Archived: Berkeley Court

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.

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.

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.

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.