The Berkeley

About the service

The Berkeley is a residential care home providing accommodation and personal care for up to 10 people with a diagnosis of learning disabilities, autistic spectrum disorder, mental health needs or sensory impairments. At the time of the inspection 7 people were living in the home.

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

Right Support:

Risks to people had not always been assessed and strategies to reduce the known risks had not always been recorded. The provider implemented the missing risk assessments and completed mitigating strategies immediately after the inspection.

Medicine management required further improvement. Medicine records were not always consistently recorded. The provider was aware, and actions were being put into place.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Right Care:

People were supported by staff who knew them well and who had been safely recruited. However, not all staff had the relevant training to ensure they had the knowledge of people’s health needs. The provider allocated new training to all staff immediately after inspection feedback.

People, relatives and staff knew how to complain. The provider had processes in place to support whistleblowing, raising complaints and completing the duty of candour.

People, relatives and staff were given the opportunity to feedback on the service. The provider sent out annual surveys and feedback was sought during regular reviews.

Right Culture:

Systems and processes to ensure good management oversight and to make improvements required improving. Not all processes were effective in identifying concerns and improvements needed. The provider implemented new systems and processes after the inspection, these will need to reviewed at the next inspection to establish if they are effective and embedded into practice.

Staff felt supported in their roles and received regular supervisions and meetings to raise any concerns, give suggestions or feedback on the service delivered.

People and relatives were positive about the attitudes and behaviour of staff and the culture of the service.

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

Rating at last inspection

The last rating for this service was good (Published 06 December 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Berkeley on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to management oversight and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The service provided was not initially developed and designed in line with the values that underpin Registering the Right Support and other best practice guidance. However, people were given choices and their independence and participation within their local community was encouraged.

Not everyone living at the Berkeley receives a regulated activity. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection it was confirmed that seven people using the service received 'personal care’.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

A registered manager was in post. 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. The registered manager was fully aware of their legal responsibilities and was committed to providing excellent leadership and support to staff.

People were treated with kindness, compassion, dignity and respect. People were supported by staff to engage in activities of their choosing. The provider built relationships with services within people’s local community to enhance people’s care experience.

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

People were protected from the risk of harm. Staff had been trained in safeguarding people and understood how to report any concerns of abuse. Risks to people's safety were comprehensively assessed to ensure they were effectively managed . Safe recruitment procedures were followed.

People were supported by staff that had received training the provider deemed as mandatory to ensure the people they were supporting received safe care. The provider had systems in place to assess and identify the support people required before receiving care.

People and their relatives all spoke positively of the staff team. The registered manager was visible, approachable and highly regarded amongst people, relatives and the staff.

Further information is in the detailed findings below.

The Berkeley is registered to provide accommodation and personal care support for up to 10 people with learning disabilities. On the day of the inspection 8 people were living in the home.

There was a registered manager in post at the time of our inspection. 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.

People felt safe in the home and relatives said they had no concerns. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. There were sufficient staff to meet the needs of the people and recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service. Staff received training in areas that enabled them to understand and meet the care needs of each person.

Care records contained individual risk assessments and risk management plans to protect people from identified risks and help to keep them safe but also enabled positive risk taking. They provided information to staff about action to be taken to minimise any risks whilst allowing people to be as independent as possible.

Care plans were written in a person centred approach and detailed how people wished to be supported and where possible people were involved in making decisions about their care. People participated in a range of activities both in the home and in the community and received the support they needed to help them do this. People were able to choose where they spent their time and what they did.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff had good relationships with the people who lived at the house. Staff were aware of the importance of managing complaints promptly and in line with the provider’s policy. Staff and people were confident that issues would be addressed and that any concerns they had would be listened to. There was a stable management team and effective systems in place to assess the quality of service provided.

At the time of our inspection six people lived at The Berkeley care home. We spoke with three people who used the service and they told us that they were happy living at the home. Because of the nature of their disabilities, they were not all able to tell us in detail about their experiences. Our summary is based on the views of people who used the service, observations during the inspection, speaking with staff supporting people who used the service, the registered manager and from looking at records. If you want to see the evidence supporting our summary please read the full report.

During the inspection we sought answers the five key questions below:

Is the service safe?

People who used the service told us that they felt safe and that they had no concerns about how staff treated them. Staff received training to ensure they understood their responsibilities in relation to safeguarding the vulnerable adults in their care. Staff also knew who to contact to report any suspicions of abuse.

Is the service effective?

People who used the service told us that they received the care and support that they needed. We saw that people's needs had been assessed and care delivered according to people's needs.

Is the service caring?

Conversations were calm and relaxed and staff treated people with dignity and respect. People told us that staff listened to them and treated them with respect.

Discussions with staff and our observations demonstrated that the manager and staff were committed to helping to ensure that people received the care and support that met their individual needs. We also heard staff speak to people who used the service with respect, and approach them in a caring manner.

Is the service responsive?

People's care needs were reviewed regularly. This helped to ensure that people continued to receive care that was appropriate and effective. We saw that when people's needs changed medical advice was sought.

Is the service well-led?

We found that the day to day management of the service was good and there were quality assurance processes in place to assess and monitor the quality of the service. We also saw that action had been taken to address the issues relating to the premises which had been identified by the inspector in July 2013. However, we saw that arrangements for keeping the premises adequately maintained were not effective.

People we spoke with told us that they were happy living at the Berkeley. One person told us that the staff were 'nice' and that they 'treat me with respect'. Another person told us 'I have lived here a long time and I like it'.

People also told us that they liked their accommodation and that they had a good choice of food available to them. One person told us that the staff encouraged them to eat in a healthy way and that they had a 'take away as a treat'. People also told us that they received their medication when they needed to and had a weekly meeting where they discussed any concerns they had about living at the home.

We found that people gave their consent to their care and treatment and received a choice of healthy and nutritious food to eat. We also found that the provider operated an effective recruitment system and that there were systems in place to monitor the quality of the service provided. However, we had some concerns regarding the safety and suitability of the premises.

We saw that staff engaged with people, conversed with them, and took an interest in what each person had done during the day. A visiting relative was very complimentary about the standard of care and said, "the staff here are so supportive."

We found 'The Berkeley' to be well organised, comfortable, and appropriately maintained. The staff on duty were friendly and enthusiastic and we saw that they got on well with the people they supported.