Archived: Handsale Limited - Bierley Court Also known as Bierley Court

Bierley Court is a residential care home providing personal care for up to 40 older people, some of who are living with dementia. Accommodation is provided over two floors in three separate units: Bronte on the ground floor and Hockney and Lowry upstairs. At the time of our inspection there were 28 people using the service.

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

Significant improvements had been made since the last inspection. People felt safe in the service. Safeguarding events, accidents and incidents were reported, recorded and acted upon appropriately. Risks to people were assessed and managed well by staff. Medicines were managed safely, although some aspects of record keeping needed to improve.

There were enough staff to meet people’s needs and keep them safe. Staff received the training and support they required to carry out their roles. Robust recruitment processes were in place.

Cleanliness of the environment had improved with a series of deep cleans and an efficient housekeeping team. Safe infection prevention and control procedures were followed. 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.

Some areas of the environment required redecoration and refurbishment. The provider had plans in place to address this in the near future.

People received the care and support they needed. There was ongoing work to improve care records. People and relatives were happy with the care provided and were involved in decisions about care. People and relatives praised the staff for their kindness and compassion. We saw staff treated people with respect and maintained their privacy and dignity. Activities had improved with external entertainers visiting as well as lots of event inhouse which people enjoyed. People had access to healthcare services. People enjoyed a choice of meals, snacks and drinks and mealtimes were relaxed and sociable.

There was no registered manager. The provider had recently brought in an external senior manager who was working alongside the management team providing additional support. Relatives and staff acknowledged the improvements made since the last inspection. Effective quality assurance systems had been implemented and issues were actioned and verified by the provider and senior management team. An action plan was in place to make sure improvements were embedded, sustained and developed further.

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 inadequate (published 26 January 2023). 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.

At our last inspection we recommended the provider reviewed their recruitment process. At this inspection we found the provider had acted on the recommendation and had made improvements.

This service has been in Special Measures since 26 January 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Handsale Limited – Bierley Court is a residential care home providing personal care for to up to 40 people. The service provides support to older people, some of who are living with dementia. Accommodation is provided over two floors in three separate units: Bronte on the ground floor and Hockney and Lowry upstairs. At the time of our inspection there were 37 people using the service.

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

People were not always safe. People were at risk of harm as the provider had not identified, assessed or mitigated risks. This included risks related to people's health and care needs as well as environmental risks. Some areas of the home were not clean and infection control was not well managed.

Medicines were not managed safely. People were not protected from the risk of harm as safeguarding incidents were not always recognised or addressed. People’s nutritional needs were not always met.

There were not always enough staff to meet people’s needs and keep them safe. Some staff had not received the training they needed for their roles. Recruitment processes required improvement. We have made a recommendation about the recruitment process.

People did not always receive person-centred care and care records did not fully reflect their needs. There were no activities taking place and there was little to occupy and interest people. People’s dignity was not always maintained and they were not always treated with respect.

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

There was a lack of effective leadership and an ineffective governance structure which meant the service was not appropriately monitored at manager or provider level.

People and relatives were generally positive about the service. Staff were described as kind and caring. People were supported to keep in touch with family and friends. People had access to healthcare services.

The provider took action during the inspection to address some of the issues we raised.

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 5 September 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We received concerns in relation to safe care and treatment and governance. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We inspected and found concerns, so we widened the scope of the inspection to become a comprehensive inspection which included all five key questions.

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.

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

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, safeguarding, consent, nutrition, privacy and dignity, person-centred care and good governance 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 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.

Handsale Limited Bierley Court is a residential care home providing personal care and can support up to 40 people. At the time of our inspection there were 29 people living at the home, the majority of whom were aged 65 and over.

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

A recent inspection by West Yorkshire Fire and Rescue Service found the premises did not meet the current fire safety regulations. The provider took immediate action to make sure people were safe. They also put an action plan in place to make sure the necessary improvements were carried out within the specified timescale. Staff had received fire safety training and drills were carried out to test their competence. People told us they felt safe at Bierley Court.

Overall people were satisfied there were enough staff to meet their needs. People received care and support from staff who were trained and supported in their roles. The service worked with other professionals to ensure people’s health care needs were met.

People told us the food had improved. They said they were consulted about the menus and confirmed their dietary needs and preferences were catered for.

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 support this practice.

People told us staff treated them well. Staff knew about people’s diverse needs and we saw staff were kind and respectful in their interactions with people.

People’s needs were assessed, and person-centred care plans were in place. This helped to ensure people received the right care and support. People’s communication needs were assessed, and appropriate support was provided where needed.

People were supported to take part in a range of social activities inside and outside the home. People told us they were involved in planning what they wanted to do.

Since the last inspection the management team have continued to work on improving people’s experiences of care. People told us they were consulted about changes such as the ongoing improvements to the environment. People told us they had confidence in the management team. A relative said, “I feel confident in the day to day running of this residential home and feel we made the best choice, all the staff are wonderful, caring, patient and I mean all staff.”

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 requires improvement (published 25 July 2018).

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.

Handsale Limited - Bierley Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home accommodates 40 people on two floors. There are three units and one unit specialises in providing care to people living with dementia. At the time of our inspection there were 27 people living in the home.

Following our last inspection, the service was rated ‘inadequate’ and placed in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At the last inspection we found the provider was in breach of four regulations; one of these was in relation to staff (Regulation 18) and was a continued breach from the previous inspection in May 2016. The other breaches were in relation to safe care and treatment (Regulation 12), meeting people's nutritional needs (Regulation 14) and governance (Regulation 17). We imposed conditions on the providers registration which required them to send us specific information every month about the actions being taken to improve the service. The provider complied with these conditions.

During this inspection we found the provider had made improvements and there were no breaches of regulations. We gave the service an overall rating of ‘requires improvement’ because there were areas which required further improvement. In addition, the provider needed to demonstrate they could sustain the improvements over time so that we could be assured people would consistently experience good care and treatment in line with the fundamental standards.

The service has 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.’

There were enough staff deployed to meet people’s care needs. Staff were trained and supported to work safety and deliver care which met people’s needs.

Improvements had been made to the way risks to people’s safety and welfare were managed. We saw lessons had been learned when things had gone wrong. Further improvements were needed to ensure the actions taken to reduce risks were clearly recorded as soon as possible after incidents.

People told us they felt safe. Staff knew how to recognise and report any concerns about people’s safety and welfare. Robust recruitment procedures were followed and this helped to protect people from the risk of being cared for staff unsuitable to work in a care setting.

The home was safely maintained. The provider was making improvements to the environment to make sure it was suitably adapted to the needs of the people who lived there.

People received their medicines as prescribed.

Improvements had been made to the way people were supported to meet their nutritional needs. People told us they were always offered a choice of food and drink. However, they also told us the quality of the food was inconsistent. The provider was addressing this and a new chef had been appointed.

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

We found the service worked in partnership with other agencies to ensure people’s health care needs were met.

People told us and we observed staff were kind. People were treated with dignity and respect and supported to maintain their independence.

People’s needs were assessed and their care plans included information about their likes and dislikes. We saw people and their relatives were involved in decisions about their care and treatment. People were supported to plan for their end of life care.

People were offered the opportunity to take part in a range of activities in the home and in the community.

The provider dealt with complaints and concerns appropriately. People were asked for their views and their feedback was used to make improvements to the service.

There were systems and processes in place to monitor and assess the safety and quality of the services provided. These systems needed to be embedded and sustained before we could be assured the service was consistently well led.

Handsale Limited - Bierley Court provides accommodation and personal care to a maximum of 40 people. There were 34 people living at the home when we carried out our inspection. Most of these people were older people and people living with dementia.

The last inspection was in May 2016 and the service was rated good overall. There was one breach of regulation in relation to staffing, (Regulation 18). During this inspection we found the provider had not made the required improvements and they remained in breach of the regulation 18. We identified other concerns and three additional breaches of regulation. We found people were not experiencing good quality outcomes. The overall rating in now inadequate and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

There was a registered manager but they had not been at the home since January 2017. They were working at another service operated by the provider. 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.

There was a new manager at Bierley Court but they were not registered with CQC at the time of our inspection.

People living at the home and relatives told us they felt the service was safe. We were concerned that people would not consistently receive safe and appropriate care because there were not always enough staff on duty.

The new manager had stared to make changes to the way staff were deployed which meant they could work anywhere in the home rather than being based on a particular unit. We found some people living in the home, relatives and staff were anxious about this change. In addition we found the change was not always supported by good communication systems which meant staff did not always have the information they needed to make sure people got the right care.

Accidents and incidents were recorded but it wasn’t always possible to find out whether or not they had been investigated and if action had been taken to protect people from harm.

For the most part people received their medicines as prescribed. However, when errors had been identified it wasn’t always possible to establish what action had been taken.

The home was clean but essential safety checks were not always carried out and staff had not all received fire training.

The required checks were done before new staff started work and this helped to ensure only staff suitable to work with vulnerable people were employed. New staff received induction training to help them carry out their roles. Staff received training to help them work safety. The provider had systems in place to check that the necessary training had been delivered but we found these were not always effective.

Most people told us they enjoyed the food and said they were offered a choice of food and drink. However, we were concerned people who were at risk of poor nutrition were not always receiving the right care and support.

We saw people had access to health care professionals but this was not always recorded and therefore it wasn’t always possible to see how decisions about people’s health care had been made.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were asked for their consent but this was not always recorded in their care records.

People told us staff were kind and caring and we saw a lot of good interactions between staff and people who lived at the home. For the most part people’s privacy and dignity were respected. However, we were concerned people’s dignity could be compromised because staff were too busy to provide support when it was needed.

People’s needs were assessed. There were care plans in place but the plans did not always provide clear guidance for staff on how to support people.

People were not consistently provided with the support they needed to take part in social activities. Although there were three activities staff employed they were regularly required to carry out other duties such as caring or housekeeping. We recommended the provider review the arrangements for supporting people to take part in person-centred activities and encouraging people to maintain their hobbies and interests

People knew how to raise concerns or make a complaint. Complaints and concerns were not always recorded and therefore could not be monitored or analysed to look for trends and patterns.

There had been a lot of management changes and the provider’s quality assurance and monitoring systems had not been operated effectively.

The provider had engaged the services of a consultant and new quality checks were being introduced.

There were meetings for people who used the service and people told us they felt they were listened to. The people we spoke with told us they would recommend the home.

We found the provider was in breach of four regulations; one of these was in relation to staff (Regulation 18) and was a continued breach from the last inspection in May 2016. The other breaches were in relation to safe care and treatment (Regulation 12), meeting people’s nutritional needs (Regulation 14) and governance (Regulation 17). You can see what action we told the provider to take at the back of the full version of the report.

At our last inspection on 14 October 2014 we found no breaches of legal requirements. However, we asked the provider to make a number of improvements to the quality of care provided.

Handsale Limited - Bierley Court provides accommodation and personal care to a maximum of 40 people. On the day of our visit there were 38 people living at the home. Most of these people were older people and people living with dementia

The accommodation is arranged over two floors linked by a passenger lift. The home is divided into three units which include a general residential unit, an early stage dementia unit and an advanced dementia unit. All bedrooms are single rooms with en-suite toilet facilities. There are communal lounges and dining areas for people to use.

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.

People told us the home provided them with a safe environment and raised no concerns about the way they were treated. Staff were aware of action they would take to keep people safe such as in the event of an emergency or if they were concerned someone was at risk of abuse.

Our observations, discussions with people and the layout of the building led us to conclude that although staff worked hard to try and meet people’s needs, there were not sufficient numbers of care staff to ensure people were provided with consistently safe and effective care.

Care records were detailed, well organised and person centred. We saw that risks to people’s health, safety and welfare were identified and action taken to reduce risk.

People told us the food was good and they were offered choices to ensure they had a varied diet. Nutritional risk was being assessed, monitored and managed.

Medicines were managed in a safe way. Records showed people received their medicines at the times they needed them and in line with the prescriber’s instructions. Further improvements were needed to ensure decision making around covert medicines was clearly evidenced and regularly reviewed.

Staff received appropriate training, support and development so that they could provide safe and effective care. Robust recruitment checks were in place to ensure only staff who were suitable to work with vulnerable people were employed.

Staff had a good understanding of the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005 and their role in protecting the rights of people with limited mental capacity. Staff sought people’s consent before they delivered care.

Where appropriate staff made referrals and worked with other health and social care professionals to ensure people maintained good health. Healthcare professionals told us care staff had worked hard to improve communication and ensure collaborative working.

Staff explained care and support to people so they could make informed decisions and understood potential risks in relation to their day to day care. Staff encouraged people to maintain their independence and respected people’s privacy and dignity.

Staff knew people well and used this information to deliver personalised care. People and their relatives were involved in how their care was planned and delivered and their individual preferences and wishes were respected.

We saw staff worked hard to ensure people received appropriate interaction and stimulation that was appropriate to their needs, specific hobbies and interests.

A system of quality assurance was in place to ensure the provider and registered manager monitored the standard of care provided. We saw examples to show that these audits were effective in identifying areas for improvement and improving the quality of care provided.

The provider used a variety of methods to seek the views of people who used the service, such as care reviews, quality questionnaires and residents meetings. We saw evidence to show people’s feedback was used to shape future development of the service and improve the quality of care provided.

We identified one breach 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.

The people who used the service told us they were looked after very well and felt safe with the care and treatment provided. Their comments included: "I like it here", 'They are all very nice' and 'It's my home'.

We found the service had appropriate systems in place to ensure consent was gained before staff proceeded with personal care.

We saw that there was an appropriate system in place for listening to and acting on people's comments and concerns.

We spent time observing care in the three lounges and dining areas during the day of our inspection. We looked at how people spent their time and how staff interacted with people.

The interactions we saw between staff and people who used the service and visitors were respectful.

We used a number of different methods to help us understand the experiences of people who used the service. This was because some people had complex needs which meant they were not able to tell us about their experiences. We spoke with a relative, who told us they were satisfied with the care and treatment their relative received but they had found when they provided information about their relative to staff it was not always followed.

We sat in the both of the lounges and observed the support and care people received. We saw the staff talked to people regularly, they explained their actions, and they asked people's consent. We saw their approach was kind and respectful.