About the service: Burnside Court is a residential care home that was providing personal and nursing care to 22 people at the time of the inspection.

People’s experience of using this service: On the day of the inspection we observed medicines were not being safely administered and people were at risk of receiving the wrong medicine. The inspection took place at the weekend when there was not normally a manager present. We were assured this method of administering medicines was not normal practice but were concerned the lack of oversight at weekends could lead to care practices falling below acceptable standards. The registered manager said they would look at introducing spot checks to monitor care standards more effectively.

Care plans contained information about people’s health and social needs and were regularly reviewed. Risk assessments had been developed across a range of areas. Some people had specific health conditions and there was not always a relevant care plan or risk assessment in place to describe their individual needs and guide staff.

Systems to prevent cross infection were not robust. There were no cleaning schedules in place, slings were shared between people and hand gel dispensers were empty. The registered manager told us this would be addressed.

Staff knew people well and there was a relaxed and comfortable atmosphere. People chatted with each other and staff and some people sang along to the radio. People moved between their own rooms and the shared lounge/dining area as they chose. The office door was normally open and people were clearly used to going into the office to chat with the management team.

People and relatives were highly complimentary of the service and no-one had needed to raise a complaint. They told us the registered and assistant manager were approachable and they would be confident raising any issues.

The service was based in an old style property and accommodation was arranged over four floors. Due to the layout of the premises, the registered manager considered people’s mobility and cognitive abilities when assessing their needs. Some redecoration was being carried out at the time of the inspection. The registered manager said this was a continual process due to the age of the property.

Staff received an induction and regular training and supervision. They told us they were well supported and encouraged to develop their skills. The registered manager did not receive any formal supervision. However, they told us the provider was communicative and supportive. They were pro-active in developing their skills and had systems in place to help ensure they were up to date with any developments in the care sector.

At our previous inspection the service was rated Good (report published 9 September 2016). At this inspection the rating had dropped to Requires Improvement.

Why we inspected: This was a scheduled inspection and was planned based on the previous rating.

Enforcement We identified breaches of the regulations in respect of the administration of medicines and governance. Details of action we have asked the provider to take can be found at the end of this report.

Follow up: We will ask the registered provider to send us an action plan outlining how they will address the concerns identified at our inspection. We will check to see the necessary improvements have been made in accordance with our re-inspection programme. If we receive any information of concern we may re-inspect sooner.

This unannounced inspection took place on 29th July and 1st August 2016. The home was previously inspected in August 2014 and the home was meeting the regulations we looked at.

Burnside Court is a residential home in Paignton, Devon providing accommodation and care for up to twenty six people. People living at the home are older people, most of whom were living with dementia. On the day of our inspection, twenty three people were living at the home. Accommodation was provided over three floors, accessed by lifts and stairs. All bedrooms had en-suite facilities. The home had an attractive garden, and a small patio and car parking area.

The home had a registered manager. 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.

On the first day of our inspection Burnside Court were holding their annual BBQ party. We had the opportunity to speak with people, friends and relatives about the care at the home. Without exception everyone we spoke with had nothing but praise for the kindness and care shown by staff at Burnside Court. There was a real family atmosphere and it was evident that staff considered the people they supported and their families, as friends.

People told us that they were happy and felt well cared for. It was clear to see that people were comfortable living at Burnside Court and really felt they were at home. People’s care was personalised and detailed, and it was evident that staff knew people they were supporting very well. We saw them interacting with kindness and compassion. People and their families described management and staff as caring, respectful and approachable. The families we spoke with had regular contact with the registered manager.

People told us they felt safe, and we found that the registered manager had a number of systems and processes in place to promote safety. Staff received training in and understood their responsibilities in relation to safeguarding vulnerable adults. Staff were knowledgeable about how to recognise and report abuse. We saw risk assessments in place regarding risks associated with people's care. These explained how people's care should be delivered in a safe way and how to reduce any risks involved.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people were deprived of their liberty applications had been appropriately made. For people who were assessed as not having capacity, records showed that their advocates or families and other health professionals were involved in making decisions in their best interests.

Staff had been recruited appropriately to ensure they were suitable to work with vulnerable adults. People who lived at the home, families and staff told us there were sufficient numbers of staff on duty at all times.

Staff knew how to meet people’s needs. Records showed they had a thorough induction and on-going training to help ensure they had the skills and knowledge they needed to provide effective care. We saw staff received regular supervision as part of their on-going development. This provided an opportunity to discuss their work, any concerns and any training opportunities they may have. We saw appropriate records were maintained to show these had taken place.

We looked at the way in which the home managed people’s medicines. Medicines were secured safely and accurate records were maintained. Staff received regular competency assessment checks to ensure the on-going safe management of medicines. Safe systems were in place to manage medicines so people received their medicines at the right times.

People and their relatives were involved in planning

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was safe. There were plenty of staff on duty to meet people's needs. Staff personnel records showed that the home only employed people once all the appropriate checks and safeguards were in place. This meant that the home had taken reasonable precautions to ensure that they only employed people with good reputations.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager was taking advice on how the recent Cheshire Judgement will affect the people living at Burnside.

Is the service effective?

Relatives told us that they were happy with the care that their loved ones received and felt that their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One relative told us "The staff know (my relative)'s every day needs and if I am not happy I say and they sort it out."

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. We observed that people were supported to do things at their own pace and were not rushed. We saw that staff explained to people what they were doing as they did it. That way people were not scared by what was happening. Visitors told us "The girls are really caring, they love the people they are looking after." And "The staff are loving and caring." One member of staff said "I love it here, I like to go and have a chat, I see them as people, it's not just a job here."

Is the service responsive?

People's needs had been assessed before they moved into the home and these were regularly reviewed by the manager. The care files contained information about people's care and support needs as well as information about the things that were important to them. We saw that the home provided various activities to stimulate and entertain people. Families and friends were encouraged to visit and, where appropriate, to bring their pets to visit.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. We saw a customer satisfaction survey had been carried out in March of 2014 and as a result the main communal areas had been redecorated. The manager told us that the home's owner was responsive to requests for essential items of equipment etc. and said that they were "very good." The manager themselves had worked for the home for many years, starting as a carer and progressing to becoming the manager, so they had a good understanding of all aspects of the home.

We inspected Burnside Court to follow up on the inspection we carried out in October 2013. At that time we had found concerns over the way that the home kept the required records. We found they had not considered people’s capacity to consent to care and treatment or record how they carried out care in people’s best interests. We had also found that some of the care planning systems had not identified or given clear instructions to staff on how to manage behaviours that were challenging. Following the inspection the provider sent us an action plan to tell us about the changes they had made.

On this inspection we found that improvements had been made.

We saw that people’s care plans had been re-written to include more information about the impact of dementia on each individual and the support they needed. We saw clearer guidance for staff on how to support people, including people in distress. Records and policies had all been updated and reviewed to reflect current practice. The home had also put in place a clearer process for recording decision making and what to do if the person lacked capacity to make decisions themselves. Senior staff had received training and taken advice from specialist practitioners with regard to the Mental Capacity Act 2005 (MCA).

Burnside Court is a long established care home, providing care for people with dementia. People we spoke with during our inspection told us the home was a nice place to live and they were happy with the services provided, One told us “I like it – it may not be everyone’s cup of tea but it suits me”. Another said “I am not sure where I am, but we are all here together and having a good time. I have had a good meal and expect I shall get a cup of tea soon.”

However, on our inspection we found that the service was not considering people's capacity to consent to care and treatment or to put in place best interest decision making processes to protect people's rights. We also found concerns over some poor record keeping, assessment and delivery of care. We found that some polices and procedures were out of date. We found the care planning systems did not identify or give clear instructions to staff on how to manage behaviours that were challenging.

We found the home was clean and free from odours and that people understood how and to whom to raise any concerns about their care or the home.

People living at Burnside Court were not able to tell us what they thought about the service they received. We observed staff interacting with people and spoke with relatives. People told us they were involved in their relatives care. One person said that people are “treated respectfully, it is a nice friendly place”.

We looked at five care files. These were well organised and easy to follow and all care plans had been regularly reviewed. The files contained a Residents Profile which had a summary of key details including things that were important to the person, such as “loves interaction with staff”.

During our visit we saw a care worker giving a person their tablets. Before giving the tablets they told the person that “the GP had prescribed the tablets and reminded the person that they had their tablets every day”. This helped the person to understand what was happening to them and why.

Staff we spoke with told us that in normal circumstances there was sufficient staff to meet people’s needs as identified in their care plan. One carer told us that in normal circumstances they had time to “play games with the person, do their nails or their hair”.

There are a number of systems in place to assess and monitor the quality of care provided. One relative we spoke with told us that they “could not think of anything bad to say” and “were happy with everything they had seen”.

People we spoke to said the staff at the home were “Lovely, really caring” people who supported them well. Another person said “They are all good and work very hard. They look after me very well”.

They told us they were not aware of the records the home kept, but we could see information in some of the files that showed us that people can be involved in assessments and reviews.

A relative told us that they come to the home every day and have some involvement with their relative’s care which is a great comfort to them both.

People told us the meals were good home cooked food. After a meal one person told us “I have had plenty of everything and I have enjoyed it”.