Berwick Grange

Updated 2 February 2023

The inspection

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

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

Inspection team

This inspection was carried out by 2 inspectors on the first day and 1 inspector on the second day. An Expert by Experience supported the inspection by making phone calls to relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service

Service and service type

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

Registered Manager

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

At the time of our inspection there was a manager registered with CQC. However, they were no longer acting as registered manager and were absent at the time of the inspection.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

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

During the inspection

We looked at the care records of 6 people and 5 people's medication records. We viewed 2 staff recruitment and supervision records and agency profiles.

We spoke with 2 people who used the service and 9 relatives about their experience of care provided. We spoke with 14 members of staff including the operations support manager, area manager, deputy manager, nurses, care workers, an activities coordinator, a housekeeper and the music therapist.

We reviewed a range of records including policies, audits, health and safety records, training records and meeting minutes.

Updated 2 February 2023

About the service

Berwick Grange is a residential care home providing personal and nursing care to up to 52 people. The service provides support to older people, some of who may be living with dementia. At the time of our inspection there were 39 people using the service.

The care home is a large purpose-built building with bedrooms and communal spaces across 3 separate units. Two of units were for people who required nursing care and were living with more advanced dementia.

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

Staff knew the people they supported well and how to meet their needs. However, there was a heavy reliance on agency staff which impacted on the quality of care provided. Staff were safely recruited but staffing levels and deployment was not always sufficient to meet people’s needs.

Care plans and risk assessments were not always effective in outlining people’s needs and how best to meet these. Staff told us that at times agency staff lacked understanding of people which increased their distress.

Audits and oversight from the provider had been ineffective in monitoring and addressing concerns in the service. Where action was identified this was not always taken in a timely manner. A service development plan had recently been implemented and progress was being made to improve the environment and outcomes for people at the service.

Staff understood their responsibilities around safeguarding and documenting accidents and incidents. The reported accidents and incidents had not always been effectively managed by leaders in the service. The provider recognised these shortfalls and had been working with the local authority to address these.

Medicines were managed safely and in line with people’s preferences.

The manager was working collaboratively with staff and other agencies to make the required improvements. Staff were knowledgeable and passionate about the people they supported and were keen to improve the service.

Staff had confidence in the changes being made and felt able to be involved. Families spoke highly of the care their relatives received from staff and welcomed the reintroduction of resident meetings.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Rating at last inspection

The last rating for this service was good (published 10 June 2019).

At our last inspection we recommended that the provider reviews best practice guidance when using agency staff and take action to update their practice accordingly. At this inspection we found the provider had implemented practice changes around use of agency staff and information was readily available.

Why we inspected

We received concerns in relation to staffing and management of risk. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Berwick Grange on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to staffing, safe care and treatment and good governance at this inspection.

We have made a recommendation about the Mental Capacity Act.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.