We inspected the service on 14 August 2018. The inspection was unannounced. Burswood Health and Wellbeing is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided and both were looked at during this inspection.

Burswood Health and Wellbeing is registered to provide accommodation, nursing and personal care for 40 younger adults and older people who have physical and/or sensory adaptive needs. The service was principally designed to accommodate people on a short term basis. Some people were admitted from hospital to the service’s reablement unit. This was so that they could receive physiotherapy and occupational therapy in order to become more independent before returning home. Other people were admitted from their own homes to the service’s assisted living unit. This was for a variety of reasons including receiving care while their family members were away. On the day of our inspection visit there were seven people receiving care in the reablement unit and four people accommodated in the assisted living unit.

The service was run by a charitable body who described themselves as being ‘Christian but welcoming people of all faiths or none’. During the inspection visit the charity was represented by their chief executive officer. The former registered manager had left the charity’s employment shortly before our inspection visit. In their place the charity had appointed a new manager who was about to apply to the Care Quality Commission to become registered in their 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 2008 and associated regulations about how the service is run. In this report when we speak about the charitable body we refer to them as being, ‘the registered provider’. When we speak about nurses, care staff, physiotherapists and occupational therapists as a group we refer to them as being, ‘the professional staff’.

This was the first comprehensive inspection of the service using our new way of quality rating services. The service was registered on 21 January 2011 and we completed our last inspection on 11 and 26 July 2013 using our legacy inspection model.

At the present inspection we found four breaches of the regulations. The first breach was because the registered provider had failed to consistently reduce risks to people’s wellbeing by providing safe care and treatment. Lessons had not always been learned when things had gone wrong as a result of which robust arrangements were not in place to suitably safeguard people from the risk of experiencing harm. The second breach was because the registered provider had failed to establish the necessary systems and processes to ensure that we were promptly told when a person not been suitably safeguarded from the risk of experiencing harm. The third breach was because the registered provider had not established reliable procedures to ensure that only trustworthy people were employed to provide care. The fourth breach was because the registered provider had not made suitable arrangements to enable the service to learn, improve and assure its sustainability by ensuring that all regulatory requirements were met.

After our inspection visit the registered provider sent us information to show that they had addressed all the breaches of the regulations to provide people with safe care and treatment.

Our other findings were as follows: Medicines were managed safely in line with national guidance. There were enough professional staff on duty. Suitable arrangements were in place to prevent and control infection.

The registered provider had not given nurses and care staff all of the

When we previously inspected Burrswood Hospital we found that the provider was not meeting all the requirements of the Health and Social Care Act 2008.

During our inspection we spoke with directors, managers and a range of medical, domestic, and administrative staff. We spoke with two patients. We reviewed policies, minutes, audits, training records and care documentation.

The improvements required to comply with the regulations in relation to obtaining consent, safeguarding patients and ensuring that robust governance systems were in place have been made.

Patients we spoke with said they received treatment and care from well trained, polite and knowledgeable staff in clean, comfortable and safe surroundings. We were told by patients how the staff focus was on patient comfort and great care was taken to respect peoples’ privacy and dignity at all stages of their treatment and care. During our visit we spoke with five patients including some who were attending out patient appointments and others who were accommodated as in-patients.

The patients that we spoke to during our visit told us they were very happy with the service and care. One patient told us “the staff are very efficient here and nice and you couldn’t wish for anything better”. Another person remarked “I cannot speak highly enough of the staff, they are always so friendly and nothing is ever too much trouble”.

Patients said that there were choices of food to suit every taste and if they wanted something individual it had been provided for them quickly and with the minimal of fuss. When we asked patients to describe the meals they told us they found the choice and quality to a good standard. One patient told us “absolutely excellent and delicious food with an amazing choice for a hospital”.

Everyone we spoke with was very pleased with the care they had received. We heard that staff were attentive and responded quickly to call bells. Someone told us “I have no complaints at all. The staff have been marvellous, and are happy to answer any question I have”. Another said “I couldn’t have asked for a nicer, better place with more caring staff”.

We responded to concerns identified by the Clinical Commissioning Group (CCG) for West Kent regarding the care and welfare of long stay patients that were accommodated at the hospital. We carried out the inspection over two separate days and employed the services of specialist inspectors to review medication, safeguarding procedures and to look at the care and treatment plans for patients. During our inspections we spoke to directors, managers and a range of staff that included medical, clinical, domestic, pastoral and administrative staff. We spoke to 15 patients, three relatives and volunteers. We reviewed policies, minutes, audits, personnel files and care records.

The hospital treats a diverse patient population ranging from those staying for a brief post-operative convalescent period through to long term patients with complex care needs. Without exception the patients and relatives told us that the care was “Exceptional”. One person told us ‘I cannot speak too highly or describe to you the care that I am getting – it exceeds not only my expectations but that of my family”.

Patients told us that although they were involved in their treatment there were not consistent systems in place to obtain, record and review their consent. One person said, “I have never been asked formally if I consented to anything, but this is implicitly understood, I would not be here if I did not consent to my being cared for”. Where people did not have the capacity to consent staff did not act in accordance with the legal requirements outlined in the Mental Capacity Act 2005.

There were sufficient staff with appropriate competencies and qualifications to meet the needs of the patients. Staff were supported to receive supervision, undertake training and participate in the appraisal process.

Information was provided to staff about the procedures to follow if there were any concerns that people were at risk of abuse and patients told us they felt safe in the hospital. However, staff had not received appropriate safeguarding training and were not knowledgeable about the correct procedures to follow if they had concerns.

The organisation had a robust governance structure in place to identify and manage risk but did not have a mechanism to supervise the practice of medicine in the hospital or provide appropriate professional support to medical and clinical members of staff.