CQC report explained · a residential care home
What the CQC found at Berwick House Rest Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- When-required medicines were not always supported by personalised guidance or complete records. Fire safety risks, care risks and some emergency evacuation information were not managed consistently.
- Effective?
- Good
- This key question was not inspected during this visit, so no new rating was given.
- Caring?
- Good
- This key question was not inspected during this visit, so no new rating was given.
- Responsive?
- Good
- This key question was not inspected during this visit, so no new rating was given.
- Well-led?
- Requires improvement
- Quality checks and audits had not consistently identified or acted on problems. Staff were positive about the new manager, but management and monitoring systems were not yet established.
What inspectors found, March 2023
Rated Requires Improvement; inspectors found kind care and signs of improvement, but medicines, safety records and management oversight were not reliable.
This was an unannounced inspection after concerns about medicines, staffing and management. Three inspectors visited, including a pharmacist specialist. They spoke with relatives and staff, observed care, checked the home and reviewed care, medicines, recruitment and management records.
The home was rated Requires Improvement overall. Safe and Well-led were both rated Requires Improvement. Inspectors found problems with when-required medicines, fire safety, risk assessments, care records and quality checks. They said these problems created a risk of poor care or harm, although they found no evidence that people had been harmed by the medicines issues.
There were also positive findings. Staff knew people well, relatives generally spoke positively about the care, staffing levels were adequate on the inspection day and infection control arrangements were satisfactory. A new manager had started in December 2022 and had already made some changes, but improvements were not yet firmly established.
The overall rating changed from Good to Requires Improvement. The report says the other key question ratings were not newly inspected and were carried over from the previous inspection.
Staff knew people well
Inspectors found that staff knew people well and generally used a person-centred approach, although this was not always recorded in care plans.
“Staff knew people well and had a person-centred approach, but this was not always documented.” from the report
Kind care
People appeared happy and relaxed during the visit. Relatives gave positive comments about the kindness of staff.
“When asked what they thought of the staff, relatives said, "Staff have been excellent" and "Staff are very kind.” from the report
Staffing and recruitment
Inspectors found adequate staffing on the inspection day. Recruitment records checked included the required background checks and references, or documented risk assessments where references were incomplete.
“On the day of our visit, there was adequate levels of staff.” from the report
Infection control
Inspectors were assured that the home had arrangements for preventing and managing infections, including the safe use of protective equipment.
“We were assured that the provider was responding effectively to risks and signs of infection.” from the report
Partnership working
The home had worked with the local authority and other professionals to improve care and support.
“The provider and manager had worked very closely with the local authority to improve overall standards and had a good working relationship with the care home team.” from the report
When-required medicines
seriousRecords did not always show whether when-required medicines had been given appropriately. Personalised instructions were missing or identical for people with different needs.
“It was not always possible to tell whether 'when required' medicines had been administered appropriately.” from the report
Fire safety risks
seriousSome emergency evacuation plans were inaccurate or not accessible to staff. Not all staff had been trained to move people downstairs in an emergency, and fire service recommendations had not been completed.
“Systems and practices had not been established to assess, monitor and mitigate risks relating to fire safety.” from the report
Inaccurate care records
seriousSome care plans contained conflicting or missing information about mobility, falls, bedrails, behaviour and support needs. One person had bedrails without a related risk assessment.
“Systems had not been established to maintain accurate and complete records.” from the report
Weak quality monitoring
seriousAudits and care plan reviews did not consistently identify or correct problems. The new quality monitoring arrangements were not yet embedded.
“The provider did not always have established systems to continually assess, monitor and improve the quality and safety of the service.” from the report
DoLS records
needs fixingTwo of the authorisations checked did not list all the equipment being used, including bedrails and CCTV. Inspectors recommended that these records be reviewed and kept up to date.
“We found the service was not fully working within the principles of the MCA.” from the report
- 01What changes have been made to the personalised guidance and recording of when-required medicines?
- 02How are fire safety recommendations, emergency evacuation plans and staff training now being checked?
- 03How do you make sure care plans and risk assessments are accurate, consistent and updated when people's needs change?
- 04What audits are now completed, how often are they reviewed, and who checks that actions are finished?
- 05Have the DoLS authorisations been updated to include equipment such as bedrails and CCTV?
This was a focused, unannounced inspection of Safe and Well-led, prompted by concerns about medicines, staffing and management; the other ratings were carried over from the previous inspection. This explanation was written from the published report of 22 March 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2018
Rated Good; inspectors found safe, kind and personalised care with strong management.
The inspection was unannounced and took place in November 2018. Inspectors checked the building, care records, medicines, staff records and management systems. They also observed care and spoke with a resident, relatives, staff and visiting health professionals.
The home had enough staff with suitable training. Inspectors found that medicines, safeguarding, infection control and environmental safety were managed well. People were supported with food, drink, health needs and decisions about their care.
Inspectors saw staff spending time with people and treating them with kindness and respect. Care plans were personalised and included people's preferences, goals and end of life wishes. All five areas were rated Good, the same overall rating as at the previous inspection in June 2016.
Enough staff
Inspectors found staffing levels and staff skills were sufficient for people's needs. Relatives and staff said people received the support and time they needed.
“We saw the registered manager had sufficient staffing levels and skill mixes to meet people's requirements.” from the report
Kind and respectful care
Staff were observed spending long periods with people, speaking quietly and offering reassurance. People and relatives consistently described the team as caring.
“During our inspection, we saw staff sitting for long periods and engaging with people, talking quietly and reassuringly.” from the report
Personalised support
Care records included people's preferences, chosen names, activities, life histories and goals for independence. Families were involved in developing and reviewing support plans.
“We found each person's documentation was personalised to their individual needs.” from the report
Good leadership
The management team was visible, worked alongside staff and used audits to monitor safety, quality and people's welfare. Feedback was used to make changes.
“The management team completed a range audits to retain oversight of quality assurance, safety and people's welfare.” from the report
Inspectors raised no specific concerns in this report.
- 01How is the new electronic care-record system checked to make sure important information is kept up to date?
- 02How would you support my relative's cultural, language or religious needs?
- 03What activities would be suitable for my relative, and how would you adapt them if their abilities changed?
- 04How would you support my relative's nutrition, hydration and weight, especially if they were at risk of losing weight?
- 05How would you involve our family in care-plan reviews and end of life decisions?
This was an unannounced inspection covering all five key questions; the report used a shorter format because the overall rating had not changed since 2016. This explanation was written from the published report of 18 December 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Berwick House Rest Home
3 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- March 2023Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2018Goodstayed GoodSafe: GoodWell-led: Good
- June 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2014
Report published without a new overall rating.
- August 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- June 2012
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 31 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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