The inspection took place on 2 and 3 May 2018. The inspection was unannounced.

People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during the inspection of the care home. Berengrove Park Nursing Home is registered to provide accommodation for older people who require nursing or personal care. The home was registered to provide nursing care and support for up to 36 people. There were 31 people living at the home at the time of this inspection. People had complex health needs, including diabetes, stroke and Parkinson’s disease. Many people were living with dementia, some at an advanced stage requiring high levels of support from registered nurses and staff.

There was a registered manager in post at the service. 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.

Our last inspection report of this service was published on 21 October 2017 and related to an inspection that had taken place on 15 and 16 August 2017. At the inspection in August 2017, we found breaches of Regulations 9, 10, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Two breaches had continued since the previous inspection relating to the management, leadership and monitoring of the service provided and people’s safe care and treatment. Three further breaches were found in relation to, people receiving care and support that meets their individual needs; people receiving care and support that respects their privacy and dignity at all times and ensuring staff were deployed to adequately meet the needs of people throughout the day.

We asked the provider to take action to meet Regulations 9, 10, 12 and 18. We took enforcement action against the provider and the registered manager and told them to meet Regulation 17 by 03 November 2017.

The provider sent us an action plan on 18 October 2017 telling us the action they were taking to comply with regulations 9, 10, 12 and 18. They told us they would be fully compliant by 01 January 2018.

At this inspection, on 2 and 3 May 2018, we found that some improvements had been made in all the areas highlighted as requiring improvement. However, further improvements needed to be made and we found other areas of concern not found at the last inspection.

Risk assessments around people’s personal and nursing care needs were in place. However, these continued to primarily focus on the areas of risk common to most people living in the service and did not reflect individual or changing needs. Health and safety hazards were observed around the premises. The control of infection within the service was not clearly managed or understood by staff.

Some elements of medicines management needed improvement in order to provide a safe and effective service when administering people’s prescribed medicines.

Mental capacity assessments had been undertaken to ensure people’s rights were protected under the basic principles of the Mental Capacity Act 2005. Documents used were of poor quality and therefore illegible at times. Decisions were not always made in people’s best interests and consent to care and treatment was not appropriately sought.

New staff received a good induction to the service and training was available for staff to complete to ensure they had the skills and training to support the people living in the service, however not all staff had kept their training up to date. Evidence was not provided that registered nurses had completed suitable professional development to make sure their nursing and clinical skills were kept up to date.

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The inspection took place over two days, 15 and 16 August 2017. The first day of the inspection was unannounced. This was a planned comprehensive inspection to follow up from the previous inspection report when we had found four breaches of the regulations

Berengrove Park Nursing Home is registered to provide accommodation for older people who require nursing or personal care. The home could provide care and support for up to 36 people. There were 32 people living at the home at the time of this inspection. People had complex health needs, including diabetes, stroke and Parkinson’s disease. Many people were living with dementia, some at an advanced stage requiring high levels of support from registered nurses and staff.

There was a registered manager in post at the service. 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.

Our last inspection report of this service was published on 06 July 2016 and related to an inspection that had taken place on 12 and 13 April 2016. At the inspection in April 2016 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to; Regulation 12, hazards had not been fully identified and managed, meaning people, staff and visitors were at risk of potential harm; Regulation 15, people who use services and others were not protected from the risks associated with unsafe or unsuitable premises because of inadequate cleaning and maintenance; Regulation 17, the provider had failed to ensure adequate auditing and monitoring were in place to check the safety and quality of the service provided. We also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009, CQC had not been notified of important events that had taken place in the service. We asked the provider to take action to meet the regulations.

The provider sent us a report of the actions they had taken to comply with Regulations 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 on 08 July 2016 and they told us they were already meeting the Regulations. They also said they had taken action to meet Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

At this inspection we found the provider and registered manager had made some improvements to the service and standard of care. However, we found improvements were still required and found a continuing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found new breaches of Regulation 9, care and support was not always provided to meet all the needs and preferences of people; Regulation 10, people’s privacy and dignity were not always respected; Regulation 12, risks were not always assessed, reviewed and monitored; Regulation 18, staff were not suitably deployed to ensure people’s needs were sufficiently met.

Risk assessments around people’s personal and nursing care needs were in place. However, risks were not always reviewed to take into account people’s changing needs or incidents that had happened.

Staff were not deployed sufficiently around the service to ensure people’s care and support needs, including social and welfare needs, were met. People were often left sitting on their own in the lounge or in their bedroom with little stimulation. People were not engaged in meaningful activities that were based on their interests and to create a motivating environment.

People’s care plans were suitable for their personal care and nursing needs. However, care plans were not person centred or focussed on people’s well-being and social and cultural needs or based on their pref

Berengrove Park Nursing Home is registered to provide accommodation and personal care for up to 36 older people. There were 33 people living there on the day of our inspection. People living in the home required varying levels of nursing and personal care. For instance, support to manage conditions such as diabetes, living with dementia or help to move around. The accommodation was arranged over three floors. Most rooms could be accessed by using a small passenger lift.

At the last inspection, on 5 and 6 August 2014, we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The breaches were in relation to the safety and suitability of premises, cleanliness and infection control and assessing and monitoring the quality of service providers. The provider sent us an action plan telling us how they were going to make changes to improve the service.

At this inspection we found that the provider had taken action to address the breaches from the previous inspection and improved the environment in some areas. However, there remained a number of areas of concern where the provider had not effectively carried the learning from the previous inspection into other areas of the home. The premises were not adequately maintained to minimise risk to people using the service. There were areas that were not cleaned to a satisfactory level, such as the kitchen and corridors. Equipment such as mobile hoists had not been cleaned to an acceptable standard. Slings used with the mobile hoists were not stored in people’s rooms, causing a cross infection hazard. The clinical room area had parts that were not maintained causing a potential infection control risk. Lighting was poor in an area that was a busy thoroughfare and had mobile hoisting equipment stored, causing a trip hazard. Auditing and monitoring mechanisms had not picked up any of these concerns, rendering them not fit for purpose.

Although care plans were in place and up to date, these were not person centred. There was no information recorded about the person as an individual or describing the person’s life before they moved to Berengrove Park Nursing Home, who was important to them or their likes and dislikes. However, staff clearly knew people well and had good relationships with them.

We have made a recommendation about this.

There was little information around the home to tell people what was happening in the service. For example, what activities were taking place and when, so people had to rely on staff to let them know.

We have made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. The manager had taken steps to comply with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. People were not being restricted and their rights were being protected. However, the registered person had not notified CQC they had made DoLS applications that had been authorised by the local authority. They are obliged to do this by law.

The manager at Berengrove Park had applied to become the registered manager. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and their relatives told us they felt safe living at the home. Staff had a good understanding of their responsibilities in keeping people safe. They could tell us their role in safeguarding vulnerable adults from abuse and were all clear they would always report any suspicions they had. Ind

We found that the provider had taken steps to ensure that people using the service, staff and visitors were protected against the risk of unsafe premises. All the fire doors were working correctly, and personal emergency evacuation plans or PEEP's had been completed for all the people living at the service. We found that window panes had been replaced to ensure that people's views were not obscured and so that rooms were effectively insulated.

We found that people were asked for their consent to care when moving into the service and in their daily lives.

People’s diverse and complex needs were understood and managed by the staff working at the service. People felt their care needs were met by caring and friendly staff. One person commented “There are some very good girls here”.

People were supported to receive adequate nutrition and hydration. One person told us “The food is pretty good, there is always a choice”.

People were not fully protected from the risk of harm because some of the door closing devices were not working properly and the provider had not completed personal emergency evacuation plans for all the people living at the service.

The recruitment policy and procedures used by the service ensured that all possible relevant checks were made on staff so that people’s welfare was protected.

The service had an effective complaints procedure in place and people living at the service felt confident that should they have made a complaint it would be dealt with.

People living at the service told us that they were offered choices on a daily basis such as what they wanted to wear, and whether they wished to take part in activities. People said that the staff were friendly and caring. One person said “They are as good as gold, I’ve got my favourites”. Another person said “The staff are very nice”. People told us that they were treated with respect and that their views were listened to. A relative told us that the staff were “Very obliging” and that it was very reassuring to have such staff caring for their relative.

Staff were confident in reporting abuse and understood that they could blow the whistle if they were concerned about how people were treated.

The service had policies and procedures in place to minimise any risks of cross infection, and we found all areas of the home clean.

We found that the service had provided staff with training updates in core areas such as moving and handling, first aid, food hygiene and The Mental Capacity Act 2005. Staff we spoke with were able to demonstrate how they had benefited from the training and apply it to their work.

The service had a robust quality assurance system in place which enabled the manager and proprietor to identify areas for improvement and assess the quality of the service.

We spoke with people living at the home and we observed interactions and the care of people who were less able to communicate with us. People we spoke with said that they were happy living at the home and that the majority of the staff were very nice, but two people commented that a couple of the staff “Could be a bit short with you”. People said that their rooms were kept clean and that their clothing was looked after by the staff in the laundry.

People said “The food is very good”, and that “There’s always a choice if you’re not keen on something, they’ll make you something you like”.

People said they liked the activities going on at the home, they also said the staff made an effort to “stick to the routines they liked”, such as their preferred times for getting up and going to bed.

Interactions between staff and people less able to communicate were seen, and staff spoke with people on their level, calmly and patiently and encouraged them to take part in activities.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was unannounced. Berengrove Park Nursing Home is registered to provide accommodation and personal care for up to 36 older people. We found that people living there required varying levels of care and support to manage conditions such as diabetes, the after effects of illnesses associated with old age and conditions such as dementia. Some people required support to move around. The premises has accommodation arranged over three floors. Most rooms could be accessed via a small passenger lift.

The manager at Berengrove Park had applied to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Risks to people’s safety were identified and managed effectively and there were enough staff on each shift to make sure that people were protected from the risk of harm. Robust recruitment procedures were followed to make sure that only suitable staff were employed to work with people in the home. However, during our inspection we noted that environmental risk were not well managed, the home had not been maintained to an appropriate standard and was not free from smells. We added this to our inspection plan. You can see what action we told the provider to take at the back of the full version of the report.

Audits were not always effective because they had not picked up issues in the home relating to maintenance in bathrooms and the need for areas of risks in the home to be removed. You can see what action we told the provider to take at the back of the full version of the report.

People were protected from the risk of abuse and risks to their health and wellbeing were well managed. The provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff knew how to safeguard the people they supported.

All of the people we talked with told us they were happy with the care home and felt safe. We observed staff had good professional relationships with the people they cared for. People were encouraged to join in activities and people could move freely around the care home. There were a range of activities available which people could chose to join in with. Staff were kind and caring, treated people with respect and maintained their dignity.

The care home manager had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS is legislation which ensures that people who are unable to make certain decisions for themselves were protected.

Staff had the information they needed to provide personalised care and support. People’s health and care needs were assessed with them, and people were involved in writing their plans of care. People told us they were very happy with the way they were cared for.

Staff received the training, supervision and support they needed to enable them to carry out their roles effectively. This included induction for new staff, key training and additional training in people’s specialist needs.

People told us they enjoyed their meals and there was always plenty to eat and drink. Meals were home cooked, freshly prepared and well presented. People were offered variety and choice. Special diets were catered for and people were involved in the assessment of and decisions about their food and drink. Professional advice and support was obtained for people when needed.

People’s health care needs were supported through arrangements for them to see health professionals such as GPs, chiropodists, dentists, nurses and opticians as required.

People were listened to, valued and treated with kindness and compassion in their day to day lives. People were involved in planning and making decisions about their care and treatment. People could be confident that information about them was treated confidentially..

People’s individual assessments and care plans were reviewed. These were updated as people’s needs changed to make sure people continued to receive the care and support they needed.

There was an open and positive culture which focussed on people who used the service. The manager and provider were approachable and people who lived in the home, staff and visitors could speak with them at any time.

Throughout our visit the staff and management team showed us that they were committed to providing a good service. There were systems in place to monitor and review the quality of the service. The management team carried out regular environmental audits in the home, but these were not always effective because they had not identified areas of maintenance that was required.