Archived: Berkeley Court

Berkeley Court is a residential care home providing personal and nursing care to 59 people aged 65 and over at the time of the inspection. The service can support up to 78 people. Care is provided across six units, within one purpose-built building.

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

We found an inconsistent approach to risk management. Risks were not always appropriately managed, relating to admissions, fire safety and following incidents. People received their medicines as prescribed although some improvements were required to ensure safe systems were in place relating to nutritional thickeners and blood thinners. We made a recommendation to ensure additional guidance was put in place for staff. Some limited incident analysis was undertaken but this needed to be more robust to examine whether there were any underlying themes and trends.

Systems to assess, monitor and improve the service needed to be made more robust to ensure that a consistent high-quality service was provided across all areas. Some care plans were out of date and training was not always up-to-date. An action plan was in place and additional management resources were available to help aid continuous improvement of the service. The service worked well with other organisations to provide stimulation and interaction for people who used the service. People and relatives said they were happy with the home and staff said they were happy to work there.

The home was clean, appropriate infection control procedures were in place and these were understood by staff. The premises were well maintained. There were enough staff to ensure people received prompt care and staff were recruited safely.

People and relatives provided good feedback about the service. They said care was provided in a safe way and said that it met individual needs. People said staff and management were kind, caring and communicated well with them.

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 17 March 2020)

Why we inspected

The inspection was prompted in part by notification of two specific incidents following which two people using the service died. These incidents are subject to an investigation. As a result, this inspection did not examine the circumstances of the incidents. The information CQC received about the incident indicated concerns about the management of choking and medicines. We also had received concerns about the management of safeguarding risk. This inspection examined those risks.

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 requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. Some of these areas were known to the provider and other areas were added to the services action plan during our inspection by the management team.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

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

We have identified breaches in relation to risk management, failure to report incidents to CQC and good governance. 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 quality of standards and safety. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Berkeley Court is a residential care home providing personal and nursing care to 69 people aged 65 and over at the time of the inspection. The service can support up to 78 people.

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

People, relatives and staff gave us very positive feedback about the caring nature of the service. There was a visible person-centred culture. Staff made positive comments about the staff team and the new manager. Care plans were in place; these enabled staff to support people in their preferred way. We spoke to the manager to ensure peoples cultural needs had been fully explored. The manager actioned to this straight away.

There were enough staff to ensure people’s care and support needs were met on the day of the inspection. People and their relatives were happy with the staff team, however felt the agency staff did not know them or their relative as well as the permanent staff. We spoke to the manager about this. Remove space

The provider completed appropriate pre-employment checks for new staff, to check they were suitable to work at the service. People had individual risk assessments in place, so staff could identify and manage any risks appropriately. We saw health professionals were frequently present in the home.

Safeguarding procedures were robust, and staff understood how to safeguard people. Systems were in place to make sure staff learned from events such as incidents and accidents. Staff told us they had training to enable them to perform their roles and were able to improve and develop new skills. Staff felt supported and told us they received regular supervision. However, this had lapsed in recent months due to a new manager in post. This was recognised, and action was taken to address this.

Medicines were managed safely. Infection control audits were undertaken which showed any issues were identified and acted upon.

Respect for privacy and dignity was embedded in the service’s culture and values. People and staff felt respected and listened to. The service promoted people’s wellbeing by taking account of their needs including activities within the service and improvements to people accessing the community had commenced. People made positive comments about the quality of food provided and told us their preferences and dietary needs were accommodated.

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. Complaints were recorded and actioned with in line with organisational policy. There were planned, and regular checks completed at the service to check the quality and safety 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 overall (published May 2017).

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.

This inspection took place on 18 and 24 May 2017. At the last inspection in February 2016 we rated the service as requires improvement. We found the registered provider was breaching two regulations associated with the Health and Social Care Act 2008. These related to the recruitment of staff and staff training and development. Following the last inspection we received an action plan from the registered provider that detailed how improvements would be made. At this inspection we found the registered provider had taken action to address the above breaches of regulation and appropriate improvements had been made in both of these areas.

Berkeley Court provides care and support for up to 78 older people, some of whom may be living with dementia. At the time of our inspection there were 70 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 service had been recently been recently re-registered following the registered provider formally taking over direct management of the service following its acquisition from a subsidiary company within the parent group. The service was at the time in the process of implementing a number of changes associated with the transfer to the registered provider.

There was a registered manager for the service. 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 had ensured care staff were provided with a programme of training and development, together with on-going professional supervision and appraisals of their skills to ensure they were supported to effectively carry out their roles.

Recruitment checks had been appropriately followed to ensure care staff were safe to work with people who used the service. Dependency levels of the people who used the service were monitored to ensure there were sufficient numbers of staff available to meet their needs. Safeguarding training had been provided to enable care staff to recognise and report potential signs of abuse and ensure they were familiar with their responsibilities for raising concerns.

Care staff had received training and were familiar with their responsibilities under the Mental Capacity Act 2005 to ensure people’s freedom was not restricted and their human rights were promoted. Systems were in place to make sure decisions made on people’s behalf were carried out in their best interests.

Care staff demonstrated compassion and consideration for people’s needs and treated them with kindness. People were supported to make choices about their lives and provided with a range of wholesome meals. People’s health and nutritional needs were monitored with involvement from health care professionals when this was required.

People were supported to make informed decisions about their lives and a programme of activities was available to enable their health and wellbeing to be promoted. People and their relatives were able to raise a concern and have these listened to and appropriately addressed.

People were able to contribute their views and these were considered to help develop the service. Quality assurance measures were in place to enable the service to be monitored. We saw that action plans had been developed to address shortfalls that had been noted, whilst the service transitioned and adopted new systems operated by the registered provider.