24 and 27 February 2015
During a routine inspection
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.