Archived: Bereweeke Court Care Home

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

We found the service to be safe, caring, responsive and well led, however we found that the provider was not complying with the essential standard relating to records management. This meant the provider was required to make improvements to ensure the service was effective. We asked the provider to tell us what they are going to do to achieve compliance and the provider sent us an action plan showing how it would address the issues found.

On 4 September 2014 we re-inspected Bereweeke Court Nursing Home to assess whether compliance with records management had been achieved. We reported on only on the question relating to effective. Below is a summary of what we found.

Is the service effective?

People's health and care records were person-centred and described their specific care needs. Records were up to date, relevant and informative. There were clear audit trails to show that care was delivered in line with people's care plans.

Records associated with the management of the home were well maintained.

All records were stored safely yet readily available for staff or people using the service to access when required.

We judged the service had achieved compliance with this essential standard.

For this inspection, our team was made up of an inspector, an expert by experience and a specialist advisor in relation to nursing care and dementia. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

We observed that people using the service were treated with respect by kind and compassionate staff. We observed good interactions between staff and people using the service

There was a system in place to make sure the manager and staff learnt from events such as incidents, comments and complaints and audits. This reduced risks to people and helped the service to continually improve.

Procedures for the management of medicines were safe.

The premises were maintained and procedures were in place to undertake routine safety checks to keep people using the service and staff safe.

There were sufficient staff to care for people safely and staff said they felt well supported in their roles.

The home used the Hampshire County Council toolkit for assessing people's mental capacity and was reviewing its procedures under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards, following recent legislative changes. The Deprivation of Liberty Safeguards were only used when it was considered to be in the person's best interest.

Is the service effective?

People's health and care needs were assessed and specialist dietary, mobility and equipment needs were noted in the care plans.

Staff told us that improved organisation of the home meant they had more time to provide care and talk with people. One person using the service commented that the home was calmer. Improved arrangements for supporting people at mealtimes meant people received the meals they required at the right time.

People's specific dietary and mobility were assessed and people's care was informed by appropriate professional advice from healthcare professionals.

We found that some records about people's care included historical information which meant there was a risk staff could follow incorrect guidance. We also found records relating to the management of the home were not readily available or monitored. We raised this with the manager and we have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to records management.

Is the service caring?

People were supported by staff who spoke kindly and with interest and humour. They were attentive and explained what they were doing. We saw that staff understood how best to support and encourage people. Most people were positive about the care they received and one person said, 'I am happy here. I have put on weight since I arrived and the staff are lovely, they can't do enough for me. I am well looked after'.

People's care needs and preferences had been recorded and care was provided in accordance with their assessed needs. Staff were able to recognise and explain how people liked to be supported.

Is the service responsive?

New activities coordinators had been appointed and they had planned a range of activities within the home in line with people's interests. They also offered small group trips to local places of interest.

We observed that people were attended to promptly when they needed assistance and this was confirmed by people using the service. They also said if they had concerns they raised them with the staff or manager directly and changes were made. Staff and people using the service also said maintenance issues were addressed promptly.

The service sought medical advice or assistance in a timely way and staff were aware of people's medical needs.

Is the service well led?

The service had recently appointed a new manager who had already initiated her application to register with the Care Quality Commission. New staff had been recruited to senior roles and there was a management structure in place. Staff and people using the service told us that organisational changes had been made which had improves the quality of care and communication. Staff said they worked well as a team, understood their roles and had access to advice and support.

The provider's quality assurance system included a programme of audits and reports and these identified areas needing improvement and we saw evidence of action being taken in response to findings.

Overall, we found the service was still failing to identify and assess risks adequately and areas of concern identified at previous inspections had not been fully addressed. Risks associated with the hot water system had not been identified, assessed and managed to keep people safe from Legionella bacteria. People did not always have access to hot water.

We found that the service was not operating at the staffing level that had been determined to meet the needs of people using the service. There were still fewer activities staff than required, and the service was short of clinical unit managers to provide clinical leadership. This created a risk as the service continued to be reliant on agency nurses. When we visited the service was managed by an interim manager and the deputy manager had left. Recruitment was still underway, but the rotas had not been amended to help alleviate the impact of staffing shortfalls.

Consent was sought from people before care and treatment was provided. People's mental capacity had been assessed and the correct legal authority had been obtained when people were deprived of their liberty under the Mental Capacity Act 2005. We judged the service was compliant with this essential standard.

We found people using the service, and their families were more involved in their care and people were treated with respect. People's health and welfare was cared for appropriately, and people said the food was good. We saw that clinical risks were assessed and managed and care plans were clear.

Although the service had arrangements in place to manage infection control and cleanliness, we found that key risks associated with the premises had not been identified and monitored effectively. Water safety checks were not managed in line with safe practices. We also found that monitoring arrangements had failed to identify and manage risks to the service to take remedial action.

The provider had made changes to improve staffing, but people told us there were not always staff to provide care when needed, and we observed this in practice. We also found that the mental capacity assessments were not carried out in line with the Mental Capacity Act 2005.

We had already undertaken inspection visits to this service in February 2013 and found the service was not meeting four regulations from the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 (the Act) and we judged these failings had a major impact on people using the service. We served warning notices relating to Regulations 9, 10, 17, 22 and of the Act which required the provider to achieve compliance by 16 April 2013. We returned on 29 April and 16 May 2013 and found the service had not achieved compliance. The provider sent us an action plan on 4 June 2013, following a meeting with the operations director, acting regional director and regional manager held on 3 June to emphasise the urgency of our concerns.

During our visit on 7 June 2013 we found inconsistencies and inaccuracies in the assessment and planning of people's care. We found that measures to minimise the risks of people having foods that placed them at risk of choking were not always effective. Clinical information from assessment and monitoring data was not analysed and interpreted appropriately. After our feedback, the provider increased the clinical leadership at the service from the following day. The provider agreed to provide weekly updates on the impact of these changes on people's care.

We identified some aspects of care were delivered effectively, such as pressure area care.

The provider sent us an action plan; we inspected again on 29 April 2013 and liaised with local authority adult services. We found some improvements in the way the home involved people using the service but people were not always treated with respect.

Although aspects of care and welfare had improved, we had concerns that people were not protected from risks relating to choking and pressure area care.

We also found that although staffing numbers had increased, and there was a new manager, the staffing arrangements meant that at times there were insufficient staff to in order to safeguard the health, safety and welfare of service users.

We found the service was reviewing incidents and using feedback from people to raise the focus on quality of care. However, we found the service's systems to identify and monitor risks were not robust.

Overall, we judged that the warning notices were not met and the service was still not compliant with the above regulations.

Overall, we judged that the service was still not compliant with the above regulations.

Most people were unable to tell us their views of the service, due to their complex care needs. We used the Short Observational Framework for Inspection (SOFI), to help us understand their experiences. We found there was little positive interaction between staff and people using the service. At times, staff did not talk or make eye contact with people or seek permission before assisting them with their mobility. People we spoke with said they were not always treated with respect.

We found people's care plans were not person centred and people did not have access to sufficient activities, planned and based on their interests. People's care and welfare was documented but there were omissions that put people at risk.

Although the premises were observed to be clean, we found that guidance on infection control was not implemented in practice. There was a risk of cross contamination as a result of unclear practices.

The manager, staff and people using the service said there were not enough staff available to provide the care people needed. There was no system to determine staffing levels based on people's needs and the layout of the building.

Overall we found provider did not protect people adequately by have effective systems to identify and manage risks.

People said they thought the care and treatment they received was good, and that the staff were 'very caring.' One person said that their health was well looked after and that their GP was called when necessary. Another told us that they were satisfied that their relative's medication was managed appropriately. People's care records supported this view.

People we spoke with were confident that staff had the appropriate knowledge and skills to meet their needs. One person said staff were 'very patient, kind and had a good mix of skills.' People said they felt safe and that staff treated them well.

The service monitored the quality of care provided, and acted on comments, complaints and the results of audits and investigations. One person told us they felt included in the care provided for their relative, and if they asked staff for anything to be done, it was always dealt with professionally. We spoke with one person who uses the service, who was on the staff recruitment panel, which they said had benefited both the service and themselves.