Archived: Berkeley House

Berkeley House is a residential care home registered to provide accommodation and personal care for up to 19 people who have learning disabilities or autistic spectrum disorder. The service is provided in four separate houses, The Windmill, The Granary, The Bakery and Pippin, and is set in large grounds. There were 8 people living at the service at the time of the inspection. Following the inspection undertaken on 20 October 2021 we took urgent enforcement action to impose conditions on the providers registration for this service. As a result of this action, The Bakery was closed and seven people moved from the service to new homes.

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

People were not supported to have maximum choice of control of their lives and staff, management and the provider 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.

People had been unlawfully restrained by staff and had been harmed. There were insufficient staff to meet people’s complex needs. Staff did not have the skills or competencies to support people when they were displaying incidents of distress and people’s human rights were not upheld.

People’s health needs were not met. When people needed support with their health conditions, they did not receive it and this led to people suffering unnecessary harm. People were given medicine they didn’t need, and this had an impact on their quality of life.

There was a closed culture in the service which was not person centered. Leadership at the service was inadequate. There was insufficient oversight of the quality and safety of service people received. This led to people being unsafe and harmed.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, Right Care, Right Culture is the guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting the underpinning principles of Right Support, Right Care, Right Culture. We found that care was not person-centered and did not promote people’s dignity, privacy and human rights. People were not supported by staff in a dignified manner and restrictive practices were used.

Enforcement

We have identified breaches in relation to staffing, mitigation of risks, medicine administration and management oversight at this inspection. Immediately following our inspection, we wrote to the provider to inform them of the seriousness of the concerns we had identified. The provider informed us that they were unable to make the necessary urgent improvements and that they would be closing the service. The provider stopped providing a service to people at Berkeley house from 30 October 2021. The service has now closed.

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.

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 22 December 2021).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about staffing levels, unlawful restraint being used, unsafe medicine administration and lack of management oversight. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Berkeley House is a residential care home providing personal care to 16 people who have learning disabilities or autistic spectrum disorder. The service can support up to 19 people within the four separate houses, The Windmill, The Granary, The Bakery and Pippin.

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

During the inspection, the majority of risks and concerns were identified in the Bakery House. However, other concerns were also found in the Windmill house.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting did not maximise people’s choice, control and independence

People were not always supported to be as independent as possible. A staff member was observed forcing a person into their wheelchair against their wishes. The setting did not maximise people’s choice and control, one of the buildings was being decommissioned and therefore people had been given notice to leave.

Right care:

• Care was not person-centred and did not promotes people’s dignity, privacy and human

Rights

People had not been consistently supported in a person centred and positive way. People’s dignity and privacy had not been upheld. One person had no blinds or curtains at their window, their window was also permanently fixed open. People’s basic human rights were not upheld as they were unable to access toilet paper, in the Bakery house, on the morning of our inspection.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people

using services lead confident, inclusive and empowered lives

The culture within the service was poor. Some staff spoke to people in a degrading manner. People were referred to a ‘verbal’ and ‘non-verbal’. There was a lack of respect from staff and management regarding the environmental aspects of the service. Staff told us that other staff members had been careless with people's bedroom furniture, and this had caused damage and the furniture had not been replaced. People’s bedrooms were dirty and unhygienic.

People living in the Bakery were living in unclean and unsafe conditions. They were not protected from the risk of harm or abuse. Safeguarding incidents had not been consistently recorded or reported to the local authority safeguarding team so they could be investigated.

Risks to people’s health were not always identified. No guidance had been provided to staff about how to support people with other risks. Risks relating to the environment had not been mitigated to keep people safe.

The service was not clean. Peoples bedrooms were dirty and unhygienic and posed a risk to their health. Government guidance regarding wearing and disposing of personal protection equipment was not being followed.

There were not enough suitably qualified and experienced staff to support people with their individual care needs.

There had been no review of incidents and accidents and they continued to happen. No trend analysis had been completed and actions had not been to be taken to mitigate future reoccurrence of incidents.

There was a poor culture within the service. Staff were heard speaking to people in a degrading manner. There was a lack of respect for people’s dignity and personal belongings.

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 oversight from senior management regarding quality assurance within the service.

Following this inspection, we worked closely with the local authorities to make sure people were safeguarded from ongoing harm. Seven people were supported to move out 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 requires improvement (published 16 June 2021)

Why we inspected

The inspection was prompted in part due to concerns received by another healthcare professional. The concerns raised were in areas such as poor leadership, poor risk management, people not being kept safe from abuse or harm and people living in poor and unsanitary conditions. A decision was made for us to inspect and examine 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.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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.

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 discharge our regulatory enforcement functions 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 the service not being able to keep people safe from harm or abuse, inadequate risk assessments and guidance for staff surrounding risks to people, insufficient suitably qualified staff, failure to treat people with dignity and respect, failure to follow legal framework for consent to care being provided and failure to effectively monitor the quality of the service 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

Following the inspection, we took urgent action to restrict admissions to the service. This meant that people living in The Bakery moved out of the service immediately following our inspection as they were not safe living there. We also took urgent action and required the provider to ensure staff were trained in administering medication to people living with epilepsy. The provider has cancelled their registration of Berkeley House. Everyone has now moved out of the service and Berkeley House is now closed.

Berkeley House is a residential care home providing personal care to up to 19 people who have learning disabilities or autistic spectrum disorder. The service is provided in four separate houses, The Windmill, The Granary, The Bakery and Pippin, and is set in large grounds. There were 15 people living at the service at the time of the inspection.

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

Staff had not always supported people in a positive manner and in the way they had been trained. Additional positive behavioural support training had been arranged.

Following a number of medicines errors, a new medicines process had been recently implemented to make sure the administration of medicines was double checked by a second member of staff to reduce the risk of errors. Medicines were stored and disposed of safely.

Infection control audits and checks were not consistently completed or effective. Some areas of the service were not clean and hygienic. The manager took immediate action to address this during the inspection. Staff wore personal protective equipment, to help keep people safe, in line with guidance. People and staff were regularly tested for Covid-19. There were clear processes in place to make sure visitors to the service also helped prevent the spread of infection.

Risks to people’s health were assessed, monitored and reviewed. Staff knew people well. Relative’s told us their loved ones were safe and their health care needs were met. A relative said, “[My loved one] is really safe and very happy at Berkeley House. I am happy with his safety”.

Staff had been recruited safely and there were enough staff to provide people with the support they needed.

A new management team was making changes to the culture and day to day running of the service. Feedback from relatives about the new management structure was positive and they commented they had noticed many improvements. The manager had identified a number of shortfalls in the quality of care across the service and there were plans to address these and drive improvements.

The manager worked closely with local authority commissioners and local safeguarding teams to address concerns.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and Independence

The model of care and setting maximised people’s choice, control and independence. People were supported to make day to day choices and were supported to be as independent as possible.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

People received care and support that was person-centred. However, people had not been consistently supported in a positive way. Some staff lacked the understanding of how to support people when they exhibited behaviours that challenge. The manager had implemented plans to address this and staff were receiving additional support for a specialist positive behavioural support team.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

Relatives and staff told us the culture had improved since a new management team had been overseeing the day to day running of the service. Relatives spoke positively about the care and support their loved ones received. Staff engaged with people and were positive about the changes at the service. The manager had a plan to continue to drive improvements across 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 (published 03 August 2018).

Why we inspected

The inspection was prompted in part due to an increase of safeguarding concerns received. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this 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.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.

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

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.

We found the following examples of good practice.

• Staff worked closely with health care professionals to ensure people’s physical, mental and behavioural needs were managed.

• Staff received training in how to use protective personal equipment (PPE) correctly. During the inspection staff were wearing PPE in line with guidance. The manager told us there was always a good supply of PPE available.

• People were supported to keep in touch with their loved ones using video calls.

• The manager and staff were well supported by the provider.

Berkeley House Residential home 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.

Berkeley House accommodates up to 19 people who have learning disabilities or autistic spectrum disorder. The service is provided in three separate buildings set in large grounds. The Granary provides accommodation for four people. The Windmill provides accommodation for five people. The Bakery has accommodation for ten people. The Granary and The Windmill are self-contained and are staffed independently from the main house. There were 17 people living at the service when we inspected.

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 our last inspection on 26 April 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last 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. The registered manager was not present during the inspection as they were on sick leave. The locality manager and the deputy managers supported the inspection.

Risks were appropriately assessed and mitigated to ensure people were safe. Medicines were managed safely. Records evidenced that people had received their medicines as prescribed.

Effective systems were in place to enable the provider to assess, monitor and improve the quality and safety of the service. Accident and incident records were closely monitored, actions were taken in a timely manner to ensure lessons were learnt.

People were happy with their care and support. Staff had built up good relationships with people. Relatives confirmed that their family members were happy living at the service. The service provided good quality care and support to people enabling them to live as fulfilled and meaningful lives as possible. People were supported to maintain their relationships with people who mattered to them.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the service was calm and relaxed. Staff treated people with dignity and respect. People’s privacy was respected. The service was homely, clean and tidy.

There were enough staff deployed to meet people’s needs. The provider continued to operate a safe and robust recruitment and selection procedure to make sure staff were suitable and safe to work with people. Staff received training, support and supervision to enable them to carry out their roles safely.

Staff knew what they should do to identify and raise safeguarding concerns. The management team knew their responsibilities in relation to keeping people safe from harm. Staff were positive about the support they received from the management team.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People's care plans clearly detailed their care and support needs. People and their relatives were fully involved with the care planning process. The service had developed care plans which clearly detailed people’s likes, dislikes and preferences. Care had been delivered in line with people’s choices. People’s care and support plans had been regularly reviewed in line with their changing needs. People were encouraged and supported to engage with activities that met their needs.

People had choices of food at each meal time. People were supported and encouraged to have a varied and healthy diet which met their health needs.

People were supported and helped to maintain their health and to access health services when they needed them. The management team and staff maintained good communication with other organisations such as the GP and other healthcare services. Relatives were kept well informed about their family member’s health needs.

People and their relatives were given information about how to complain. People and their relatives were actively involved in improving the service, they completed feedback surveys and had meetings.

Further information is in the detailed findings below.

Berkeley House is a service that provides accommodation and personal care for people with learning disabilities. People had a variety of complex needs including mental and physical health needs. The service is provided in three separate listed buildings set in large grounds. Currently, The Granary provides accommodation for four male people with less complex needs. The Windmill provides accommodation for five female people. The main house, The Bakery, provides accommodation for nine male people. The Granary and The Windmill are self-contained and are staffed independently from the main house.

People had a limited ability to verbally communicate with us or engage directly in the inspection process. However, we used observations and people demonstrated that they were happy in their home by showing warmth to the staff that were supporting them. Staff were attentive and communicated with people in a warm and friendly manner. Staff were available throughout the day, and responded quickly to people’s requests for care and support. We observed staff supporting people with their daily activities.

A registered manager was employed at 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 Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

Staff had been trained to recognise and respond to the signs of abuse. Discussions with them confirmed that they knew the action to take in the event of any suspicion of abuse. Staff understood the whistle blowing policy and how to use it. They were confident they could raise any concerns with the registered provider or outside agencies if this was needed.

There were enough staff with the skills required to meet people’s needs. Staff were recruited using procedures designed to protect people from the employment of unsuitable staff. Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.

Staff respected people in the way they addressed them and helped them to move around the service. We saw several instances of a kindly touch or a joke and conversation as drinks or the lunch was served and at other times during the day.

Staff were knowledgeable about the needs and requirements of people using the service. Staff involved people in planning their own care in formats that they were able to understand, for example pictorial formats. Staff supported them in making arrangements to meet their health needs.

Medicines were managed, stored, disposed of and administered safely. People received their medicines when they needed them and as prescribed.

People were provided with food and fluids that met their needs and preferences. Menus offered variety and choice.

There were risk assessments in place for the environment, and for each individual person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. People were involved in making decisions about their care and treatment.

There were systems in place to review accidents and incidents and make any relevant improvements as a result.

Management investigated and responded to people’s complaints and relatives/advocates said they felt able to raise any concerns with staff.

People were given individual support to take part in their preferred hobbies and interests.

There were systems in place to obtain people’s views about the quality of the service and the care they received. People were listened to and their views were taken into account in the way the service was run.

One inspector visited the home, to follow up previous non-compliance regarding Records. During this visit, we were able to answer one of our five questions; Is the service well led?

Below is a summary of what we found. The summary was based on the records we saw, the person who lived in the home and staff we spoke with during our visit.

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

Is the service well led?

We found since our previous inspection 28 April 2014 that the manager had arranged for all the people who lived at the home to have their support re-assessed and a new support plan had been written. All the support plans seen were dated and signed by staff and showed that they had been written with the involvement of the people who used the service.

One person told us about how staff had respected their wishes. They said 'I refused one person to see my file and staff told them they could not look at it.' This meant staff understood confidentiality regarding people's personal documents. We saw that each support plan was discussed each month with the person who used the service to make sure they remained up to date.

We found that support records were being audited monthly to make sure that the records remained up to date and valid.

Below is a summary of what we found. The summary was based on our observations during the inspection, speaking with people using the service and the staff supporting them. We also looked at people's plans of care and support and other records relevant to people care.

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

Is the service safe?

The people who lived at Berkeley House were treated with respect and dignity. Although the people were not all able to communicate verbally, we saw that they were comfortable and happy with the staff. Safeguarding procedures were in place and staff understood how to safeguard the people they supported. We saw that the home had a safeguarding and whistleblowing policy and followed the safeguarding protocols supplied by the local authority. There were systems in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve. The home worked alongside the social services care managers in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made. This meant that people were safeguarded.

The service was safe, clean and hygienic. The registered manager sets the staff rotas, they took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were always met.

Is the service effective?

The person's health and care needs were assessed with them and their family. They were involved in writing their plans of care where ever possible. The care and support needs were reviewed by the person's key worker with them at their monthly meeting and these were recorded. Goals had been agreed and monitored in order that the staff could enable the person to improve their life skills and their quality of life. We were told that people's care and support needs were also reviewed every six months by staff, with the family and social services care manager. However, these reviews had not happened since August 2013and therefore were outside their normal procedure. We also found that changes to care and support had not been documented in the people care and support plan.

Is the service caring?

The people were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting them. The people's preferences, interests, and diverse needs had been recorded and care and support had been provided in accordance with their individual wishes. The staff understood the people who were not able to communicate verbally. The staff were able to described well the meaning of the person's different behaviours and from this we were able to see that the person who lived in the home was happy around the staff. We were able to see that the person was happy with our presence and comfortable with doing what they wanted during the visit. Staff guided the people only, they promoted their independence, and were very patient with them.

Is the service responsive?

The people were involved a range of activities in and outside the service regularly. The staff enabled the people who lived in the home to be involved with their local community. People had differing likes and dislikes and undertook different activities to meet their interests and capabilities. Staff showed that they understood triggers for people's individual unwanted behaviours. Staff showed they knew how to manage these and de-escalate the behaviours to prevent potential risk of harm to person and others.

Is the service well-led?

The service worked well with other agencies and services to make sure the people received their care in a joined up way. The service had a quality assurance systems, records seen by us showed that areas were monitored and identified shortfalls were addressed promptly. We did find the some areas of monitoring had lapsed but this had been identified and was now in hand. Staff spoken with were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Staff spoken with also said that they were well supported by the management of the service, and that they always had someone to discuss things with if they were unclear. This helped to ensure that people received a good quality service at all times.

We saw that people felt relaxed and comfortable living in the home. Some people did not have verbal communication, but smiled or grunted in acknowledgement of the Inspector's comments. Other people made remarks such as 'Staff talk with me about everything, so I know about my care'; 'They look after me very well and help me to do things for myself'; 'The staff are all nice and help me'; and 'I have lots to do. I like it here.'

The home had reliable consent procedures in place, so that people did not receive any care or treatment without their agreement, or that of their representative.

We saw that care planning and risk assessments were thorough, and provided clear instructions for staff to carry out effective care.

There were suitable arrangements in place for the provision of food, so that people were offered a varied and nutritious diet.

The premises provided a suitable environment to enable people to live according to their choice.

We found that staff recruitment procedures were managed appropriately, ensuring that staff were suitable people to work with vulnerable adults.

The home had procedures in place to enable people to share their views about the home, and their viewpoints were taken into consideration for ongoing improvements with the service.

We saw that people living in the home were relaxed with the staff, and responded well to them. Some people were able to use verbal communication skills, and responded positively to questions such as 'Do you like living here?' with answers such as 'Yes', 'I like it here', and 'I am happy here.'

We saw that the service provided people with a wide variety of activities, and opportunities to develop their daily living skills and individual ambitions.

We found that the home emphasised the importance of person-centred care, and protected people's dignity and encouraged their independence.

We checked medication processes, and found that reliable systems were in place.

Some areas of the buildings required attention to the d'cor, flooring and general upkeep. The manager told us that the estates department had already been informed about this.

We found that people's views were listened to, and action was taken in response to people's ideas and concerns.