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, to have more positive experiences of the service they received, than those people who used Berkeley House.
The completion of re-positioning records had improved, following supplementary records being made more accessible to staff. However, we found nutrition and hydration charts were not always completed in a timely way, which meant we could not be assured that records accurately reflected people’s actual intake.
We found areas within the service where odours were apparent and stained corridor carpets. An unattended housekeeping trolley had disposable red plastic bags hanging from the handrail. There was no risk assessment in place for this arrangement. We have made a recommendation about this.
People had care plans in place, however we found these were not always person centred and missed important information about how staff should care for people. We found some people’s risk assessments were not up to date following changes in need. This meant important care could be missed.
There was some inconsistency with the application of Mental Capacity Act legislation. Some people had assessments of capacity and records in their care files when restrictions were in place, but this was not consistent throughout the service.
New staff received an induction and had access to training. Staff training had improved and following training, staff understanding and competencies were assessed. However, not all staff had received training in first aid; this meant there were periods in the service where there was no trained first aider available.
Supervision had recently been introduced following the appointment of the new manager, but appraisals had not taken place.
The care staffing levels had been increased in recent weeks to support the occupancy and dependency levels. There were sufficient staff provided to meet people’s individual needs and support them safely.
There were policies and procedures in place to guide staff in how to keep people safe from abuse and harm. People who used the service confirmed they were safe and had no concerns about their safety. Robust staff recruitment processes were in place and we found relevant pre-employment checks were completed, to help ensure appropriate candidates were employed. This helped to ensure people were protected from harm.
We found people’s health care needs were met. People told us they had access to their GP, dentist, chiropodist and opticians should they need it. Staff knew what to do in cases of emergencies and people who used the service had a personal evacuation plan.
People enjoyed the meals provided to them, menus provided them with choices and alternatives. Staff contacted dieticians and speech and language therapists when they had concerns.
Although people were provided with a range of activities, we found there was less availability for those people who were supported in bed. The manager was hoping to address this with the appointment of a second activity coordinator.
People and their relatives told us if they had any concerns, they would discuss these with the management team or staff on duty. People were confident their concerns would be listened to, taken seriously and acted upon. They told us since the appointment of the most recent manager they felt things were improving.
Staff told us the overall culture across the service was more open and the new management team were supportive of them in their roles and listened to them.