informed of any changes or developments and that communication with the staff group was good. People also told us that they had been involved in the care and treatment planning for their relative.