Inspection on 20/04/09 for The Berkshire Care Home

This is the latest available inspection report for this service, carried out on 20th April 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Berkshire Care Home 24/04/07

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Berkshire Care Home 126 Barkham Rd Wokingham Berkshire RG41 2RP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Amanda Longman     Date: 2 0 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: The Berkshire Care Home 126 Barkham Rd Wokingham Berkshire RG41 2RP 01189770233 01189787157 the.berkshire@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Four Seasons Rosedale Ltd care home 58 Number of places (if applicable): Under 65 Over 65 58 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is 58. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home The Berkshire Nursing Home is owned by Four Seasons Rosedale Limited. The home is a large adapted house situated in pleasant grounds on the outskirts of Wokingham. Public transport, shops and other amenities are approximately half a mile away. The home has three lounges and a large airy conservatory, which leads to a patio area and garden that has level walkways for people to enjoy. The home provides nursing care for adults aged over 65 and is staffed by qualified nurses and care assistants. The fees for this home are #460 to #850 per week. Additional charges are levied for chiropody, hairdressing and newspapers. Care Homes for Older People Page 4 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of The Berkshire Care Home was an unannounced key inspection. It was a thorough look at how well the service is doing. It took account of information received from the manager prior to our site visit. This was in the form of the Annual Quality Assurance Assessment (AQAA), completed by the manager and sent to us when we requested it. The inspection was undertaken by Amanda Longman, regulatory inspector, on 20 April 2009. During the site visit we (the Commission) toured the home, observed care practices, spoke with people living at the home, with visitors, with the manager and with some members of staff. We also examined a selection of care records and staff records. The last inspection for this service was completed on 21 April 2008. Care Homes for Older People Page 5 of 24 Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 24 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed to ensure the home is able to meet them. The information collected needs to fully cover all aspects of the persons lifestyle and care needs. Evidence: The people living at the home who returned surveys to us said that they had received enough information about the home and all confirmed they had a contract with the home. The home introduced a new assessment process in October 2008. Detailed information is obtained about the person, including their personal details. Information for the new Care and Health Assessment Profile is collected at the pre-admission assessment and at the admission assessment. It is an extensive document which holds information relating to their medical conditions and treatment needs, physical and mental functioning (including consent and capacity), personal care needs, spirituality, end of life care needs and any specialist interventions required. We looked at the Care Homes for Older People Page 9 of 24 Evidence: assessment information held for five people living at the home. The extent to which detail had been completed on the form varied and in some cases information was limited or missing. For example, in one case the mobility assessment just said that the person required two people to assist them, and information relating to sexuality and end of life care were not completed in most cases. We discussed this with the new manager who was able to show us evidence of a meeting with senior nurses on 14 April, where he had raised the issue of these forms not being adequately completed and addressed it. The home is not registered to provide specialist dementia care, however, as a nursing home the home does admit people who may have dementia where their primary needs are for nursing care, and the manager has assessed their needs and judged that the home has the skills and resources to meet them appropriately. Dementia care training is provided to staff. Care Homes for Older People Page 10 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are generally met. The home needs to continue to ensure that care plans reflect individual choices and preferences. Evidence: We looked at the care plans for five people living at The Berkshire. These were detailed. For each assessed need there is a corresponding page with the expected outcome and the support and care to be provided. We saw evidence of appropriate individual interventions in the care plans, for example regarding the management of pressure sores and regarding the management of weight loss. We also saw evidence that care plans are signed by the individual or their representative every time the care is changed. Continence records are maintained when required. Daily records are maintained which show how an individual has been. The home operates a key worker system and we saw evidence that key workers complete diairies which provide more information about a persons well being. Staff we spoke with during our site visit were familiar with peoples care plans. Of those people who returned surveys to us 50 said they always and 50 said they usually receive the care and support they need. 75 Care Homes for Older People Page 11 of 24 Evidence: said they always received the medical support they required. We spoke with several people who live at the home and some who were visiting, about the level of care. People were generally happy with the level of care, which reflected the information we received in our surveys. However, we noticed that several people who were seated in wheelchairs were in them for a long time. These people were not hoisted or assisted in to arm chairs nor dining chairs at meal times. When we spoke with some of these people they commented that staff were busy but we heard a number of people say that they were not comfortable in their wheelchairs all day. Subsequent to our site visit we discussed this with the manager, who provided evidence that the care plans for people who use wheelchairs had been reviewed to ensure that their individual preferences for where they sit were accomodated. Because the Berkshire is a nursing home some people are nursed in bed. Staff informed us that people being nursed in bed are checked every hour and records confirmed this. The home had an inspection by the PCT pharmacist 21 November 2008 which showed that medication standards were met. The home has appropriate policies and procedures in place. No one at the home self medicates, medicine is securely stored and administrative records are appropriately maintained. The home has an end of life care manual and staff have received some training in this area. The manager is currently liaising with MacMillan nurses to provide a further half day training session for staff. Staff we spoke with were knowledgable about end of life care and spoke of the need to know and respect a persons individual, cultural or religious wishes. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People generally enjoy the lifestyle at The Berkshire. There is scope to increase the number and range of activites offerred. Evidence: The manager and the staff we spoke with stated that people can get up and go to bed when they like. Some people like to get up early and then night staff will assit them. People who wish to go to bed early are assited to get ready for bed by the day staff in the early evening. People who wish to stay up later are assited by the night staff. The people living at the home that we spoke with confirmed they can get up and go to bed when they wish. The home employs an activities organiser three days per week and the manager stated he is planning to employ another person for a further two days per week. We saw the planned activities for April and these included gardenning, baking, quizes, exercise classes, piano recitals, debating, snail racing, painting, book club and poetry afternoons. The residents produce their own newsletter and liaise with the staff about activities. They have submitted ideas to the manager for how to use the increase in activity hours to increase one to one activities for people in their rooms. Examples Care Homes for Older People Page 13 of 24 Evidence: include reading aloud, taking people on a one to one basis in to the garden and just having time to listen and talk. On the day of our site visit some people were watching television, some people were sitting in the conservatory where there were a variety of arts and crafts materials and a computer (which was being used) and some people were sitting in the front lounge. people said they liked the activities on offer but would like more. Of those people who responded to our survey 50 said there were always activities that they could join in and 50 said there were usually. One comment made was that the activities co-ordinator has inspired many of us in discovering new talents/abilities and developing old ones. The Berkshires own 2008 survey showed that whilst approximately 68 of residents felt the choice and variety of activities was good or very good, 30 felt the variety of activities was poor or very poor and nearly 70 said outings were very poor. Some one to one activities are provided for those who are being nursed in bed, for example reading to them or doing their nails. Visitors and relatives are welcomed in to the home at any time and the scedule of activites invites freinds and relatives to join in. The home states it is able to meet the needs of individuals regarding their cultural, religious and dietary needs. The methodist church currently provides prayer groups in the home and Church of England services and Roman Catholic masses are provided monthly. The home was about to admit someone from a minority religion and an assessment had been undertaken to ensure their individual needs could be met. The home has new care plans in place which cater for same sex couples. The home employs a qualified chef and a deputy chef. The most recent inspection by Wokingham Environmental Health Deaprtment rated the kitchen as four stars (out of a possible five). The home offers a varried menu and caters for different dietary needs, including diabetis and those needing a soft diet. We ate tea with the people living at The Berkshire, who choose to eat in the dining room, on the day of our site visit. The dining room is bright and airy and comfortably furnished. There was a choice of meal and the people we spoke with stated the food was usually good. Staff were observed to know residents and were polite and chatty with them, assisting them appropriately if required. Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the Berkshire have their complaints and concerns listened to and acted upon, although there is scope to improve the recording of, and actions taken relating to, comments left in the comment book. People are safeguarded from abuse. Evidence: The home has a complaints procedure which is available to service users in their information guide. The home received 24 complaints in the year up to the end of January 2009, all of which were dealt with within 28 days. 11 of these complaints were upheld. The home has a comments book in the hall in which residents and visitors can record any positive or negative comments. The manager goes through this book periodically to address anything which is outstanding. We discussed with the manager the need to do this formally, on a regular basis, and maintain records of any of these comments which constitute complaints (albeit minor) and ensure an audit trail is available noting followup action. The manager agreed to address these points. The manager needs also to consider aspects of confidentiality which may be raised within this book. People we spoke with said they knew who to speak with if they were not happy about anything. Care Homes for Older People Page 15 of 24 Evidence: The home has in place an appropriate procedure for safeguarding vulnerable adults and all staff have received training in this area. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at The berkshire benefit from an environemnt which is clean, comfortable and safe. Evidence: The home currently has 50 rooms, of which one is a shared room. There were 48 people staying at the home on the day of our site visit. On the day of our site visit the home was clean, comfortable and homely. Decor was of a good standard. The individual rooms that we saw were personalised with the occupants own possessions, such as pictures, photographs and small items of furntiure. 75 of thoses who responded to our survey said the home was always fresh and clean and 25 said that it usually was. The home has approptiate infection control procedures in place and staff receive training in infection control practices. Information provided by the home prior to our site visit showed that all maintenance checks are in place and that electrical and other equipment is maintained appropriately. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the Berkshire are supported by staff who have been appropriately recruited and trained. Care staff are encouaged to become qualified. The number and skill mix of staff needs to be kept under constant review to ensure individual needs and preferences can be met. Evidence: There are five nurses on duty between 8:00am and 2:00pm, with three remaining on duty until 8:00pm. There are also seven care assistants on duty from 8:00am until 2:00pm and five until 8:00pm. The manager and deputy manager are supernummery. At night there are two nurses and three care assistants on duty between 8:00pm and 8:00am. The nurse in charge of each shift starts work 15 minutes early for a handover meeting and in turn meets with the staff beginning their shift to pass on information. We saw documented evidence of these hand over meetings during our site visit. In addition the home has a chef who is qualified to NVQ level three, a deputy chef and other kitchen staff who have all received training in food hygeine. There are also laundry and domestic staff. The records showed there had been a high turn over of staff in the last year but the manager reported that staff are now settled and the workforce is stable. The home has Care Homes for Older People Page 18 of 24 Evidence: an appropriate recruitment procedure in place which is in line with the relevant regulations. We looked at the records for two recently recruited members of staff which showed that appropriate pre-employment checks had been completed including a full employment history and clearance from the criminal record bureau. Two references had been obtained for both people, however, one reference appeared to be from a friend. We discussed this with the manager who confirmed this type of reference would no longer be acceptable to the home. People who live there who returned surveys to us said that 66 of the time staff were always available when they needed them, and 33 said usually. However this was a very small sample. Of the staff who replied to surveys, half said there were usually enough staff to meet individual needs and half said there were not enough staff. Again, this was a small sample. Comments made about staffing both from surveys and during our site visit, included that the staff were kind, helpful and respectful, that they look after me well and that the staff are caring and work hard for the residents. However, other comments included that they need more staff and that they are always understaffed. Our observations on the day of the site visit confirmed that staff are kind and respectful to individuals and are busy. Call bells appeared to be answered promptly. Staff follow an induction program which is in line with that prescribed by Skills for Care. We saw an example of the workbook used. We saw the current training plan for staff. Examples of the courses provided include induction training, infection control, death and dying, life story training, person centred care, dementia care and cathetar care. The home has 22 care assistants employed. One person already holds an NVQ qualification, ten staff are currently working towards NVQ level 3 and three are about to start the process. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by a suitably qualified individual who is applying to register with the commission. Quality assurance procedures are in place but there is scope to improve how these systems are used to develop services. Peoples financial interests are safeguarded, as is their health and safety. Evidence: After being managed by a peripatetic manager for approximately one year, the home has a new manager who started in March 2009. He is a qualified nurse and is currently applying for regisitration with CQC. He has experience within Four Seasons Health Care managing another one of their homes. The home has a bank account for residents funds from which additional charges, for example for hairdressing, chiropody and other personal expenses are paid. Receipts are kept and cross referenced to the expenditure incurred. Care Homes for Older People Page 20 of 24 Evidence: The majority of residents are local authority funded. We saw minutes of the three most recent residents meetings which had occurred in October 2008, January 2009 and March 2009. These documented residents involvement in the home. For example they have set up a trolley shop for residents. The residents also have their own magazine which is compiled and printed by residents. It contains both entertainment and news and views from the people who live at The Berkshire. Regular quality audits of polices, procedures and records are undertaken and a remedial action plan is devised following each quality audit. However there is currently no audit of actions taken. Target dates are set but there is no formal review of this. We discussed this with the manager who will address this to ensure there are clear audit rails and reviews of whether or not targets have been met. The home has relevant health and safety policies and procedures. Examples include: contingency plans for emergencies, including evacuation which were reviewed in January 2009; all people living at the home have an individual evacuation assessment; an up to date fire risk assessment is in place and records showed that fire equipment is regualrly serviced and alarms are regularly tested; training is provided for staff in the control of substances hazardous to health. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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