Archived: The Berkshire Care Home

The Berkshire Care Home is a care home with nursing that provides a service for up to 58 older people, some of whom may be living with dementia. The accommodation is arranged over two floors. At the time of our inspection there were 46 people living at the service.

The service did not have a registered manager as required. However, the home manager was in the process of applying to the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

Changes to people’s care and treatment needs were not always well recorded. In some cases this put people at risk. They were not having their individual health and care needs met on time. People had sufficient to eat and drink to meet their nutrition and hydration needs, however support from staff at meal times was inconsistent. People had access to health care professionals. However, staff did not always record and act upon health issues. Therefore, appropriate care and treatment was delayed and did not help people stay healthy at all times.

People’s safety was compromised in the home. The premises and some equipment were not cleaned or well maintained. Procedures to control the spread of infection were not robust. There was inconsistent and ineffective support for people who became distressed or who were unable to make their needs known.

We observed kind and friendly interactions with staff. People and relatives made positive comments about the staff and the care they provided. However, we observed people’s dignity was not always respected and their privacy was not always maintained. There was an activities programme, however opportunities for social engagement were limited and some people living at the home were not engaged in meaningful activities to avoid isolation.

The provider had a system to assess staffing levels and make changes when people’s needs changed. The provider was using agency staff to ensure the right numbers during each shift and was trying to book the same agency staff to maintain continuity of care and support. People told us they thought the changes in staffing could affect some of their support as the new staff did not know them well. We saw the time to answer calls bells varied. Relatives told us there were not always enough staff to support people with activities.

Staff training records indicated which training was considered mandatory by the provider. Not all staff were up to date with, or had received their mandatory training. We saw evidence that learning was not always put into practice when staff supported people. The provider could not be sure staff had the appropriate knowledge and qualifications to meet people’s needs at all times. Staff said they felt supported to do their job and could ask for help when needed. However, they did not receive regular supervision. The team meetings were not always held regularly, thus opportunities to discuss matters with the team were not always available. We asked to see evidence regarding staff’s professional development such as National Vocational Qualifications (NVQ) or Qualifications and Credit Framework (QCF) awards. However, we did not receive any information regarding this.

Relatives felt their family members were kept safe but were not always satisfied with the care and support provided. Care staff knew how to identify potential abuse and understood their reporting responsibilities in line with the service’s safeguarding policy. Staff followed the principles of the Mental Capacity Act 2005 (MCA) when supporting people who lacked capacity to make decisions. We reviewed information held regarding Deprivation of Liberty Safeguards (DoLS) to ensure people’s liberty was not restricted in an unlawful way and people’s rights and freedom were protected. Although the provider had taken some action with the local authority to apply for DoLS we did not receive sufficient information regarding all the people living in the home to ensure appropriate measures were in place.

The provider had systems in place to assess and monitor the quality of care. The provider investigated and responded to people’s complaints, according to the provider’s complaints procedure. Annual questionnaires were sent so people and relatives could share their views. However, the quality monitoring system did not effectively identify all issues, practices or concerns with the home. Without an effective system the home was not able to make improvements where and when necessary so that people could receive the support and care they needed. There was a reasonable amount of resources provided to address the issues and concerns raised by us and other professionals. However, we did not see a steady progress of addressing these. We were concerned that the lack of organisation and leadership prevented improvements being achieved promptly. The provider did not take proper steps to ensure people were protected against the risks of receiving unsafe and inappropriate care and treatment.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of this report.

At our inspection on 8 January 2014 we did not speak with people who use the service but we did discuss recruitment procedures with the registered manager.

We found the provider had completed all recruitment checks required under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Since our last inspection the manager had completed an audit of all the recruitment files of staff employed by the service. Gaps identified in employees' work histories had been investigated and explanations were recorded. All other recruitment checks required were documented. This ensured people who use the service were cared for by suitable staff.

We saw people’s needs were assessed and documented. Care plans were reviewed monthly to ensure care and treatment met people’s needs. One person told us “My experience of living here is excellent.”

People told us they enjoyed the menu and were able to influence menu choices. Staff understood people’s dietary needs and monitored intake to ensure appropriate actions were taken to maintain people’s health and wellbeing.

Recruitment checks were undertaken. We found some of the information required in accordance with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 was not available. We did not see explanations of gaps in employment history, but other requirements such as Disclosure and Barring Service checks and proof of identity were completed appropriately.

The service carried out surveys and held residents’ meetings to ensure people’s views were gathered and areas of concern were addressed. Documentation was reviewed monthly and audited quarterly to ensure people were supported safely in accordance with their needs.

People’s care needs were assessed and reviewed. Care was provided in accordance with care needs identified and recorded, and agreed with the person receiving care. Care notes included people’s likes and dislikes, and identified, assessed and reduced risks for people, for example from falls or smoking.

The provider had a clear safeguarding policy, and staff understood and followed this, to ensure people were protected from abuse. People told us they felt safe in the home.

Staff undertook regular training in accordance with the provider’s mandatory requirements, and were supported to gain additional qualifications.

We saw complaints were investigated and resolved in accordance with the provider’s procedure. People who use the service told us any concerns they had were dealt with informally and quickly: they had not had need to raise a formal complaint. One person told us “staff look after me well.”