Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 27/10/08 for Bereweeke Court Nursing Home

Also see our care home review for Bereweeke Court Nursing Home for more information

This inspection was carried out on 27th October 2008.

CSCI 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Peoples needs are assessed very thoroughly before they move in. This is important to ensure that the home can meet with peoples wishes and expectations. Staff attend to peoples personal and healthcare needs well and respect peoples dignity. The current care planning system helps to ensure that people maintain some independence for as long as possible. Food is good and people are happy with the range of activities available. The staff team is consistent and staff feel that they are provided with good training opportunities. The home is well managed and there are effective quality assurance processses in place to ensure that people continue to be satisfied with the service.

What has improved since the last inspection?

More staff have completed NVQ level 2 or above in Care. Care planning has become more person centred. This means that staff now have a better idea of what is important to people. The homes most recent survey indicates that relatives overall satisfaction with the service has improved. There has been some improvement to the environment through the ongoing refurbishment programme.

What the care home could do better:

Some residents would like to have meetings so they can be more involved in the running of the home. Once the refurbishment has been completed the environment will improve for all. The frequency of staff supervision needs to increase. The manager is already making arrangements to ensure that this will happen in the future.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bereweeke Court Nursing Home Bereweeke Road Winchester Hampshire SO22 6AN     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: Kathryn Kirk     Date: 2 7 1 0 2 0 0 8 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. the things that people have said are important to them: They reflect 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 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Bereweeke Court Nursing Home Bereweeke Road Winchester Hampshire SO22 6AN 01962878999 01962863663 hilliert@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Tracey Louise Hillier Type of registration: Number of places registered: BUPA Care Homes (CFC Homes) Ltd care home 56 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: All service users must be at least 60 years of age. Date of last inspection Brief description of the care home Bereweeke Court is a care home providing nursing care. The home is registered to accommodate up to 56 service users from 60 years of age, who have dementia and mental health care needs. The home is situated in a pleasant residential area on the outskirts of the city of Winchester and is close to local amenities, which residents can access with the support of relatives or staff. The home is owned by BUPA. The building is currently undergoing a complete refurbishment. The fees for the home are based on Care Homes for Older People Page 4 of 25 Over 65 56 15 56 10 3 0 Brief description of the care home individual assessments and are from £850 per week, with extras charged separately, such as chiropody and hairdressing. Care Homes for Older People Page 5 of 25 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: We looked at all the information we have received since our last review of the service in October 2007. This included: The homes annual quality assurance assessment (AQAA) which was completed by the manager. This provides information about how the service is meeting National Minimum Standards and also provides some numerical information. Any notifications the home have sent to us regarding significant incidents that have happened. Surveys that we sent out. We received two surveys back from visiting health professionals and four surveys back from staff. A visit to the home was carried out on 27/10/08. It lasted for six and a half hours. During this time the premises were toured, some records were viewed and the inspector met with five service users, one visiting professional, one visitor and five staff. They provided information about what it is like to live, visit or work at the home. Time was also spent Care Homes for Older People Page 6 of 25 with the manager. The needs of most of the service users are such that they are unable to say what they think about the quality of the service that they receive. Time was also spent therefore observing interactions between people who live at the home and staff. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 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 9 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admissions to the home are not made until a full assessment of need of the person has been completed. This helps to ensure that the service can provide appropriate levels of care and support. Intermediate care is not provided. Evidence: The statement of purpose was most recently updated in July 2008 and is available in the homes foyer for reference. It includes information about staffing, the homes aims and objectives and informs people how to make a complaint should they wish to do so. At previous inspections it has been established that the service assesses peoples needs before any move to the home is agreed. The manager confirmed that this was still the case and this was substantiated by checking two records of service users who had been admitted in the last twelve months. Both files contained detailed assessments Care Homes for Older People Page 10 of 25 Evidence: including information about peoples personal and health care needs, communication needs, preferred lifestyle and any religious or cultural beliefs. The assessments are carried out by the manager or deputy and those seen were sufficiently detailed to enable an accurate plan of care to be drawn up, for example, they contained information such as need to speak clearly and slowly loves tea, does not drink coffee and very small meals, needs to be cut up The AQAA confirms that all those who are referred through care management processes have also had an assessment of need carried out by a council or health professional. Care Homes for Older People Page 11 of 25 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. There is a good understanding of peoples health personal and care needs. Peoples privacy and dignity is respected. Evidence: Service users spoken with could not always remember if they were consulted about their needs, although one person said that when they moved in they were asked a lot of questions about their likes and dislikes. Records show that a lot of information is gathered as part of the care planning process and the manager felt that this has improved during the last 12 months with the introduction of the Quest system of care planning. This uses a person centred approach to take into account the individuals diverse needs. Information is gathered about family members, previous employment, favourite holidays and lifestyle plans are developed to describe what the person likes to do and when they like to do it. This helps to provide staff with valuable insight about what is important to people and is especially useful when people are unable to provide this information for themselves. Care Homes for Older People Page 12 of 25 Evidence: Plans of care seen had not always been reviewed every month but there was evidence that they had been updated when a change had been identified. Files seen provided staff with clear guidance on how to minimise any risk that had been identified and how to manage any challenging behaviours. Risk assessments seen included the following; prevention of falls, moving and handling, nutrition, and tissue viability. There was written evidence that relatives are consulted as part of the care planning process and this was confirmed by a regular visitor to the home. Staff surveyed generally felt that they are provided with up to date information about the needs of people they support. Records are kept of health care appointments and one service user said that staff are very prompt in contacting a GP when there is a need. One visiting health care professional said that staff had the skills and experience to care for people appropriately and another health professional who responded in a survey agreed, saying Generally I think the nursing care standard is high. The nurses have cared for many of my patients when extremely frail and bed bound and succeeded in looking after them over long periods with good skin care The manager said that there are also visits to the home from Chiropodists and Dentists. Medication records are checked as part of the monthly quality assurance visit by managers. During the visit, medication was seen to be securely and appropriately stored. One person manages their own medication and has been provided with lockable storage space. A risk assessment has also been completed to ensure that this is being managed safely. There are policies and procedures in place regarding the management of medicines and staff spoken with felt that they have a good understanding of the system and of their responsibilities. Service users were observed to be spoken with in a friendly and respectful way by staff. Care plans are written in such a way as to enhance privacy, for example, one talks about a service user who likes to spend their time alone in the evenings. Medical consultations are carried out in private and service users confirmed that they choose what they want to wear every day. Screens are provided in shared rooms. One visitor said that they felt that staff had a friendly and kindly approach towards residents. Care Homes for Older People Page 13 of 25 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. Service users are given choice in their daily lives and social activities match their interests. Visitors are made welcome. Evidence: As discussed in earlier sections the care planning system takes into account peoples preferences regarding daily routines. The manager said that residents have a memory box in their room to help those with dementia keep links to their past. The home has links with local churches and contact details for other faiths. One visitor spoken with said that they are made to feel welcome at the home and two staff described the atmosphere as happy and relaxed and cheerful The home employs two activity coordinators. One service user spoken with said that they particularly enjoyed the activities, staff and visitors also thought the number and quality of activities organised were good. Peoples nutritional needs are considered as part of menu planning. One mealtime was observed. People were offered a choice of two cooked meals at lunchtime. These were attractively presented and people were given the choice of where they wanted to eat, either in the communal dining room or in their rooms. Staff offered assistance but checked carefully with the individual that Care Homes for Older People Page 14 of 25 Evidence: this was required on that day. People were not rushed and staff interacted effectively with them.The manager confirmed that special diets can be catered for. Care Homes for Older People Page 15 of 25 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. There is an effective complaints and adult protection procedure in place. Evidence: The service has a complaints procedure which is on display in the foyer. All staff spoken with and surveyed said that they knew what to do if a service user or other involved person had concerns about the home. One visiting professional said that the service has always responded appropriately to any concerns raised. This was verified by looking at the complaints log. Any complaint made had been responded to in an appropriate and timely manner. The manager said that all complaints and complements are reviewed as part of the monthly quality assurance visits to the home. The service has procedures in place to help to safeguard service users from abuse or neglect. This includes a whistle blowing procedure for staff. All staff spoken with said that they have received training in adult protection matters. Staff spoken with confirmed that they would know what action to take if they witnessed or were told about a possible abusive situation. The manger said that it is intended that information regarding the Mental Capacity Act will be built into the adult protection training . The manager confirmed that any small amounts of money held on behalf of people is securely stored and records are kept of all financial transactions. Care Homes for Older People Page 16 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The location and layout of the home meets collective needs and the decor will be much improved when the refurbishment programme has been completed. Evidence: One visiting professional commented the physical environment looks quite run down. The upgrading of the decor of the home is already underway and the manager said that it is expected that the planned refurbishment will be complete by early 2009. At the time of this visit, some bedrooms had been upgraded and the area outside the home was being landscaped. One resident who had recently moved back into their bedroom said that they really liked the new decorations and their new furniture. Other areas of the home are still to be completed. The improvements have meant a certain amount of disruption for some, notably for five service users who are temporarily sleeping in a large communal room. The manager acknowledged that this situation was not ideal but said that it had been carefully considered and felt to be the least disruptive solution. A full risk assessment had been drawn up and consideration had been given to ensuring that people had as much privacy as possible, by the positioning of the beds and the use of screens. As people involved lack capacity to consent relatives had been consulted. The manager said that residents had been carefully monitored and had had not appeared to have been unsettled by the temporary changes. Care Homes for Older People Page 17 of 25 Evidence: Records indicate that pipe work and radiators are now all guarded within the home. No adverse odours were found during a tour of the home and all areas appeared clean. Staff were observed to wear protective clothing and confirmed that laundry facilities are appropriate to meet current needs. Care Homes for Older People Page 18 of 25 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. Staff have a range of skills and are employed in sufficient numbers to meet needs. The homes recruitment policy helps to protect service users. Evidence: Service users who were able to say felt that there are sufficient staff on duty always to meet needs. This view was endorsed by visitors and by observation during the visit to the home. One person said the staff are busy but the atmosphere does not seem so hectic as to compromise patient care. The manager said that agency staff had been used only on two occasions since April 2008. At the previous key inspection it was noted that under 50 of care staff had attained an NQV level 2 or above in care. This situation has improved- the AQAA says that now 50 of staff have achieved this qualification and another six staff have been nominated to start the course. The AQAA confirms that all staff have completed satisfactory pre employment checks. Staff spoken with during the visit said that they felt that the recruitment process was thorough . Records of two recently employed staff were checked and these contained evidence of two satisfactory written references, a completed health declaration, evidence of a satisfactory criminal bureau records check and a copy of the job description and statement of terms and conditions. Staff spoken with and surveyed felt that the training provided by the organisation was Care Homes for Older People Page 19 of 25 Evidence: particularly good. They confirmed that the induction programme and mandatory training provided helped them to understand and meet the needs of service users in their care. Staff files seen showed that staff are provided with training in fire safety, moving and handling, managing challenging behaviour, food hygiene, health and safety, Protection of vulnerable adults, infection control and COSHH. Some staff said that they had also attended a course yesterday, today, tomorrow which is run by the Alzheimers society. Care Homes for Older People Page 20 of 25 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 well managed in the best interests of service users. Evidence: The registered manager, Mrs Hillier, has over twenty years experience in caring for older people with dementia. She described how she has an open door policy and demonstrated that she has a good understanding and insight into the day to day running of the home. Staff say that she is supportive the manager is always willing to help or advise any member of staff who approaches her. The manager is very dedicated to the home, residents and staffare representative of the comments made. Staff also felt that the manager is well supported by the deputy and senior nurses. The service has a number of ways in which checks are made on the quality of care provided. These include relatives meetings and newsletters. Relatives are also encouraged to take part in care planning processes. A questionnaire is sent to all relatives every year. The results are collated and a report is sent to BUPA. An action Care Homes for Older People Page 21 of 25 Evidence: plan is devised from the analysis of this report. The most recent results show a high level of satisfaction of relatives in all aspects of the service. A monthly visit also takes place of a BUPA manager and a report is devised. The most recent visit reviewed finance, health and safety, complaints, recruitment, training, medication, care plans, wound management, infection control, and food hygiene issues. The needs of the majority of the residents are such that they would be unable to express their views about the quality of care at the home. Two service users said, however, that they would like to have meetings to talk about daily life in the home. This was discussed with the manager who agreed that this would be pursued. As discussed in a previous section written records of all financial transactions are maintained. Staff supervision was discussed with the manager. She said that all staff are given supervision , including administrative and catering staff. Nurses receive clinical supervision from a Registered General Nurse. All staff are given an annual appraisal and an action plan is drawn up from this. At present the manager said that nurses are having four supervision sessions a year but said that this would increase to a minimum of six next year. She is aware that six times is the minimum amount specified in National minimum Standards. The AQAA confirms that equipment within the home has been maintained and that the service has three monthly health and safety meetings to promote safe working practices. Care Homes for Older People Page 22 of 25 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 23 of 25 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 24 of 25 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) 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. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!