Archived: Berwick Care Home

Updated 28 May 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection team consisted of an inspector; a specialist advisor in governance and an expert by experience, who had experience of services for older people and care homes. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

The inspection took place on 24 February 2015 and was unannounced. We carried out a second announced visit to the home on 27 February 2015 to complete the inspection.

We spoke with 15 people and 14 relatives. We conferred with a community matron for nursing homes and a continuing health care assessor, who were visiting the home on the days of our inspection. We contacted by phone a reviewing officer from the local NHS trust; a local authority safeguarding officer and a local authority contracts officer. We also spoke with a church minister.

We spoke with the regional manager; registered manager; two deputy managers; a nurse; an activities coordinator; maintenance person; five care workers; housekeeper; cook and kitchen assistant. We read four people’s care records and five staff files to check details of their training. We looked at a variety of records which related to the management of the service, such as audits, minutes of meetings and surveys.

Prior to carrying out the inspection, we reviewed all the information we held about the home. The provider completed a provider information return (PIR). A PIR is a form which asks the provider to give some key information about their service; how it is addressing the five questions and what improvements they plan to make.

Updated 28 May 2015

The inspection took place on 24 February 2015 and was unannounced. We carried out a second announced visit to the home on 27 February 2015 to complete the inspection.

The home was last inspected on 18 September 2014 when the provider was in breach of two of the regulations which we inspected. These related to care and welfare of people who used the service and assessing and monitoring the quality of service provision. At this inspection, we found that improvements had been made regarding people’s care and welfare. However, further improvements were still required with regards to assessing and monitoring the quality of service provision.

Berwick Care Home is a purpose built home situated in Berwick upon Tweed. It accommodates up to 60 older people, some of whom have dementia related conditions. There were 31 people living at the home at the time of the inspection.

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.

There were safeguarding procedures in place. Staff knew what action to take if abuse was suspected.

We had concerns regarding certain areas of the premises. We found that new flooring had been laid, but other refurbishment had not been carried out as planned. We read a fire risk assessment which had been carried out in November 2014. This had identified issues with fire doors, compartment walls and automatic fire detection in certain areas of the home.

We passed on these concerns to the local fire service and local authority contracts and commissioning team.

We found the design and decoration of the premises did not always meet the needs of people who had a dementia related condition. We have made a recommendation that the design and decoration of the premises is based on current best practice in relation to the specialist needs of people living with dementia.

Most people and relatives told us that there were sufficient staff employed. However, they informed us that more staff would be beneficial. We noted that some nursing staff had worked in excess of 60 hours on two of the staff rotas we viewed. The manager explained that there had been issues with staff sickness on those two weeks. She informed us that she was in the process of recruiting more bank nurses to support the permanent nursing staff.

Medicines were managed safely and accurately recorded. There was a system in place to obtain, receive, store and dispose of medicines safely.

Staff told us that training courses were available in safe working practices and to meet the specific needs of people who lived there, such as dementia care. We found however, that certain training had not been completed as planned following our previous inspection, such as moving and handling and person centred care. Following our inspection, the manager informed us that staff had undertaken moving and handling training and person centred training was planned.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. We found that the service had made a number of applications to the local authority to deprive people of their liberty in line with legislation and case law. The manager was aware that further work was required to ensure that “decision specific” mental capacity assessments for people were completed in line with the MCA. We have made a recommendation that records evidence that care and treatment is always sought in line with the Mental Capacity Act 2005.

People were complimentary about the meals and we observed that staff supported people with their dietary requirements.

Staff who worked at the home were knowledgeable about people’s needs. We observed positive interactions between people and staff. Staff communicated well with people.

The service had acted proactively following a recent safeguarding allegation which was not upheld. Following this allegation, the manager told us that the information which was sent with people when they went to hospital was not robust enough. They were working with a community matron for nursing homes to address this issue.

There was an activities coordinator employed to help meet the social needs of people who lived there. She spoke enthusiastically about ensuring people’s social needs were met. New gardening equipment had been purchased and a spring gardening club set up.

Staff told us that morale had improved at the home. A number of checks were carried out by the manager. These included checks on health and safety; care plans; the dining experience; infection control and medicines. We noted, however that the manager was not always able to provide evidence that actions were implemented or sustained in all areas.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This related to the safety and suitability of premises. This corresponded to a breach of the new Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the premises and equipment. The action we have asked the provider to take can be found at the back of this report.