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Inspection carried out on 8 July 2019

During a routine inspection

About the service

Berkeley House is a residential care home which can support up to 84 older people in the main building. It can also accommodate up to 10 people with a learning disability or autism in three separate bungalows ‘Berkeley Square’ within the complex. At the time of the inspection, there were 66 people living in Berkeley House; one of the areas on the first floor was for people living with dementia.

There were seven people living in two of the bungalows in Berkeley Square; the third bungalow was vacant. This part of the service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People who used the service lived in a safe and clean environment. Risk assessments were completed to help guide staff in how to minimise incidents without being overly restrictive. Any accidents and incidents were checked so lessons could be learned. Staff knew how to protect people from the risk of abuse and how to raise any concerns.

Staff were recruited safely and there were enough staff on duty. People told us staff were caring and looked after them well. They said staff responded quickly when they called for assistance.

People were involved in their assessments and care plans. These gave staff guidance in how to support people in ways they preferred.

People’s health and nutritional needs were met, and health professionals were contacted in a timely way when required. Medicines were obtained and stored safely, and people received them as prescribed. Staff were honest when any medicines errors occurred, so action could be taken quickly.

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 supported this practice.

The service applied the principles and values Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The quality of the service provided to people was monitored through audits, surveys and meetings. This made sure people’s views were obtained and any shortfalls in service could be addressed. The complaints process also helped to improve 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 and update

The last rating for this service was requires improvement (published 18 July 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 12 June 2018

During a routine inspection

The inspection took place on the 6 and 12 June 2018 and was unannounced.

Berkeley House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Berkeley House is registered to accommodate up to 94 people. This number includes 84 older people who may be living with dementia and 10 people who have a learning disability. Separate accommodation is provided for people with a learning disability in three purpose built bungalows adjacent to the main house. These are known as Berkeley Square. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the time of the inspection there were 50 people living in the main house and eight people living in the bungalows.

The service did not have a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered provider’s, 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. A manager was appointed in March 2018 and had applied to register with us. We have referred to this person as the ‘manager’ throughout this report.

At the last inspection on 28 and 29 September 2017, we rated the service as ‘Requires Improvement’ and found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. This was because care plans were not sufficiently detailed to enable staff to meet people’s needs, there was an inconsistent application of the Mental Capacity Act 2005 and not everyone’s capacity had been recorded. People did not have risks to their safety mitigated and quality assurance systems and oversight of people’s needs was ineffective. The provider had failed to provide staff with training, supervision and appraisal. The provider had not always acted in accordance with their registration; they did not always notify us of important events that occurred in the service. This was a breach of Regulation18 (Notification of other incidents) (Registration) Regulations 2009. On this occasion we wrote to the provider reminding them of their responsibility regarding notifications to CQC.

We received a comprehensive action plan. At this inspection, we looked at the previous breaches of the Regulations and the action plan to check that improvements had been made. We found further improvements were required.

The integrated Commissioning and Contracts monitoring team completed a Quality Assessment Framework visit in July 2017. This had identified areas for improvement and had led to a suspension of all admissions to the service being imposed. The suspension was removed in June 2018.

At this inspection we found a new breach of Regulation 9 person centred care, and continuing breaches of Regulations 11, consent, Regulation 17, good governance and Regulation 18, staffing. During the inspection, we found some concerns regarding quality monitoring which had resulted in shortfalls being missed when audits were completed. Examples included; gaps in care plans and consent records, lack of behaviour management plans, accident analysis and staff appraisal. You can see what action we have told the provider to take at the back of the full version of the report.

We found people who used the Berkeley Square service were found overall

Inspection carried out on 28 September 2017

During a routine inspection

The inspection took place on 28 and 29 September 2017 and was unannounced. Berkeley House is registered to provide care and accommodation for a maximum of 94 people. This number includes 84 older people who may be living with dementia and 10 people who have a learning disability. Accommodation is provided separately for people who have a learning disability in small bungalows adjacent to the main home.

The main building provides accommodation over three floors accessible by lift. The homes units are; King George, Victoria and Queens, which are all residential and situated on the ground floor, first floor and second floor respectively. Facilities in the home include six lounges, five dining rooms, a conservatory, garden and a hairdressing salon. The Berkeley Square bungalows cater for up to 10 people with learning disabilities and are called Aldridge, Carlton and Trinity.

The service did not have a 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A manager was appointed in May 2017 and has yet to apply to register with us. We have referred to this person as the ‘manager’ throughout our report.

The Integrated Commissioning and Contracts monitoring team completed a Quality Assessment Framework visit in July 2017 this had identified some areas for improvement and had led to a suspension of all admissions to the service being imposed. The provider has provided an action plan describing the action they are taking to address these issues.

The provider did not have effective systems to ensure risks to people were effectively assessed, monitored and reviewed. Improvements were needed to ensure the manager and providers checks were consistently effective in identifying shortfalls and to drive improvements.

The provider did not always act in accordance with their registration; they did not always notify us of important events that occurred at the service.

There were times when the application of the Mental Capacity Act 2005, used to protect people when they lacked capacity, was inconsistent. Not everyone's capacity had been recorded. Best interests meetings held had not always included professionals in the decision making process. The manager had taken action and submitted applications to the local authority when people’s liberty had been deprived; some of the applications had been authorised but several people were awaiting assessment by the local authority.

Further improvements were needed to ensure that staff received appropriate on going or periodic supervision in their role to make sure their competence was maintained. We saw that although a supervision plan was in place, few of the staff team had received any supervision.

Improvements were needed to make sure all records maintained for people were accurate and completed to show care instructions had been followed so that people received the care and support they required in line with their individual needs.

There were sufficient, suitably recruited staff to meet people’s needs. People were provided with a varied and balanced diet and accessed the support of other health professionals, when required.

Staff had caring relationships with people, promoted people’s privacy and dignity and encouraged them to maintain their independence. People were encouraged to keep in contact with their family and friends and visitors were able to visit without restriction.

People and their relatives felt able to raise concerns and complaints. People’s views were sought in the planning of the service, but changes made were not always monitored to ensure they were effective. Staff felt supported by the manager and the provider.

We found breaches of the Health and Social Care Act 2008 (R

Inspection carried out on 17 November 2016

During a routine inspection

Berkeley House is registered to provide care and accommodation for a maximum of 94 people. This number includes 84 older people who may be living with dementia and 10 people who have a learning disability. Accommodation is provided separately for people who have a learning disability in small bungalows adjacent to the main home.

This inspection was carried out by two adult social care inspectors on 17 and 18 November 2016. The service was last inspected in April and May 2015 and was found to be compliant with all of the regulations that we assessed at that time.

There was no registered manager in post; the previous registered manager had left the service in July 2016. A manager had undertaken the role as manager on 1 November 2016 and was in the process of becoming the registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

The bungalows had a separate staff team who was managed by the bungalow's manager. The bungalow's manager was overseen by the manager of the service.

People who used the service were protected from abuse and avoidable harm by staff who had been trained to recognise the signs of potential abuse and knew what actions to take if they suspected abuse had occurred. Staff were recruited following safer recruitment processes and were deployed in suitable numbers to meet the assessed needs of the people who used the service. People’s medicines were stored safely and administered as prescribed.

People were supported by staff who had been trained to carry out their roles effectively; they had the skills and abilities to communicate with the people who used the service. Consent was gained before care and support was delivered and the principles of the Mental Capacity Act were followed within the service. People were supported to eat a balanced diet of their choosing; dietary requirements were catered for. A range of healthcare professionals were involved in the care and treatment of the people who used the service.

People told us they were supported by kind and caring staff who knew their preferences for how care and support should be delivered. During observations it was clear caring relationships had been developed between the people who used the service and staff. People’s privacy and dignity was respected by staff who encouraged people to be independent and make choices and decisions in their daily lives. Private and sensitive information was stored confidentially.

People were involved with the initial assessment and the reviews of their care and support. Their levels of independence and individual strengths and abilities were recorded. People were encouraged to maintain relationships with important people in their lives and to take part in a range of activities inside and outside of the service. The registered provider had a complaints policy which was made available to people who used the service. When complaints were received they were responded to in line with the registered provider’s policy and used to develop the service whenever possible.

Staff told us the manager was approachable, supportive and listened to their views regarding developing the service. A comprehensive quality assurance system was in place to ensure shortfalls in care and support were identified and drive the continual improvement of the service. The registered provider and manager understood their responsibilities to report accidents, incidents and other notifiable incidents to the CQC as required. Meetings were held with staff and people who used the service to ensure their views were known and could be acted upon.

Inspection carried out on 17 April and 14 and 15 May

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 11 and 12 December 2014. During the inspection we found the registered provider was in breach of Regulations 9, 10, 11, 13, 18, 22 and 23 of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2010 which relate to Regulations 9, 17, 13, 12, 11 and 18 of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014.

After the comprehensive inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to each breach.

We undertook a focused inspection on 17 April and 14 and 15 May 2015 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive

inspection, by selecting the 'all reports' link for Berkeley House on our website at www.cqc.org.uk.

Berkeley House is registered to provide care and accommodation for a maximum of 94 people. This number includes 84 older people who may be living with dementia and 10 people who have a learning disability. Accommodation is provided separately for people who have a learning disability in small residential bungalows adjacent to the main home. 77 people were living in the service at the time of the inspection.

This service does not have a registered manager in place, as the person undertaking this role at the last inspection has left. 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A manager has been in place since March 2015. We have called them the acting manager throughout this report.

Following our comprehensive inspection, the registered provider was found to be non-compliant with regulations pertaining to the care and welfare of people who use services. During our focused inspection we saw that the registered provider had developed care plans encompassing all of the assessed needs of the people who used the service and were delivering care that met people’s needs.

Following our comprehensive inspection, the registered provider was found to be non-compliant with regulations pertaining to assessing and monitoring the quality of service provision. During our focused inspection we found that an audit schedule had been developed which was supported by regular compliance visits carried out by head office staff.

Following our comprehensive inspection, the registered provider was found to be non-compliant with regulations pertaining to safeguarding service users from abuse. During our focused inspection we saw systems had been developed to ensure people who used the service were safe. When accidents or incidents took place, de-briefing meetings were held and action was taken to prevent future re-occurrence when possible.

Following our comprehensive inspection, the registered provider was found to be non-compliant with regulations pertaining to the management of medicines. During our focused inspection we saw that the registered provider had developed medication protocols to ensure medication was administered safely. Recording and storage of medication had also improved.

Following our comprehensive inspection, the registered provider was found to be non-compliant with regulations pertaining to consent to care and treatment. During our focused inspection we observed staff gaining people’s consent before care and treatment was provided. Care plans had been signed by people who used the service or their appointed representative.

Following our comprehensive inspection, the registered provider was found to be non-compliant with regulations pertaining to staffing levels. During our focused inspection we saw evidence to confirm new staff had been recruited and suitable numbers of staff were deployed to meet the assessed needs of the people who used the service.

Following our comprehensive inspection, the registered provider was found to be non-compliant with regulations pertaining supporting workers. During our focused inspection staff told us they received support during one to one meetings and had completed training to enable them to carry out their role effectively. We saw evidence to confirm this.

Inspection carried out on 11 & 12/12/2014

During a routine inspection

This inspection was unannounced and took place on 11 and 12 December 2014. The previous inspection of the service took place on 28 January 2014; the service was compliant with the regulations that were inspected at that time.

Berkeley House is registered to provide care and accommodation for a maximum of 94 people. This number includes 84 older people who may be living with dementia and 10 people who have a learning disability. Accommodation is provided separately for people who have a learning disability in small family type bungalows adjacent to the main home. 83 people were living in the home at the time of the inspection.

The service had a registered manager 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.

Improvements were required in how people’s care and treatment was planned and delivered. Some people who lived at the service had needs that were not planned for. This led to them not receiving the care they required to keep them and other people who lived at the service safe.

Accidents and incidents that took place within the service were not reported to the Care Quality Commission or the local authority safeguarding team as required. We found a number of incidents had not been investigated and action had not been taken to prevent their future reoccurrence.

People were not always consulted before care tasks were carried out and we witnessed episodes of poor care during the inspection.

People’s medicines were not always administered as prescribed. Some people were prescribed medication to reduce their levels of anxiety; we found that the service did not have instructions for staff to follow as to when this medication should be given.

There was not enough staff to meet the assessed needs of people who lived at the service. The registered provider did not have accurate and up to date records of what training staff had completed. Staff told us they did not feel supported by the registered manager.

An adequate quality assurance system was not in place which would highlight the shortfalls within the service. When feedback was received from people who lived at the service and their relatives via satisfaction surveys and complaints, it was not clear what action the service had taken to improve.

Breaches were found in regulations 9, 10, 11, 13, 18, 22 and 23 we have deemed this was a major risk to people who lived at the service. You can see what action we told the registered provider to take at the back of the full version of the report.

Inspection carried out on 22 January 2014

During a routine inspection

Staff we spoke with were able to describe the process for obtaining consent in relation to providing personal care, involvement in activities or other duties to support assistance. For example, when a person needed lifting and handling or assistance during meal times.

We spoke with people who used the service and their visiting relatives. Comments included, �The staff are lovely, very friendly�, "The care is brilliant, you cannot beat the staff here� and �I wouldn�t say anything wrong about this home.�

We saw that people�s food intake was monitored and if anyone was having a poor nutritional intake this was monitored closely, the relevant professionals were involved and risk assessments put in place. This ensured people were receiving the correct diet to meet their needs.

We carried out a tour of the building and found there were suitable communal areas, a library, two conservatory extensions and a sensory room. One conservatory extended into the garden area which was kept to a very high standard. The garden was sufficiently well kept to offer outdoor activity for example gardening, to existing people who used the service and their relatives.

Staff we spoke with commented, �The business really help me with my training and they would also support me with any personal needs as required too� and �We have a unit manager and we can approach them anytime and the manager has an �open door� policy if we need to speak with them.�

Inspection carried out on 28 May 2012

During a routine inspection

People we spoke with told us the home was very relaxed and they could do as they pleased. They told us they could use their rooms as they wished and could join in with plenty of activities. One person told us, �It�s not like being at home but for me it�s the next best thing.�

People also told us they had attended residents meetings and they felt they could contribute to the running of the home.

People told us they felt well cared for and the care was good. One person was able to tell us they had been involved with their care plan and they had attended reviews. Comments included, �The care staff are excellent you just can�t fault them�, �Yes, I know who my key worker is and she is very good, she looks after me really well.�

People told us they would see the manager if they had any concerns and they were confident these would be dealt with appropriately.

Inspection carried out on 28 April 2011

During a routine inspection

People who live at the home told us they felt safe and found the staff kind and helpful, one person told us the staff made them feel special. They told us they found the manager and the staff easy to get along with. They told us there was a nice relaxed atmosphere and they could do as they pleased.

People told us they would approach the manager if they had any concerns or complaints and felt confident these would be taken seriously by the manager and would be dealt with properly. They told us they felt safe at the home and that the staff looked after them properly.

People told us they were involved in meetings and felt confident in raising any matters with the staff or the manager; however they did not remember completing any surveys or questionnaires about how the home was run.

Reports under our old system of regulation (including those from before CQC was created)