Berwick House Rest Home

Berwick House Rest Home is a residential care home located near South Shore Blackpool, providing Accommodation for persons who require nursing or personal care. The service provides support for up to 24 people; younger adults, older people and people living with dementia. At the time of our inspection there were 17 people using the service. The property is set over 2 floors with lift access to the upper floor. There were several communal areas and a large enclosed rear garden accessible for people to use. Aids and adaptations were in place to meet people’s individual needs.

CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

Systems were in place for the safe handling, storage and disposal of medicines but management of ‘when required’ medicines was not always effective.

Relatives and staff told us they thought people were safe. However, the provider did not demonstrate that risks were consistently monitored around people’s care needs or fire safety.

Staff knew people well and had a person-centred approach, but this was not always documented. Some care plans did not include accurate and up to date information on people’s behaviours, mobility and support needs; at times information conflicted.

Though staff supported people in the least restrictive way possible and in their best interests; records and systems did not fully support this practice.

The provider did not always have established systems in place to continually assess, monitor or improve the quality and safety of the service.

A new manager had been in post since December 2022. There was a lot of favourable feedback from staff; “Things are really good, really positive.” “I like the new manager.” Staff referred to ongoing improvements to the home environment, activities, processes and staffing. The manager talked us through some of the changes they had implemented and those planned for the future. From our observations, people seemed happy and relaxed. When asked what they thought of the staff, relatives said, “Staff have been excellent” and “Staff are very kind.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

The inspection was prompted due to concerns received about medicines, staffing and management. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Following our feedback, the provider and manager have taken positive action to lessen the risk and drive improvement.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Berwick House Rest Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the management of ‘when required’ medicines, risk management, record keeping relating to people’s care and support and assessing, monitoring and improving quality and safety.

We identified evidence that Deprivation of Liberty Safeguards (DoLS) were not complete and up to date for everyone.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last inspection on 01 June 2016, the service was rated good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

During this inspection visit, we found there were sufficient staffing levels and skill mixes to meet people’s requirements. People and their relatives said staff took their time and were calm and patient. One person stated, “Yes, there’s always staff about.” They said this helped them to feel safe and secure at Berwick. When we discussed safeguarding vulnerable adults from the risk of harm or abuse with staff, we found they had a good understanding.

The registered manager had multiple environmental procedures and auditing systems to ensure the continued safety of those who lived at Berwick. They provided guidance for staff to assess and mitigate the risk of unsafe or inappropriate care.

People who lived at Berwick and their relatives told us staff managed their medication safely and administered them on time. The registered manager undertook audits to assess the continued safety of medication procedures.

Staff files we reviewed showed the registered manager completed recruitment procedures to verify they employed suitable staff. Records we looked at evidenced staff had a range of training and qualifications to underpin their knowledge and experience.

Care records we looked at held a variety of assessments and monitoring forms to mitigate the risks of malnutrition and dehydration. We observed staff offered choice at lunch and supported people, where applicable, discreetly and patiently.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. A visiting professional commented they observed staff were patient and gave people the time and basic information they needed to make decisions.

The registered manager went above and beyond to guide staff to people’s diverse needs and preferences about their culture and beliefs. Those who lived at Berwick and their relatives consistently commented about a kind and respectful team approach. One relative said, “The staff have such a loving attitude. They are like family.”

During our inspection, we saw staff sitting for long periods and engaging with people, talking quietly and reassuringly. A relative told us, “[My relative] loves it here. She is almost like another staff member in that she chats with the other residents and keeps them company. The staff really encourage that.” People and their relatives were at the heart of their care and fully involved in the development of their support plans.

We found each person’s documentation was personalised to their individual needs. Each care planned area included agreed goals to help people maximise their independence and life-skills.

Those who lived at Berwick and their relatives told us the home was well organised and had good leadership. We further noted everyone at the home was involved in its ongoing development. A relative commented, “[The registered manager] frequently asks me if there is anything else they could improve on.” The management team completed a range of audits to retain oversight of quality assurance, safety and people’s welfare.

Further information is in the detailed findings below.

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘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.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

Outcome 5 ' Meeting nutritional needs

Outcome 13 ' Staffing

This was because the service was not compliant at the previous inspection.

We spoke with the registered manager and three staff. Because people who lived at the home had mental health conditions, we were unable to discuss care with them. We undertook a Short Observational Framework for Inspection (SOFI). This involved observing staff interactions with people in their care. SOFI helps us assess and understand whether people who lived at the home were receiving the level of care that met their individual needs. This helped us to gain a balanced overview of what people experienced whilst living at the service.

We saw people were relaxed and happy during our inspection. The service had increased its staffing levels in the busy morning periods. This meant people were adequately supported to maintain their nutritional needs during breakfast. People were protected against unsafe care because the provider had increased staffing levels to meet their needs.

As part of the inspection visit we looked at how people were being cared for and supported. How the service ensured peoples nutritional needs were being met. We looked at what procedures were in place to ensure the service had effective infection control measures to protect people. We looked at how the service staffed the home. We did this to see how they responded to the needs of residents. Also to see if staff were employed in suitable numbers and had the knowledge and skills to provide care and support. We also looked at quality assurance systems to see how the service developed the services it provided to people.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, staff supporting them, relatives and by looking at records. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Amber Court.

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

Is the service safe?

We looked at the staffing levels. Overall staffing levels met the needs of people using the service. However observations made during the breakfast period showed there were times when people waited for long periods for assistance with their meal. People were left unsupported to eat their meals. During the morning period staff were busy carrying out their duties, away from communal areas where most people spent their time. There was little engagement with people. This showed us the staffing levels during the morning period were inadequate to meet the needs of people.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Although there were no current applications in place, staff training had yet to be completed. However we saw this was planned for all staff so that they would understand when an application should be made and in how to submit one. This meant people would be safeguarded as required.

Maintenance service certificates were in place and up to date to ensure systems in the home were safe.

Is the service effective?

We were told that each person's health and care needs had been assessed prior to the service commencing. This was to make sure that the home could provide the level of care and support required. Records were available to support this.

Specialist dietary, mobility and equipment needs had been identified in care plans where required. This included specialist nutrition such as prescribed supplements, which ensured people who were unable to take a normal diet received nutritional aids to meet their needs.

We noted there was a repellent odour in communal areas and some people's bedrooms. Whist we saw evidence of regular carpet cleaning taking place every few days more needs to be done to eliminate the odour.

During the morning period we observed people were sat for long periods without any stimulation or activities provided to meet their needs. This was because staff on duty were carrying out their roles in other areas of the home.

Is the service caring?

People were seen to be supported by attentive and respectful staff. We saw that care workers showed patience and gave encouragement when supporting people.

Staff we spoke with told us it was a role they found rewarding. Comments included, 'It's a job I have done for some time now and really enjoy it'. Another told us, 'I had never worked in care but I really enjoy my role here'.

People we spoke with during the inspection told us they were satisfied with the way their relatives were cared for. Comments included, 'I don't know how they do it but they are all very patient. I see that every time I come here'. Also, 'They have done a really good job with my relative. It has really helped us as a family'.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes. Personal profiles had been developed by staff. Staff we spoke with told us this had helped them to understand things that were important with individual residents.

Is the service responsive?

The service had a range of activities in place to support people to undertake chosen interest. There was evidence of organised parties and events throughout the year which people told us they enjoyed. This had included a recent dancing with dementia day at Blackpool Tower Ballroom. Also, people had attended an armed forces day. Staff told us they were happy to come in and assist with special days out as it was a team effort and everyone got something out of it.

People using the home and their relatives or advocates had completed six monthly satisfaction surveys. The results were used to inform the development and quality of the service. Any issues highlighted were looked at and responded to in order to ensure the home was responding to the needs of people.

Is the service well led?

We saw there was evidence regular audits were taking place by looking at the systems and records in operation at the home. However there was no evidence to show how staffing levels were being monitored. By not doing so shortfalls noted during the morning period had not been identified by the provider. This had the potential to impact on the level of support available to people.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. They told us they felt supported by the manager and that they felt comfortable sharing any issues or concerns with them. They felt confident they would be listened to and action taken where necessary.

We shared this information with the local authority who visited the service to look at some of the issues. When we visited Berwick House we looked at records and spoke with the manager, four members of staff and a visitor. In addition we spoke with some of the people living at the home. People using the home had various levels of dementia therefore some of the communication was limited.

Records demonstrated the manager had reviewed all care planning records and made a number of changes in individual cases. We found routines were flexible and we witnessed staff treating people with sensitivity.

Staff told us staffing levels were generally suitable to meet peoples needs. One person told us, 'We can be pushed sometimes but there is enough time to do our jobs as well as doing activities with residents'.

The manager was reviewing all systems in place but also taking account of the views of residents and relatives. A relative told us they were very happy with the care their relative received. 'I come in most days and the girls are wonderful. My relative is very happy here'.

People living at this home had a range of dementia conditions. This affected how they communicated with us. For this reason we spent time in communal areas, so we could observe how the home was operating and how staff communicated and helped people.

We were told that the staff team were patient and kind. People also told us that they felt their relative was safe living at the home. One person said, 'My relative has not been here for long but I think the staff are very attentive. The staff do very well'. Another relative told us, 'They know how to manage the needs of mum'.

We observed the interaction between the staff and some of the people who used the service. We observed staff were respectful of people and treated them with dignity. For example, we saw staff sitting with people, talking with them sensitively and listening to what they were telling them. We also saw staff offer assistance with personal care needs in a discreet and dignified manner.