The inspection took place on 22 January 2019 and was unannounced.

The last inspection of the service was on 27 February 2018, when we rated the service 'requires improvement' for all key questions and overall. Following this inspection, we asked the provider to complete an action plan to show us what they would do to improve the service to at least 'good.'

At this inspection we found that they had made improvements, however some aspects of the service required further improvement.

The Burroughs is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is for up to 75 older adults, some people were living with the experience of dementia. The provider does not employ nursing staff and cannot meet the needs of people with complex nursing needs. At the time of our inspection 55 people were living at the service.

The service is managed by Care UK, a private organisation providing health and social care throughout the United Kingdom.

There was 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.

The provider had not always monitored or mitigated the risks to people's safety and wellbeing. For example, we found risks within the environment, which included areas which were not clean and with access to electrical meters and wiring.

The provider's governance systems had not always identified and mitigated these risks.

Some of the support people received focused on the tasks the staff were performing rather than the needs and preferences of the people being cared for. However, we observed that staff interactions were kind and caring. The staff had a good knowledge of the people who they were caring for.

People liked living at the service. They told us their needs were being met and that they were able to make choices about their care and how they spent their time. People had good relationships with the staff, they trusted them and felt safe.

People were supported to take part in a range of different activities and fulfil their particular 'wishes' for special events. The staff had started to support people to be more involved in helping around the service, if this is what the person wanted, such as laying tables and dusting.

Care plans were sufficiently detailed and included information about the risks people were exposed to, people's preferences and how they wished to be cared for and the medical professionals involved in people's care. People had access to healthcare services and the staff worked with these professionals and followed their guidance. People received their medicines in a safe way. They had enough to eat and drink and made choices about the food they ate.

The staff were well supported. There were enough staff to meet people's needs. The provider's recruitment checks ensured they were suitable. The staff had access to training, support and information about their roles and responsibilities. There were appropriate systems for the staff to share information and work effectively together.

The provider had undertaken some work to promote an environment which supported people from the LGBT+ (Lesbian, Gay, Bisexual and Transgender) community. The staff had taken part in the London Pride march where they highlighted some of the issues for older people identifying as LGBT+. They had also had special events to celebrate diversity and encourage people to discuss their identity in a non-judgemental environment.

The provider had systems for monitoring and improving the quality of the service. There was evidence of imp

The inspection took place on 27 February 2018 and was unannounced.

The last inspection of the service took place on19 April 2016 when we rated the service Good in all key questions and overall.

At this inspection we have rated the service Requires Improvement in all key questions and overall.

The Burroughs is a 'care home'. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide care for up to 75 older people in a single building. Accommodation is provided on two floors. The ground floor is for people living with the experience of dementia. The first floor accommodates older people who may or may not be living with the experience of dementia. The provider does not employ nursing staff. However, local community nurses work closely with the staff and have an office at the service from which they provide any nursing care which people need. At the time of our inspection there were 59 people living at the service.

The service is provided by Care UK Community Partnerships Ltd, part of Care UK, a national organisation providing health and social care.

The registered manager had left the service since the last inspection. There was no registered manager in post. The provider's representatives told us that they had recruited a manager who was due to start work at the service in July 2018 and that this person would apply to be registered with the Care Quality Commission. 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.

The provider was not always acting in accordance with the Mental Capacity Act 2005 because the assessments of people's capacity were not always reflected in the way their care was planned. People had not always been asked to consent to their care and treatment and the staff did not always understand their responsibilities under the Act.

The provider's systems for identifying and mitigating the risks to people's safety were not effective because they had not always checked that the environment was safely maintained or that risks had been fully assessed and recorded. The systems and processes for monitoring and improving quality had not always been effective in achieving improvements.

We found two breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to consent to care and treatment and good governance . You can see what action we told the provider to take at the back of the full version of the report.

The provider was not always meeting people's needs in a person centred way. For example, people's preferences in relation to personal care were not always being met. People were not always involved in reviewing how they were being cared for.

Some of the staff felt that improvements were needed in the way they worked effectively together as a team to deliver care to people because they felt communication needed to be improved and that not all staff were working the same way.

The provider had not employed a full time or permanent manager for the service. The registered manager of another similar sized home was working part time at both services and this meant that they did not always have enough time to embed the improvements which were needed.

People felt they were safe and well cared for. They liked living at the service and they had good relationships with the staff. The staff were kind and caring. They knew people well and wanted to meet their needs. Care was planned in a person centred way with enough information for the staff so they knew how to support people. People were a

The inspection took place on 19 April and the 22 April 2016 and was unannounced.

The last inspection took place on 22 September 2015 when we found breaches of four Regulations relating to the safe care and treatment of people, the deployment of staff, consent to care and treatment and good governance. At the inspection of April 2016 we found these breaches had been addressed and all Regulations were being met.

The Burroughs is a residential home providing personal care for up to 75 older people. Some people were living with dementia. The home is managed by Care UK, a national organisation. At the time of our inspection 62 people were living at the home.

There was 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.

People told us they felt safe at the service.

There were enough staff on duty to meet people's needs and keep them safe.

The provider had appropriate systems and procedures to safeguard people.

The risks to people's wellbeing and safety had been assessed and there were plans for staff to help keep people safe.

The environment was appropriately maintained and safe.

People had the help they needed to take their medicines.

The provider asked people to consent to their care plan and other aspects of their care.

People were cared for by staff who were well trained and supported.

The staff gave people the support they needed to meet their nutritional needs.

People were given the support they needed to stay healthy.

The staff were kind, polite and caring.

People's privacy was respected.

People’s care needs had been assessed and planned for. People received care which met their individual needs.

There were a range of organised activities which met people's needs.

There was an appropriate complaints procedure and the people felt able to make complaints or raise concerns.

The service was appropriately managed and people found the manager professional and approachable. There was a positive culture and people felt the service was well run.

Records were accurate up to date and clear.

There were systems of audits and quality checks to make sure people were receiving a good service which met their needs.

The inspection took place on 22 September 2015 and was unannounced.

The last inspection of the service was on 29 April 2014 where we found no breaches of Regulation.

The Burroughs is a residential home providing personal care for up to 75 older people. Some people were living with dementia. The home is managed by Care UK, a national organisation. At the time of our inspection 67 people were living at the home. There was 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.

The staff did not always follow the directions of healthcare professionals with regards to the consistency of the food people were given, therefore people were at risk of choking.

People had not always been involved with or consented to their care plans.

We identified some risks to people’s health, safety and well-being. The provider had taken action to reduce these risks but the action had not been sufficient to mitigate against the risk of harm.

The staff had completed risk assessments which were accurate, up to date and included plans to manage the risks to people.

People’s medicines were managed in a safe way.

The staff had the training and support they needed to care for people.

People’s nutritional needs were met.

People’s health care needs were met.

The staff were kind, polite and caring. People had good relationships with the staff.

People’s privacy and dignity were respected.

People’s care needs had been assessed and planned for. People received care which met their individual needs.

There was a range of organised activities, although some people told us they were not aware of these and some people told us they felt lonely.

There was an appropriate complaints procedure and people felt able to make complaints or raise concerns.

The provider had comprehensive systems for auditing the home and asking stakeholders for their feedback and opinions.

You can see what action we told the provider to take at the back of the full version of the report.

In this report the name of a registered manager appears who was not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

People were cared for in a way which met their individual needs. There were enough staff employed and they were suitably trained and supported. People’s individual needs had been assessed and were regularly reviewed. People’s health and wellbeing was monitored. The risks which people experienced had been assessed and action had been taken to minimise risks. People said they felt safe and other professionals we spoke with told us the staff followed appropriate procedures. There was a record of all complaints and safeguarding alerts and these showed how concerns had been investigated and acted upon. The environment was well maintained and regular checks took place to ensure there were no hazards. We saw the staff made sure people used equipment appropriately so they could move around safely.

Is the service effective?

Generally people’s individual needs were met. They told us they were happy and well cared for. One person said, ‘’they are really good here’’ and another person told us, ‘’the staff are marvellous’’. They said that the staff knew them well and were kind and respectful. People were able to see healthcare professionals whenever they needed and they were supported to stay healthy. There was a choice of nutritious food and drinks. However, the provider had not always made arrangements for the people who had dementia. For example, there were not enough things for people to do when they did not want to take part in the organised activities.

Is the service caring?

People told us the staff were kind and caring. We saw the staff caring for people in a considerate way. They offered people discreet support and listened to people’s wishes and choices. The staff made sure everyone looked well presented and dressed comfortably. They offered them drinks and food at regular intervals. However, some of the staff focussed on the practical tasks they were undertaking rather than the people they were supporting.

Is the service responsive?

People’s needs were reassessed on a regular basis and they were involved in planning their own care. These needs had been recorded in care plans and we saw these had been followed. Where people had become unwell or there had been a change in their needs – this had been recorded and acted upon. People living at the home and other stakeholders were asked for their opinions about the service and these were listened to.

Is the service well-led?

There were systems for monitoring the quality of the service. Where problems had been identified these had been put right. There were suitable procedures for recruiting and supporting the staff. The staff were aware of their roles and responsibilities. One member of staff told us, ‘’my role is to provide the best care, meeting their individual needs is paramount’’. People living at the home and their representatives were consulted about their care and the service. Complaints, incidents and accidents were appropriately investigated and action had been taken when things had gone wrong.

People told us staff asked them about their choices and respected these. They said staff supported them appropriately to meet their needs, cared for them when they were not well and called the doctor if required. In at least two cases the changes in people’s needs were not reflected in their care plans to make sure that their needs were being addressed appropriately.

We observed that people looked well cared for and relaxed in the home. Seven out of the 12 people we spoke with said they were at times bored and there were not enough recreational and social activities to keep them stimulated and active.

People reported that staff explained things before providing care and support to them and promoted their independence, but they said that they were not very involved in drawing up and reviewing their care plans. The manager told us people were involved in the annual review of their care records. He however, agreed that care plans needed to be discussed and reviewed more often with people or their relatives. This would keep them informed of changes in people’s needs and confirm whether they were satisfied that people’s needs were being met appropriately.

We spoke with 12 people using the service, 7 visitors, 3 healthcare professionals and 9 staff. The previous manager had left the service and an acting manager was in post. The regional director said a new manager and deputy manager were due to start in September 2013.

People said they were being well cared for in the service. Comments people made included “People here are very good (staff)” and “The food and staff are lovely here.”

One visitor said “I am very very pleased with the way they look after my (relative)” and another told us “I feel like one of the family….I cannot find a single fault.” One healthcare professional told us “the home is very good and residents are well looked after”.

People’s nutritional needs were being identified and met and systems were in place to identify any concerns and get professional input.

The previous inspection visit in February 2013 had identified a need to improve recording and investigation of bruises and unexplained injuries and the management of people's medicines. At this inspection we found action had been taken to improve in these two outcomes.

Staff understood safeguarding and whistleblowing procedures and knew to report any concerns. The service had a complaints procedure in place and people and visitors said they were confident to raise any issues.

Whilst the electronic care records were up to date, some paper care records were not, which could place someone at risk of not having their current needs met.