Archived: Berrywood Lodge

Berrywood Lodge is a residential care home providing personal care to 20 people with a diagnosis of learning disabilities, autistic spectrum disorder and/or mental health at the time of the inspection. The service can support up to 30 people.

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

People were not always protected from abuse. Records of incidents were not always in place and investigations had not always been completed to identify the cause of an unexplained injury.

People were at risk of inappropriate physical intervention from staff. Staff had not received training in physical intervention and other people using the service had at times become involved in these interventions.

Risks to people had not always been identified and recorded. Risk assessments that had been completed did not always contain the correct information. Staff had not always followed the mitigation strategies identified to reduce the risk of harm.

People were at risk of not receiving healthcare support in a timely manner. Records of appointments and follow up appointments were limited. Some information had not been recorded.

Care plans were incorrect and did not contain all the information required to support the person safely. We found limited evidence that people had been involved in their own care planning.

Staff had not received all the training required to support people using the service. Staff recruitment required improvement, pre employment checks had not always been completed fully before staff started to work at the service. The service used a high number of agency staff.

Medicine management required improvement. Staff did not always have protocols in place for as required [PRN] medicines to know when and why they would administer people’s medicines.

Cleaning schedules were not consistently completed, and we found no evidence of shared bathrooms being cleaned between use. Staff did not use PPE effectively and safely.

Systems and processes to ensure good oversight of the service were either not in place or suitable to ensure the provider was meeting all of the regulations.

People and staff were supported to have regular COVID 19 testing.

People told us the food was good and we saw they had access to drinks as required.

People were not always supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible and in their best interests.

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 did not maximise people’s choice, control and independence. We found limited evidence of people being involved in their care plan or being asked to feedback on the support they receive.

Right care:

• Care was not always person-centred or promoted people’s dignity, privacy and human rights. We found care plans were incorrect, had missing information and people’s choices and preferences had not been recorded.

Right culture:

• Ethos, values, attitudes and behaviours of the new manager supports people using services lead confident, inclusive and empowered lives.

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 requires improvement (published 04 February 2021).The provider was found to be in breach of regulations 17, 13, and 12.

At this inspection enough improvement had not been made and sustained and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: safe care and treatment and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good Governance, had been met.

The overall rating for the service has changed from requires improvement to inadequate. 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.

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 assessing risks, safeguarding people from abuse, staffing levels and oversight 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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

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.

Berrywood Lodge is registered to accommodate 30 people with mental health conditions and learning disabilities. At the time of our inspection there were 21 people living in the home.

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

The registered provider had failed to implement effective governance systems or processes and had not effectively assessed, monitored or driven improvement in the quality and safety of the care being provided in the home.

The provider had not ensured that there were clear lines of responsibility and accountability at all levels. Leadership was poor and staff were not fully aware of what was expected of them. The provider had not kept under review the day to day culture in the service.

Risks to people had not always been reviewed and did not accurately reflect each person’s current situation. Action had not always been taken to mitigate known risks. Health and safety procedures were not always followed and this had placed people and staff at risk.

Systems and processes were not established or operated effectively to safeguard people from financial abuse or mismanagement of their finances.

Safe staff recruitment procedures had not always been followed. This had recently been identified by the new manager and an action was in place to address the issues found. The provider failed to ensure staff had received the appropriate training to support people with complex mental health needs.

The environment continued to require extensive refurbishment. A service improvement plan was in place to address this.

There were enough staff deployed to meet people’s needs. People’s medicines were managed in a safe way.

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 Requires Improvement (published 20 December 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about leadership, management and oversight of the service. A decision was made for us to inspect and examine those risks.

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

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 coronavirus and other infection outbreaks effectively.

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 safe care and treatment, safeguarding service users from abuse or improper treatment ,and lack of governance and oversight of the service.

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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Berrywood Lodge is registered to accommodate 30 people with mental health conditions and learning disabilities. At the time of our inspection there were 24 people living in the home.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 30 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

The service was still requiring extensive refurbishment. A scheduled plan of works was in place and some work had been completed. However, the timelines for main refurbishment had been delayed. Repairs and maintenance were not always undertaken in a timely manner.

People mostly enjoyed living at the home and told us they were treated well by kind and helpful staff. Staff supported people with patience and understanding.

People received safe care, and staff understood safeguarding procedures and how to raise concerns. Risk assessments were in place to manage risks within people’s lives, and staff we spoke with felt safe supporting people with a wide range of needs.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out. Medicines were stored safely, and records showed that they were administered correctly.

Staffing support matched the level of assessed needs within the service and staff were trained to support people effectively.

People were supported to have their nutritional needs met. Healthcare needs were met, and people had access to health professionals as required. Care plans outlined any support people required to manage their healthcare needs.

People's consent was gained before any care was provided, and they were supported to have maximum choice and control of their lives. Staff treated people with kindness, dignity and respect and spent time getting to know them. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Care plans reflected peoples’ likes, dislikes and preferences. An activities programme was in place, and people were supported to pursue holidays and activities they enjoyed with staff support.

A complaints system was in place and used effectively. The manager was keen to ensure people received good care and support and listened to feedback when provided.

Investigations took place into accidents, incidents and any events that could be learnt from. Learning was shared with the team and improvements were made when required.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 Requires Improvement (published 7 November 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made/ sustained and the provider was still in breach of a regulation.

Enforcement

We have identified a breach in relation to failure to improve the quality of the service in a timely manner.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Berrywood Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Berrywood Lodge is registered to accommodate 30 people with mental health conditions and learning disabilities. At the time of our inspection there were 24 people living in the home.

At the last inspection in June 2016 this service was rated good. At this inspection we found the service to require improvement.

The premises had not been adequately cleaned. One person’s bedroom had not been sufficiently cleaned by staff, and some furnishings within it were soiled and had been missed by the cleaning staff.

Cleaning records and audits to check that areas within the home had been cleaned appropriately, were not robust and did not contain enough detail to ensure that standards remained high for people.

There were areas throughout the service that had not been well maintained and required refurbishment. We were shown that work was due to start on the refurbishment of certain areas throughout the home, however, these improvements had not been carried out in a timely manner.

There was 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.

People felt safe. We saw that staff had been appropriately recruited in to the service and security checks had taken place. There were enough staff to provide care and support to people to meet their needs. People received their prescribed medicines safely.

The care that people received continued to be effective. Staff had access to the support, supervision, training and ongoing professional development that they required to work effectively in their roles. People were supported to maintain good health and nutrition.

People told us their relationships with staff were positive and caring. We saw that staff treated people with respect, kindness and courtesy. People had detailed personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences.

People knew how to raise a concern or make a complaint and were confident that if they did, the management would respond to them appropriately. The provider had implemented effective systems to manage any complaints that they may receive.

The service had a positive ethos and an open and honest culture. The manager was present and visible within the home.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the registered provider to take at the back of the full version of the report.

Further information is in the detailed findings below.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were safeguarded from harm as the provider had systems in place to prevent, recognise and report concerns to the relevant authorities. Senior staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and had applied that knowledge appropriately.

There were sufficient numbers of experienced staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person. Recruitment procedures protected people from receiving unsafe care from care staff unsuited to the role.

People’s care and support needs were continually monitored and reviewed to ensure that care was provided in the way that they needed. People had been involved in planning and reviewing their care when they wanted to.

People were supported to have sufficient to eat and drink to maintain a balanced diet. Staff monitored people’s health and well-being and ensured people had access to healthcare professionals when required.

Staff understood the importance of obtaining people’s consent when supporting them with their daily living needs. People experienced caring relationships with the staff that provided good interaction by taking the time to listen and understand what people needed.

People’s needs were met in line with their individual care plans and assessed needs. Staff took time to get to know people and ensured that people’s care was tailored to their individual needs.

People had the information they needed to make a complaint and the service had processes in place to respond to any complaints.

People were supported by a team of staff that had the managerial guidance and support they needed to carry out their roles. The quality of the service was not always effectively monitored and timely action taken by the audits regularly carried out by the manager and by the provider.

This is a summary of what we found-

Is the service safe?

People told us that they felt safe living at Berrywood Lodge, one person said 'I am comfortable living here, the staff are nice and they know how to help me'. People told us they knew how to raise any concerns with the registered manager should they need to do so.

Individual plans of care contained risk assessments to promote people's safety, including safe access to the local community, nutritional risk, the risk of falls and the effects of pressure on the body.

We found that staff had the right checks before they started working in the home and that staff had the right training to ensure people were well cared for and were safe.

The right checks were done to ensure that environment and the equipment used were well maintained and safe to use.

Is the service effective?

Staff related well to people and knew how they liked to be supported. All of the people living at Berrywood Lodge had an individual plan of care; these had been regularly reviewed to ensure that they contained appropriate information.

We saw people were comfortable and relaxed within their environment, people looked well cared for and they were dressed according to their age, gender, culture and the weather conditions. We saw that people had access to a range of aids and adaptations to support their independence and mobility.

Records showed that people had access to a range of health professionals and other NHS services when they were required.

Is the service caring?

We saw that staff were mindful of people's privacy and that they treated them with respect. We saw that people were involved in decisions about their care and any restrictions were made in their best interests and with their consent.

We saw that staff understood people's needs including their non-verbal communication and were swift to respond when people became distressed.

Is the service responsive to people's needs?

People we spoke with told us they felt there were enough staff to meet their needs. We saw that care plans had been updated when people's health needs had changed and that referrals had been made to health and social care professionals when needed. We saw that staff were mindful of people's privacy and that they treated them with respect. For example we saw that staff referred to people by their preferred name and obtained people's consent before providing any support.

Is the service well lead?

The registered manager and the provider had conducted the appropriate checks to ensure that people who used the service were safe and well cared for.

Staff recruitment systems ensured that people were protected from abuse and unsafe care. Systems were in pace to ensure that staff had the right skills to care for people safely. Individual plans of care reflected people's health care needs and personal preferences. Risk assessments were in place to reduce and manage the impact of identified risk factors.

The provider sent us an action plan advising us about the action they had taken to ensure improvements. We conducted a further inspection on the 27 August 2013 to review improvements to both outcomes.

We found the provider had failed to take adequate action to meet Outcome 4: Care and welfare of people who use services because people had not been adequately assessed for the risks associated with pressure on the body.

We found the provider had taken adequate action to achieve compliance with outcome 5: Meeting nutritional needs.

During this inspection we found that the provider was not meeting essential standard in relation to Outcome 21 Records.

People told us that they had regular access to food and fluids and that they had enough to eat and drink. One person commented 'we get enough to eat and drink, we have three meals a day and we can have 'seconds' if we want more. We also have drinks and snacks like biscuits, cake and fruit at other times during the day'.

Another person told us 'the staff help me to keep my bedroom clean and tidy'. And another person said 'the home is kept nice and clean.

One person said 'The staff are very good; they are all nice to me and I feel safe living here'. Another person commented 'The staff are nice, they know what they are doing and I would let them know if I wasn't happy about something'.

However we found that the provider was not meeting standards in relation to care and welfare of people who use services and meeting nutritional needs.

Two people told us they were able to make decisions about their lives, such as their choice of food, clothing and personal routines. They told us there were activities going on in the home that they could join in with if they wanted to. They also told us that they were able to access the community and local amenities. People told us that they enjoyed the activities provided within the home such as painting and other arts and crafts sessions.

All of the people that we spoke with told us that the staff asked for consent before supporting people with their personal care and that they felt they were well looked after at Berrywood Lodge. They told us that the staff knew how they needed and wished to be supported.

All of the people that we spoke with told us the staff were nice to them and that they felt safe living at Berrywood Lodge. People told us that they knew how to raise their concerns if they needed to do so.

Two of the people we spoke with told us they thought there were enough staff on duty to meet their needs and expectations.