About the service:

The Berkshire Care Home is a care home with nursing that provides a service for up to 58 older people, some of whom may be living with dementia. The accommodation is arranged over two floors. At the time of our inspection there were 45 people living at the service. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

People’s experience of using this service:

People felt safe living at the service. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately. There were appropriate recruitment processes in place. Relatives felt their family members were kept safe. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us staff were available when they needed them and staff knew how they liked things done most of the time. The registered manager reviewed and improved staffing numbers to ensure enough qualified and knowledgeable staff were available to meet people's needs at all times.

People and their families told us they were happy with their care and had seen a lot of improvements. People confirmed staff respected their privacy and dignity. The registered manager was working with the staff team to ensure caring and kind support was consistent.

We reviewed information held regarding Deprivation of Liberty Safeguards to ensure people's liberty was not restricted in an unlawful way and people's rights and freedom were protected. The management team told us they reviewed people to ensure no one was deprived of their liberty unlawfully. The deputy manager took appropriate action to ensure appropriate applications were made where necessary.

We observed people were treated with care and kindness. People and their families were involved in the planning of their care. The service carried out risk assessments and had drawn up care plans to ensure people's safety and wellbeing. Staff recognised and responded to changes in risks to people who use the service. These changes were reported to the senior person to ensure a timely response and appropriate action was taken.

There were contingency plans in place to respond to emergencies. The premises and equipment were cleaned and well maintained. The dedicated staff team followed procedures and practice to control the spread of infection and keep the service clean.

People had sufficient to eat and drink to meet their nutrition and hydration needs. Hot and cold drinks and snacks were available between meals. People had their healthcare needs identified and were able to access healthcare professionals such as their GP. The service worked well with other health and social care professionals to provide effective care for people. People received their prescribed medicine safely and on time. Storage and handling of medicine was managed appropriately.

Staff training records indicated which training was considered mandatory by the provider. The registered manager had planned and booked training to ensure staff had appropriate knowledge to support people. Staff said they felt supported to do their job and could ask for help when needed.

The registered manager held residents and relatives' meetings followed by staff meetings to ensure consistency in action to be taken. The staff team had handovers and flash meetings to discuss matters with the team.

People were able to engage in meaningful activities, spend time with their visitors or, if they chose, be by themselves. Their choices were always respected. We observed people were offered different activities and were encouraged to join in.

We have made a recommendation about seeking guidance from a reputable source to ensure principles of the Accessible Information Standard are me

The inspection took place on 27, 28 and 29 November 2017 and it was unannounced.

The Berkshire Care Home is a care home with nursing that provides a service for up to 58 older people, some of whom may be living with dementia. The accommodation is arranged over two floors. At the time of our inspection there were 44 people living at the service. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a registered manager as required. However, the newly appointed home manager was in the process of applying to register with CQC. A registered manager is a person who has registered with the CQC 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.

At the last inspection the service was rated Requires Improvement. At this inspection we found the service remained Requires Improvement.

People told us they felt safe living at the service. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately. There were appropriate recruitment processes in place. All necessary safety checks were completed to ensure prospective staff members were suitable before they were appointed to post. Relatives felt their family members were kept safe.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

We reviewed information held regarding Deprivation of Liberty Safeguards (DoLS) to ensure people's liberty was not restricted in an unlawful way and people's rights and freedom were protected. The management team told us they reviewed people to ensure no one was deprived of their liberty unlawfully. The deputy manager took appropriate action to ensure appropriate applications were made where necessary.

People told us staff were available when they needed them and staff knew how they liked things done most of the time. The manager reviewed and improved staffing numbers to ensure enough qualified and knowledgeable staff were available to meet people's needs at all times. Most of the staff were knowledgeable and focused on following the best practice to make sure people were supported appropriately. We observed people were treated with care and kindness. People and their families were involved in the planning of their care.

The service carried out risk assessments and had drawn up care plans to ensure people's safety and wellbeing. Staff recognised and responded to changes in risks to people who use the service. These changes were reported to the senior person to ensure a timely response and appropriate action was taken. People received support that was individualised to their personal preferences and needs most of the time. Some records were not always informative enough to ensure people's support needs were followed.

There were contingency plans in place to respond to emergencies. The premises and equipment were cleaned and well maintained. The dedicated staff team followed procedures and practice to control the spread of infection and keep the service clean. However, some maintenance checks were not always up to date. Some equipment and personal items were stored under the stairs. The premises and adaptations were not always dementia friendly. We made a recommendation to review guidance on making the environment more ‘dementia friendly’.

People were given a nutritious and balanced diet. Hot and cold drinks and snacks were available between meals. People had sufficient to eat and drink to meet their nutrition and hydration needs. Support from staff at meal times was much improved with a more relaxed atmosphere. Peopl

This was the first comprehensive ratings inspection of The Berkshire Care Home under the new provider. Previously this service had been registered under a different legal entity. However, the overall brand for the new entity remains the same. The new registration took place in August 2016. The representatives of the new legal entity were aware of improvements that needed to be made to the service following the last inspection under the previous legal entity. This inspection took place on 26, 28 and 29 September 2016 and was unannounced.

We last inspected the service in 17, 19, 23, 25 February and 01 March 2016 due to concerns raised about the safety of the people who use the service and the poor management of the service. We conducted a comprehensive inspection of this service and found four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. The service was rated ‘inadequate’ and placed into ‘special measures’. When a service is rated as inadequate and placed in ‘special measures’, we will inspect again within six months. We took civil enforcement to ensure people’s safety and ensure improvement occurred at the service. We served one warning notice to the provider following the inspection. A warning notice gives a date the service must be compliant by and we inspect again to check that compliance against the content is achieved within the timescale. The provider was required to be compliant with the warning notices by 1 August 2016. The purpose of this inspection was to check what improvements were made and whether the ‘special measures’ framework continues or can be removed. We found the service was compliant with the content of the warning notices.

When we report on issues found at the previous inspection during February and March 2016, we will refer to it as ‘the previous inspection’.

The Berkshire Care Home is a care home with nursing that provides a service for up to 58 older people, some of whom may be living with dementia. The accommodation is arranged over two floors. At the time of our inspection there were 33 people living at the service. One person was at the hospital at the time of our inspection.

The service did not have a registered manager as required. However, the home manager was in the process of applying to the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

During this inspection the home manager was on leave. The clinical lead, the deputy manager and the regional manager assisted us with the inspection carried out over the three days.

People told us they felt safe living at the home. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately. There were appropriate recruitment processes in place. All necessary safety checks were completed to ensure prospective staff members were suitable before they were appointed to post.

Relatives felt their family members were kept safe. Staff followed the principles of the Mental Capacity Act 2005 (MCA) when supporting people who lacked capacity to make decisions. People's rights to make their own decisions, where possible, were protected and staff were aware of their responsibilities to ensure those rights were promoted. People were treated with care and kindness. People and their families were involved in the planning of their care. We reviewed information held regarding Deprivation of Liberty Safeguards (DoLS) to ensure people's liberty was not restricted in an unlawful way and people's rights and freedom were protected. The management team told us applications had been made for some people. However, they were not sure if all the