Archived: Berrywood Lodge

Updated 22 July 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was completed by two inspectors.

Service and service type

Berrywood Lodge is a ‘care home’. People in care homes receive accommodation and nursing or 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 this inspection.

The service had a manager registered with the Care Quality Commission. However, they were no longer employed by the company. A new interim manager was in place. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.

During the inspection

We spoke with three people who used the service and two relatives about their experience of the care provided. We spoke with eight members of staff including the manager, regional director, care workers and the chef.

We reviewed a range of records. This included five people’s care records and multiple medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data, rotas, governance and quality assurance records.

Updated 22 July 2021

bout the service

Berrywood Lodge is a residential care home providing personal care to 20 people with a diagnosis of learning disabilities, autistic spectrum disorder and/or mental health at the time of the inspection. The service can support up to 30 people.

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

People were not always protected from abuse. Records of incidents were not always in place and investigations had not always been completed to identify the cause of an unexplained injury.

People were at risk of inappropriate physical intervention from staff. Staff had not received training in physical intervention and other people using the service had at times become involved in these interventions.

Risks to people had not always been identified and recorded. Risk assessments that had been completed did not always contain the correct information. Staff had not always followed the mitigation strategies identified to reduce the risk of harm.

People were at risk of not receiving healthcare support in a timely manner. Records of appointments and follow up appointments were limited. Some information had not been recorded.

Care plans were incorrect and did not contain all the information required to support the person safely. We found limited evidence that people had been involved in their own care planning.

Staff had not received all the training required to support people using the service. Staff recruitment required improvement, pre employment checks had not always been completed fully before staff started to work at the service. The service used a high number of agency staff.

Medicine management required improvement. Staff did not always have protocols in place for as required [PRN] medicines to know when and why they would administer people’s medicines.

Cleaning schedules were not consistently completed, and we found no evidence of shared bathrooms being cleaned between use. Staff did not use PPE effectively and safely.

Systems and processes to ensure good oversight of the service were either not in place or suitable to ensure the provider was meeting all of the regulations.

People and staff were supported to have regular COVID 19 testing.

People told us the food was good and we saw they had access to drinks as required.

People were not always supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible and in their best interests.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting did not maximise people’s choice, control and independence. We found limited evidence of people being involved in their care plan or being asked to feedback on the support they receive.

Right care:

• Care was not always person-centred or promoted people’s dignity, privacy and human rights. We found care plans were incorrect, had missing information and people’s choices and preferences had not been recorded.

Right culture:

• Ethos, values, attitudes and behaviours of the new manager supports people using services lead confident, inclusive and empowered lives.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 04 February 2021).The provider was found to be in breach of regulations 17, 13, and 12.

At this inspection enough improvement had not been made and sustained and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: safe care and treatment and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good Governance, had been met.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to assessing risks, safeguarding people from abuse, staffing levels and oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.