Inspection on 21/04/08 for The Berkshire Care Home

This inspection was carried out on 21st April 2008.

CSCI found this care home to be providing an Adequate 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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Berkshire Care Home 126 Barkham Rd Wokingham Berkshire RG41 2RP Lead Inspector Sally Newman Unannounced Inspection 21st April 2008 10:00 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Berkshire Care Home Address 126 Barkham Rd Wokingham Berkshire RG41 2RP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0118 977 0233 01189 787 157 the.berkshire@fshc.co.uk Four Seasons Rosedale Ltd Mrs Lysbeth Jane Simpson Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (0) of places The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is 58. 24th April 2007 Date of last inspection Brief Description of the Service: 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. The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced inspection that was conducted over the course of 3 days and included a visit to the service of 5 hours duration. A detailed questionnaire was provided by the service prior to the visit and information held by the Commission about the service was used in the formulation of this report. Surveys were sent to staff and service users and 8 completed service user surveys and 4 staff surveys were returned to the Commission. Evidence from these surveys has been incorporated into this report. Upon arrival at the home the inspector was informed by the attendant Area Manager and the Care Services Manager that the manager had been suspended from her post. A thorough investigation was underway into alleged failings on the part of the registered manager. The inspector was assisted with the inspection by the Area Manager, the Care Services Manager and the Deputy Manager. A range of documentation was seen, a tour of the premises was undertaken and staff and service users were spoken to. Observation of care practice and staff and service user interaction was conducted throughout the course of the inspection. The provider has a range of polices and procedures relating to equality and diversity. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to meet the needs of individuals with various religious, racial or cultural backgrounds. The inspector gave feedback about her findings to the Area Manager and Care Services Manager at the end of inspection. What the service does well: The home is comfortably furnished and is well decorated throughout. The food provided is highly valued and the service is flexible enough to meet individual needs and tastes. Nursing and care staff were well regarded by service users and were considered to be kind, caring and helpful. The activities organiser is highly regarded and provides a comprehensive range of activities for service users. The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. Service users are fully assessed prior to admission to ensure their needs can be effectively met by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Admissions to the home only take place if the service is confident that staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. All prospective residents are fully assessed by the management of the home prior to admission. The documentation for six people who use the service was examined. The records evidenced that all necessary information about the users’ health and personal care needs were sought prior to admission. It was the view of the Care Services Manager that the information currently obtained needed to be improved to a more detailed standard in line with current company policy and she would be implementing training to achieve this objective. The use of The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 9 clinical tools to assess the users’ nutrition, communication, mobility, risk of falls, continence and mental state were well developed. The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. Clear information is in place to enable staff to meet the health and personal care needs of residents. The arrangements for medication are robust and protect service users. Service users feel they are treated with respect but that not all felt there was a prompt response to personal and health care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A random sample of 6 care plans was seen. All contained comprehensive information about individual needs and provided staff with clear guidance on how those needs should be met. There was evidence of regular review and all aspects of a person’s lifestyle including their personal, health and social care needs are considered. Service users are offered a shower or bath on a regular basis and are supported to remain as independent in their personal hygiene as possible. Service user surveys indicated that the response to the call bell system was not always prompt. One service user indicated in a survey that this could be particularly problematic when requiring assistance after using the toilet. One service user spoken to stated that the response to the call bell The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 11 could take a long time. The inspector tried the call bell in this service users room and it was responded to within one minute. During feedback the Care Services manager indicated that she was not aware of a problem in this area but she would implement a weekly call bell monitoring programme to identify any difficulties and remedy accordingly. There was evidence in care plans that a wide range of health care professionals are called upon to meet the health care needs of individual service users. There was also evidence that extensive mobility aids are utilised to assist service users and appropriate guidance is sought on their correct use. One service user survey stated that despite requests she had not been enabled to see a dentist or an optician. The senior management present undertook to identify this individual to ensure that access was arranged unless it was found that this had already been addressed. The arrangements for medication were seen. Evidence provided indicated that good practice guidelines are followed although it was noted that homely remedies were being stored within the medication room in an unlocked cupboard. The Care Services Manager had already identified this deficit and had arranged for a lockable storage cabinet to be obtained. A pharmacy inspection took place on 15.1.08 and the report identified no issues and declared the standard as met. The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. A range of activities is offered that provide opportunity for mental and physical stimulation. Service users are encouraged to maintain contact with their family and friends and are able to have visitors at any time. The home provides a varied and nutritious menu designed to meet the needs of its service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was clear from evidence seen, from discussion with staff and from the results of surveys that the home provides a wide range of activities to meet the physical and intellectual needs of service users. There is a dedicated activities organiser who is clearly highly regarded by service users. One survey response stated ‘the activities co-ordinator’ “is excellent. Her enthusiasm and ideas lift people and give them things to look forward to”. Information provided by the service prior to the visit stated that the home would like to improve the provision of activities by providing more opportunities for service users to go on outings outside of the home on a more The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 13 regular basis. Residents meetings are held and consideration should be given to arranging these on a more frequent basis. It is the policy of the organisation and the practice of the home that visitors are welcomed at all reasonable times and are encouraged to join in regularly arranged social events at the home with their relatives. Several relatives who assisted with service user surveys indicated that they felt welcome in the home and could visit at anytime. There is an established and experienced chef who manages the kitchen and arranges the provision of food in the home. A sample menu was provided, which included a wide range of food and meal options. It is the practice that all service users are individually asked each afternoon for their preference for that days’ tea and for the following days main meal. The kitchen was flexible enough to be able to provide an alternative when a service user changed their mind on the day of the planned meal. One service user stated on a survey that, “I am a fussy eater, chef tries to cook me different things where possible”. A food safety inspection was carried out on 18.3.08 where various requirements were made. The inspector was informed that almost all the issues had already been addressed and the home was just awaiting the delivery of uniforms for the kitchen staff. The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. The organisation has a robust complaints policy that has not always been adhered to by the homes management appropriately. Service users are mostly protected from abuse and exploitation by staff who have received appropriate training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The area of complaints handling is the subject of current and ongoing investigation by the provider organisation. There was substantial evidence that the organisation had responded to concerns raised by the Local Authority appropriately and without delay. Concerns centre on the judgement adopted as to the seriousness of complaints raised and to the extent of appropriate communication with concerned parties. The Commission has not received directly any concerns or complaints about the service since the last inspection but they have been provided with copies of an ongoing complaint that has not been resolved to the satisfaction of the complainant. All staff have received protection of vulnerable adults training and most have received recent training to up date their understanding and knowledge and the remainder are due to attend planned refresher training. There were concerns The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 15 about the appropriateness of the management response to an incident in the home that had the potential to place a service user at risk. This incident was in the process of being thoroughly investigated and safeguards were already in place to ensure that all service users were safeguarded from abuse. The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. The standards of décor and furnishings in this home offer service users a comfortable and homely place to live. Standards of hygiene are good throughout. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is well maintained throughout and is decorated and furnished to a good standard. Service users are encouraged to personalise their bedrooms and those occupied bedrooms seen contained personal effects and some furniture brought in by the occupant. During the tour of the premises it was noted that some fire doors were wedged in the open position. Despite a previous requirement no evidence of consultation with the Fire Service could be found although the Deputy Manager advised that hold open devices had been ordered in September 2007. During feedback the management staff undertook to address the wedging of fire doors and to consult with the Fire The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 17 Service without delay. The day following the inspection it was confirmed to the inspector that 20 hold open devices had been ordered and the in house fire safety officer would be arranging contact with the Wokingham Fire Service for advice later the same day. It was also confirmed that consideration was being given to the fitting of automatic door closers to fire doors in the communal areas. The home employs dedicated cleaning and laundry staff. The home was clean and hygienic throughout and service users indicated on surveys that the home is always clean. Lost laundry was referred to in service user surveys and has been the subject of at least one complaint. The laundry is staffed by several part-time individuals whose function is often undermined because clothes are not always appropriately labelled with the name of the owner. However, one service user did comment that even marked clothes do sometimes go astray. It was advised that a review of the system for laundering service users clothes be undertaken to minimise the risk of losing further items. The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. Staff recruitment procedures are satisfactory and protect service users from harm. Staffing levels are sufficient to meet the needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A recent review of staffing levels had been undertaken in the home and appropriate adjustments to the rota had been made. The staffing levels are adequate to meet the needs of the current residents although there were two responses in staff surveys that stated that staffing levels were low. Observations of the interactions between staff and service users provided evidence that mutual respect existed with staff observed adopting a warm and friendly approach to service users. Evidence from files indicated that all staff receive on average of four one to one supervision sessions per year. The inspector was informed that the supervision structure was being reviewed with a view to providing supervision training to more staff so that the national minimum standard of 6 supervisions per year could be achieved. Six staff files were seen and provided evidence that the recruitment procedures operating in the home were robust and conformed to the regulations and standards. There was some concern over the whereabouts of The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 19 POVA first records for 4 members of staff. This had been identified by the external Senior Management team and appropriate action had been taken. The inspector was advised that staff meetings are held in the home although minutes since 26.9.06 could not be readily located. This was an issue raised at the last inspection because staff did not feel that they had a collective forum in which to raise common concerns or to share ideas. A review of the frequency and format of staff meetings should be undertaken to ensure staff are provided with the opportunity to come together to discuss issues or concerns. There is a rolling programme of training in the home to which all staff have access. Information provided by the service prior to the visit confirmed that 23 of care staff held an NVQ qualification or were working towards one. Planned and booked training included protection of vulnerable adults, infection control and manual handling. This planned training was designed to ensure that all staff were up to date with training required in line with the organisations own policy. The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. The provider organisation has made appropriate provision for the management of the home where the interests of service users are paramount. Service users financial interests are safeguarded and the arrangements for health and safety protect service users and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of inspection the registered manager had been suspended by the provider organisation and practices operating in the home were being fully investigated. It was planned that a temporary full time and experienced manager would take over the day-to-day running of the home on the day following the inspection until such time as the investigation was concluded. However, the home would still be subject to regular external review by the The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 21 provider organisation until such time as permanent management arrangements were put into place. Information provided by the service prior to the visit advised that a customer satisfaction survey was currently in the process of being undertaken. The managers present confirmed that the results of this exercise were collated by the organisations’ head office when any actions or outstanding issues were identified. Feedback about the quality of the service was obtained in various ways and included individual service user reviews, regulation 26 visits, quality audits and resident meetings. Evidence taken from information provided by the service and held by the Commission about the service confirmed that the home does not administer service users’ monies or accept valuables for safekeeping. All service users are required to have a family member or advocate who deals with their financial affairs if they are unable to manage their monies themselves. The home benefits from a designated maintenance man who provided records of the various health and safety checks and servicing records that the home maintains. Checks undertaken and recorded included emergency lighting, hot water outlets, monthly cleaning of shower heads and extractor fans, lighting and various general checks, nurse call bell system and fire door and escape routes. Servicing records were maintained for boilers, gas appliances, portable appliance tests, baths and hoists, the lift and an up to date legionella inspection. Health and safety meetings are held and the last recorded was 1.6.07. Overall the health and safety systems operating in the home are considered to be of a satisfactory standard. The accidents record was seen and did not give rise to concern. The inspector was informed that an up to date recording format was on order that complied with current legislation. The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 The Berkshire Care Home DS0000068325.V362797.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP10 OP12 OP26 OP27 Good Practice Recommendations Ensure that a prompt response to call bells is undertaken. Review the frequency of residents meetings to ensure all service users are kept informed of what is happening in the home. Review the system of laundering service users clothes to reduce the risk of loss. Review the frequency and composition of staff meetings to ensure all staff have the opportunity to share issues, ideas and concerns. 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