Archived: Bereweeke Court Care Home

Bereweeke Court is a care home which provides nursing dementia care and residential dementia care. The service can accommodation up to 50 people. The home is located in a residential area close to community facilities. At the time of the inspection there were 21 people living at Bereweeke Court.

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

Improvements had been made which ensured that risks relating to people’s care and support had been adequately assessed or planned for. There were now sufficient numbers of experienced staff deployed at all times to ensure people’s safety. Medicines were managed safely. There were systems in place to learn from incidents and accidents. Infection control procedures were robust and the service was visibly clean, and no malodours were noted. Staff had a positive attitude to reporting concerns and not tolerating poor care.

Improvements had been made which ensured that staff undertook training relevant to their role and which kept their skills and knowledge up to date. Improvements were being made to ensure that care plans contained adequate information to guide staff. This remained a work in progress. We have made a recommendation that the audit systems in place be reviewed to support this. The mealtime experience had improved. We observed that it was a more person-centred and positive experience for people. People were supported to have maximum choice and control of their lives and staff and the systems in the service supported this approach. Legal frameworks regarding the use of consent were being followed. People had access to a range of health care professionals.

People told us that staff were kind and caring and treated them with respect. We observed that staff supported people to express their views and choices wherever possible. Staff engaged with people in a friendly and compassionate manner.

Improvements had been made to the culture within the service which meant that there was now a focus on the importance of delivering person centred care at all times. This was driven by the registered manager who had a clear value base which placed the person at the centre of their care. Improvements had been made which ensured that people were provided with access to activities which they enjoyed, and which were in keeping with their interests. This was a work in progress and further improvements were planned. People and their relatives continued to express confidence that they could raise any issues or concerns with any member of staff or the registered manager and that these would be addressed. People were supported to have a comfortable and pain free death when they were at the end of their lives.

Improvements had been made to the governance arrangements. Tools used to assess the quality and safety of the service were used effectively to help identify areas where quality of care was being compromised and to drive improvements. Feedback about the registered manager was very positive. Staff and relatives told us his appointment had had a positive impact throughout the service in terms of quality, culture and leadership. The registered manager was clearly driven to look at how the home might continue to improve in all areas.

Rating at last inspection

The last rating for this service was ‘Requires improvement’ (November 2019). We found four breaches of the Regulations. The provider completed an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned, comprehensive, inspection based on the previous rating and to check they had followed their action plan and to confirm they now met legal requirements

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Bereweeke Court is a care home which provides nursing dementia care and residential dementia care. The service can accommodation up to 50 people. The home is located in a residential area close to community facilities. At the time of the inspection there was 30 people living at Bereweeke Court.

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

Risks relating to people’s care and support had not been adequately assessed or planned for. There were insufficient numbers of experienced staff deployed at all times to ensure people’s safety. Overall staff followed a safe process for the storage and disposal of medicines, but we did find some areas where best practice frameworks needed to be embedded further. There were systems in place to learn from when things had gone wrong. The service was visibly clean, and no malodours were noted. Staff had a positive attitude to reporting concerns and about not tolerating poor care.

Staff had not undertaken all the training they needed to keep their skills and knowledge up to date. Care plans did not consistently cover all the required areas or contain an appropriate level of detail to support staff to deliver effective care or to meet identified needs. People were served meals that were in line with their dietary requirements. However, staff were not adequately monitoring known risks associated with people’s hydration and nutrition. The meal time experience needed to be improved to make it a more person-centred and positive experience for people. Legal frameworks regarding consent were not fully met and people were not always supported to have maximum choice and control of their lives and staff and the systems in the service supported this approach. People had access to a range of health care professionals.

More needed to be done to support people with expressing their views and to be involved in decision making. People told us that staff were kind and caring and treated them with respect. However, some of our observations indicated that staff did not always provide care and support in a person-centred manner and there were missed opportunities for staff to engage with people. People were supported to have a comfortable and pain free death.

Care was often task focussed and there was limited interaction with people outside of completing care tasks. Staff told us they did not have time for this. We were not assured that people’s individual preferences and needs were being met. People were not being provided with sufficient opportunities to take part in meaningful activities. People and their relatives mostly expressed confidence that they could raise any issues or concerns with any member of staff or the registered manager and that these would be addressed. There was some evidence that the service was complying with the Accessible Information Standard. People were supported to have a comfortable and pain free death.

Feedback about the registered manager was generally positive. Tools used to assess the quality and safety of the service had not been consistently used to help identify areas where quality of care was being compromised and to drive improvements. The provider was taking action to address this. We were not reassured that the feedback from people and their relatives was always being acted upon effectively. Local health care professionals told us they had open and collaborative working relationships with the service.

Rating at last inspection

The last rating for this service was ‘Good’ (March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We found four breaches of the Regulations. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection was conducted on 27 March 2017 and was unannounced. There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We received mixed views from people about staffing levels and some told us they sometimes had to wait for staff to support them. At mealtimes, we saw staff struggled to support everyone who needed help to eat at the same time; however, at other times, we found staff responded promptly to requests for assistance. Following the inspection, the registered manager wrote to us detailing alternative arrangements they had made to help ensure there were enough staff available at mealtimes.

People felt safe and felt able to raise concerns. Staff understood their safeguarding responsibilities and knew how to prevent, identify and report abuse. People were protected from individual risks in a way that supported their independence and environmental risks were managed effectively.

People were supported to take their medicines safely. Suitable arrangements were in place for ordering, storing, administering and disposing of medicines, including topical creams.

The process used to recruit staff was safe and helped ensure only suitable staff were employed. Plans were in place to deal with foreseeable emergencies. Fire safety equipment and procedures were tested regularly and staff were trained to administer first aid.

Staff underwent a comprehensive induction and training programme. They were knowledgeable and skilled at meeting people’s needs. They were suitably supported in their role through the use of supervision and appraisal processes.

Staff acted in the best interests of people and followed legislation designed to protect people’s rights. They also involved people or their relatives, where appropriate, in discussing and planning the care and support they received.

People were offered a choice of meals and their dietary needs were met. They were encouraged to drink often. People were supported to access other healthcare services.

People were offered a choice of meals and their dietary needs were met. They received appropriate support to eat, when needed, and were encouraged to drink often.

People were supported to access other healthcare services and staff worked well with external professionals. Staff had the necessary skills to help ensure people received appropriate end of life care in a dignified way.

Staff cared for people with kindness and compassion, respected people’s privacy and treated them in a dignified way. They interacted positively with people to build meaningful relationships and supported people with their spiritual needs.

Staff were committed to meeting people’s needs in a personalised way according to their individual needs. Care plans contained comprehensive information to enable staff to support people in a consistent way and care plans were reviewed regularly.

People were encouraged to make as many choices as possible. They received mental and physical stimulation through a range of suitable activities in a group setting or on a one-to-one basis.

The provider sought and acted on feedback from people. There was a suitable complaints procedure in place and people were confident any concerns would be addressed.

People and their families felt the service was run well. They had confidence in the management, as did the staff. There was a clear management structure in place. Staff understood their roles and worked well as a team.

There was a robust quality assurance system in place that focused on continual improvement. A wide range of audits was conducted, together with effective oversight and support by the provider.

There was an open and transparent culture at the home. Visitors were welcomed at any time, CQC were notified of significant events and positive links had been developed with the community to the benefit of people.