25 November 2022
During an inspection looking at part of 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.