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Archived: Berkeley Court Requires improvement

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Reports


Inspection carried out on 24 February 2016

During a routine inspection

This inspection took place on 24 February 2016. At the last inspection in July 2015 we rated the service as requires improvement. We found the provider was breaching two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. People were not always protected against the risks associated with medicines and the provider did not have effective systems in place to monitor the quality of the service delivery. At this inspection we found the registered provider had taken action in both areas.

Berkeley Court provides care and support for up to 78 older people. At the time of our inspection there were 74 people using the service. The accommodation for people is arranged over three floors. There are two units per floor. Each unit has single bedrooms which have en-suite facilities. There are communal bathrooms and toilets throughout the home. There are open plan communal lounges and dining rooms on each of the units.

The registered provider had a recruitment procedures were in place. However we found the registered provider did not always follow their policy and procedures. We found one person’s reference in their file did not match the references on their application form or previous employment history on their application form

The service had a registered manager in place. 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.

When we looked in staff files we found evidence that showed some staff had not received individual supervision. We also found staff annual appraisals had not taken place. This meant staff were not appropriately supported in relation to their roles and responsibilities which may affect the delivery of care.

Records we looked at showed staff training was not fully up to date. This meant staff were at risk of not being able to perform their duties safely or appropriately.

People who used the service told us they were happy living at the service. They said they felt safe and staff treated them well. Staff told us they respected people’s choice and treated them with dignity and respect.

Care records did not show how people who used the service were involved in the planning their care and there were also limited ends of life care plans. Relatives told us they were consulted about their family member’s care.

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People were encouraged to maintain good health and received the support they needed to do this. Medicines were managed safely and people received their medicines when they needed it. People’s views on food and menus in the home were good. We saw people received regular drinks and snacks to make sure their nutrition and hydration needs were met.

People who used the service were involved in a wide range of activities within the home. Most people we spoke with said they enjoyed these.

Staff spoke positively about the registered manager of the home saying they were approachable. The home had systems in place to deal with concerns and complaints, which included providing people with information about the complaints process. Information on how to complain was clearly displayed in the home, giving people the contact details they needed if they wished to do so.

There were systems in place to assess and monitor the quality of the service; which included regular audits of the home.

Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 were found during this inspection. You can see what action we told the provider to take at the end of this report.

Inspection carried out on 27 July 2015

During a routine inspection

This was an unannounced focused inspection carried out on the 27 July 2015.

Berkeley Court is in a residential area off Harehills Lane in Leeds. It is close to the city centre and St James' Hospital and has excellent transport links to the neighbouring areas of Crossgates, Seacroft and Halton. The accommodation for people is arranged over three floors. There are two units per floor. Each unit has single bedrooms which have en-suite facilities. There are communal bathrooms and toilets throughout the home. There are open plan communal lounges and dining

rooms on each of the units.

The home provides care and support for up to 78 older people, some of whom are living with dementia or related mental health problems. At the time of the inspection there were 77 people living at Berkeley Court.

At the last inspection on date November 2014 we found the provider had breached six regulations associated with the Health and Social Care Act 2008.

We found the provider did not have effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who use the service.

People who used the service were not enabled to make, or did not participate in making decisions relating to their care or treatment.

Before people received any care or treatment they were not asked for their consent and where people did not have the capacity to consent, the provider did not act in accordance with legal requirements.

People were cared for by staff who were not supported to deliver care and treatment safely to an appropriate standard.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

There were not enough qualified, skilled and experienced staff to meet people’s needs.

We told the provider they needed to take action and we received a report in March 2015 setting out the action they would take to meet the regulations. At this inspection we found some improvements had been made, however the provider had not followed their plan and some legal requirements had not been met.

This report only covers our findings in relation to the agreed action plan from the provider received in March 2015. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Berkeley Court on our website at www.cqc.org.uk

The home had a registered manager who has worked in this role since November 2014. This person is registered with 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 and associated Regulations about how the service is run.

At this inspection people who used the service told us they were happy living at the home and they felt safe. We found appropriate arrangements were not in place to manage the medicines of people who used the service. We are taking action with the provider to ensure this is addressed.

We found that overall people were cared for by sufficient numbers of suitably trained staff. We saw that staff now received the training and support required to meet people’s needs. People’s needs were assessed and care and support was planned and delivered in line with their individual care needs.

The registered manager told us they monitored the quality of the service by monthly quality audits, daily walk rounds, resident and relative meetings and talking with people. However we found more work was required around monitoring of medications.

Care plans contain individual risk assessments. These were completed as appropriate on admission and evaluated monthly or more frequently if specific needs were identified.

All care plans were individually audited and consent was discussed and sought in writing which was not obtained previously.

A supervision planner was available in the office and senior staff had received additional training to deliver supervision in a positive manner.

Staff spoke positively about the manager of the home saying things have improved and they had confidence in the manager.

We found the home was in breach of Regulation 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 3 and 7 November 2014

During a routine inspection

We inspected Berkeley Court on 3 November and 7 November 2014. The visit was unannounced. Our last inspection took place on April 2014 and, at that time, we found the service was not meeting the regulations relating to management of medicines and staffing. We asked them to make improvements. The provider sent us an action plan telling us what they were going to do to ensure they were meeting the regulations. On this visit we checked and found improvements had not been made in all of those areas.

Berkeley Court is in a residential area off Harehills Lane in Leeds. It is close to the city centre and St James' Hospital and has excellent transport links to the neighbouring areas of Crossgates, Seacroft and Halton.

The accommodation for people is arranged over three floors. There are two units per floor. Each unit has single bedrooms which have en-suite facilities. There are communal bathrooms and toilets throughout the home. There are open plan communal lounges and dining rooms on each of the units.

There was a manager in post; however this person was not registered. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. On the day of our inspection the new manager of the home had recently commenced their employment.

On both days of our visit’s we saw people looked well cared for. We saw staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated that they knew people’s individual characters, likes and dislikes.

People’s safety was being compromised in a number of areas. This included the staffing levels in place at night. We found that when staff were administering people’s medicines at night there were a number of people at the home who were not supervised by staff. This meant people were not safe.

We were unable to find evidence within care records to show people had been involved in the planning of their care. People we spoke with told us they were not aware of their care plans and could not recall having input in their reviews.

Staff were not always following the Mental Capacity Act 2005 for people who lacked capacity to make a decision. We also saw that where mental capacity assessments had been carried out these were not decision specific. We also saw evidence in people’s care records which showed the home were not obtaining consent from people.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

We saw evidence which showed some staff at the home had not received supervision. Staff we spoke with told us they did not feel supported by the management team at the home. One staff member said “You only ever get spoken to if you’ve done something wrong.” We looked at staff training records which showed staff had received adequate training to perform their roles. We also saw training was booked to ensure staff skills were kept up to date. This meant people received support from staff who had the required skills and training to meet their needs.

People enjoyed the food and we observed people were offered choice and independence in accessing food and drink was promoted. People’s nutrition and hydration needs were being met. People said they received appropriate healthcare support when required. For example people said, “The GP visits whenever they are needed.”

We observed positive interactions between people who used the service and staff. For example, we observed one staff member being very patient showing a person how to do things whilst at the same time talking them through the activity.

People we spoke with said they felt comfortable to raise concerns with staff who assisted them. For example one person told us “I am really happy here.” “The staff are really good.” Staff we spoke with told us they would immediately raise any concerns with their manager and they were confident they would take action to address concerns raised.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 22 April 2014

During a routine inspection

This visit was carried out by two inspectors who visited the home where they looked at records and spoke with the regional manager, registered manager, care workers, people who used the service and visitors to the home. They also spoke with Medicines Management Collaborative Team for Leeds, the Local Authority Contracts Department and the safeguarding team.

We considered all the evidence we had gathered under the outcomes we inspected.

We used this information to answer the five questions we always ask;

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We looked at the arrangements for handling medicines because we have recently received information of concern. This indicated people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to safely manage them. People had not been having their medicines �as prescribed�. At this inspection we found the arrangements for the recording and safe administration of medicines were not fully effective which placed the health and wellbeing of people at unnecessary risk.

We found external medicines such as creams were not safely handled. We found little information to support their use and the records about them were not always available. For example, one person was prescribed four different creams but there was no evidence to show these were being applied. The service had a topical medication care plan for only two of the creams. One topical medication care plan said the cream should be applied twice a day but staff told us it was only applied once a day. The other topical medication care plan said the cream should be applied four times a day but there was no evidence to show this was complied with. We asked to look at records to show the creams were being applied but were told these were not available. Another person was prescribed cream that should have been applied twice daily but their external medicines chart showed it was only applied once daily. The provider had identified in February 2014 that creams were not always signed for. In addition to the above the provider�s policy states once topical medication is �applied staff must sign the topical administration record chart�. We found staff did not always complete a record chart. Failing to handle creams safely places the health and welfare of people at unnecessary risk.

The provider had failed to safeguard the health, safety and welfare of people who used the service by not taking appropriate steps to ensure that, at all times, there were sufficient numbers of suitably qualified, skilled and experienced care staff employed.

During the inspection we observed staff were not always present in the lounge and on one occasion we had to go to find a member of staff to attend to a person who required assistance.

There had been a number of safeguarding issues raised. These related to service users lashing out at each other and a number of service users having falls. Most of these incidents were not witnessed by staff because there were not sufficient numbers around to observe and monitor service user�s movements and intervene as required.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to people been protected against the risk associated with medicines. The second concern regarding inadequate staff members to meet people�s needs must also be addressed.

Is the service effective?

People�s files contained pre-admission assessments, which showed that people's health, personal and social care needs were assessed before they moved into the home.

When people were identified as being at risk, their plans showed the actions required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and walking aids.

Relatives told us they were well informed about their relative�s care and treatment and were involved in their regular care plan reviews. They told us the staff were helpful and kind. They said the staff were quick to inform them of any significant changes in their relative�s general health.

Visitors confirmed they were able to see people in private and visiting times were flexible.

Is the service caring?

Visitors we spoke with told us they were very happy with the care provided and in their opinion people were well looked after. They described staff as friendly, patient and caring.

People who used the service told us they were happy with the staff at Berkeley Court and with the care they provided. One person who used the service said, �It�s excellent here. I enjoy reading and relaxing. It�s very comfortable.�

We found the care staff we spoke with demonstrated a good knowledge of people�s needs and were able to explain how individuals preferred their care and support to be delivered. We saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

The provider�s quality assurance feedback from people who used the service, relatives and visitors, showed there was a high level of satisfaction. All felt the quality of care was excellent or good. The registered provider had analysed the results and identified what they could improve and develop.

Is the service responsive?

The provider had taken some action in response to concerns that had been raised about management of medicines and it was evident that some arrangements had improved.

People and their families were involved in discussions about their care and the risk factors associated with this. Individual choices and decisions were documented in the care plans and reviewed on a regular basis.

People knew how to make a complaint if they were unhappy. Two relatives spoken with told us they have had their complaints addressed. We saw the complaints log and saw any complaints made had been acted upon appropriately and any actions taken had been fed back to the person making the complaint. People can therefore be assured that complaints will be investigated and action taken as necessary.

Is the service well-led?

Staff spoken with had a good understanding of the whistleblowing policy. All of the staff said if they witnessed poor practice they would report their concerns.

Staff spoken with told us the registered manager is very approachable. One member of staff said, �The manager looks after us. She supports us in work and also outside if we are having problems. I�ve no concerns about the service.�

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuously improving.

Inspection carried out on 8 August 2013

During an inspection looking at part of the service

During our visit, we spoke with a number of people who used the service, they all told us they were happy living at Berkeley Court and received the care and support they needed. One person told us "I go shopping to Morrisons just next door and staff always make sure I go to hospital appointments." and "These girls do work hard to ensure everyone is well."

People told us the staff were kind and looked after them well. Family members of the people told us they were satisfied with the care their relatives received from Berkeley Court. One relative of a person who used the service said, �The carers are very good with my mum I come and visit regularly and I can see how well the staff look after people here.�

We found people were treated with dignity and respect and received care that met their needs.

We spoke with some visitors. They told us they were happy with the care provided. One person said, "I find the staff very helpful and I think people are getting good care.� Another person said, �You�re always welcomed you could not wish for a better place� and �The staff cannot do enough.�

There were arrangements for regular supervision. The manager also arranged regular staff meetings. We saw minutes of staff meetings. Staff said they had opportunities to undergo relevant training and development and were encouraged to obtain further qualifications.

Inspection carried out on 3 April 2013

During a routine inspection

People told us that they were happy and satisfied with the care and support they received. This was because people were treated with respect and supported in meeting their care needs, whilst maintaining their independence.

People said they felt able to tell staff if they required any changes to the way in which they were cared for.

People who used the service said they felt safe within the home and would feel comfortable discussing concerns with staff and the manager.

People�s privacy, dignity and independence were respected. People�s views and experiences were taken into account in the way the service was delivered to meet individual needs.

There was an effective complaints system in place and any complaints made were responded to appropriately. People told us if they had any issues or complaints they would discuss them with members of staff and were confident of using the complaints system.

However, we found the that the care plans in place did not provide staff with clear guidance on how to meet people�s needs and therefore there was a risk of mistakes being made or people not receiving the care, treatment and support they require.

We also found that the staff training matrix was not up to date and there were no systems in place to ensure staff updated their training on a regular basis.

Inspection carried out on 3 July 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because the inspection was part of an inspection programme to assess whether older people living in care homes are treated with dignity and respect and their nutritional needs are met.

The inspection team was led by a CQC inspector, and joined by an �expert by experience� and a healthcare professional. These are people who have experience of using services and can provide that perspective and professional advice.

People told us that they enjoyed living at the home and that the care they received was good. They said that staff were kind and tried to get to know their needs and interests, but were always very busy

One person said �The staff are always on the go, but they always manage to help me.� Another said �I like living here, I can get up when I want and sit in the lounge and read my book or else watch television in my room. I can please myself.�

Inspection carried out on 4 August 2011

During an inspection in response to concerns

Relative told us they were worried about the staffing levels in the home. They said the staff were lovely but were busy. They said staff had no time to spend with people living in the home.

People who use the service said they were generally treated well and had their views taken into account. One person said �I get up at a time that suits me and I�m happy with the care�.

People who use the service and their visitors said the home is clean. One person said, �The place is always clean�.

One visitor said �When I have visited I have always found the home to be clean and tidy.

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