Archived: The Berkshire Care Home

Updated 25 February 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 4 inspectors, a specialist advisor and an Expert by Experience

An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Berkshire Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Berkshire Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed previous reports about the service and information we had received from other professionals and the local authority. We reviewed notifications we had received from the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people who use the service and 11 staff including the registered manager, deputy manager, regional manager, regional support manager, activities coordinator, care staff, nurses and care home assistant practitioners. We reviewed a range of records. This included six people's care records and multiple medicines records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were also reviewed. We spoke with 13 relatives.

Updated 25 February 2023

About the service

The Berkshire Care Home is a care home providing personal and nursing care for up to 58 people over two floors in one building. The service provides support to older people and younger adults. At the time of our inspection, there were 26 people using the service.

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

Staff were not always deployed in the most effective way. We observed several people were left without stimulation or engagement for extended periods. One person identified as being at risk of choking was left unsupervised in their room whilst eating their lunch. People were not always protected from a risk of harm and we found concerns about risk management and medicines. People were not always protected in the event of an evacuation. Medicines were not always managed safely. We received negative feedback about staffing levels with some people commenting at times they needed to wait to be supported.

People’s hydration was not monitored effectively. Not all staff were up to date with the provider’s mandatory training and had not received training in relation to people’s specific needs to support those people living with conditions such as Parkinson’s Disease or epilepsy. The provider had not made sufficient adaptations to the premises to meet the needs of people living with dementia.

People told us at times they felt rushed as the staff were so busy but felt that most staff were caring towards them.

We have recommended the provider reviews people’s communication needs and ensures the service supports people in order to meet the Accessible Information Standard.

Some staff were responsive to people’s needs. However, we observed several people who were in need of support were left alone for long periods and their care plans were not always individualised to identify their spiritual and cultural needs.

The service now had a registered manager who was appointed in June 2022 to support the development of the home. A new clinical lead had also been employed to support with the nursing aspects of the care provision. Although we recognised the positive changes implemented by the new management team and further improvements planned, we found the provider’s governance required further improvement. We took this into consideration when making our judgement to ensure the most proportionate regulatory response to the concerns identified. Notifications had not always been sent to CQC when required.

The provider followed safe recruitment practices.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Complaints were managed effectively, and the registered manager supported people to raise concerns as needed.

Staff supported people to receive the care needed at the end of their lives and had completed end of life care training.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 9 May 2022). The service is now rated inadequate. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

This service has been in 'special measures' since 14 December 2021. Further improvements are required, as some regulations remain in breach and new breaches of regulations were identified.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and recommendations

We have identified breaches in relation to medicines management, risk assessments, environmental risks, nutrition and hydration, staffing, staff training, good governance, notifications not being sent to CQC when required, person centred care, dementia friendly premises and incident and accidents at this inspection.

We have made a recommendation in relation to the Accessible Information Standard.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good.

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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.