Archived: Berrystead Nursing and Residential Home Limited

Berrystead Nursing and Residential home is a residential care home providing personal and nursing care to 34 people at the time of the inspection. The service can support up to 46 people.

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

People were not always safe because risk in the environment was not identified or managed effectively. People were not protected from the risk of infection. The environment was poorly maintained and not fit for purpose in multiple areas. There was only one working shower in the building and this shower was not clean or fit for purpose. This meant people did not have access to suitable and accessible baths or showers.

Staffing numbers were not sufficient to meet people’s needs or keep them safe.

Quality monitoring and governance was not effective. There were limited opportunities for people to be involved with or feedback about their care and support. There was no consideration of people’s needs with regards to premises and equipment. Many areas of the home were poorly maintained, unsightly and not fit for purpose.

There was a lack of oversight and support at director level.

People told us they felt safe and could speak with staff. People and staff found the manager approachable and accessible. Staff were recruited in a safe away. People’s medicines were managed in a safe way so that people received their prescribed medicine at the right time and in the right way. People said they liked the staff and said they knew how to meet their needs and preferences.

Rating at last inspection

The last rating for this service was Good (report published 19 October 2017)

Why we inspected

We received concerns in relation to the premises and the environment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

Enforcement

We have identified breaches in relation to safety, staffing and governance.

We imposed conditions on the provider's registration to restrict admissions and to be sent regular service improvement updates.

We have taken enforcement action and the service is now closed.

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by one inspector.

Service and service type

Berrystead Nursing and Residential home 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.

Notice of inspection

The inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with three people who used the service about their experience of the care provided. We spoke with five members of staff including the provider, registered manager, care workers, and a housekeeper.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

About the service

Berrystead Nursing and Residential Care Home is a residential care home. They can support up to 46 people at the service. However, at the time of the inspection no people were living at the care home.

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

At the time of the inspection, no people were using the service. We are therefore unable to comment on people’s experiences of using Berrystead Nursing and Residential Care Home.

This was a targeted inspection to consider the provider’s compliance with the court-imposed consent order. A consent order is a court-imposed judgement, that has been agreed in advance by both parties. In this case, the agreement was between the CQC and the provider of Berrystead Nursing and Residential Care Home.

The consent order required the provider to not admit new people to Berrystead Nursing and Residential Care Home without prior agreement from the CQC. The provider had not requested permission to admit new people to the home. We found that the provider had complied with this part of the consent order, as no one was living at the care home.

The consent order required the provider to create a dependency tool to inform the staff team. The provider had created a tool to calculate a suitable number of staff to care for people safely. The registered manager explained how they intended to use this tool to guide safe staffing levels. As no people were living at the care home, we were unable to fully assess how this tool was used.

The consent order required the provider to provide evidence of a proposed induction plan for new staff. The provider had created a proposed induction plan.

The consent order required the provider to complete refurbishment and provide documentation on this refurbishment for; the wet room (bathroom), the kitchen and compartmentalisation of fire safety. We saw the provider had completed this refurbishment. The provider was also completing other refurbishment to improve the environment.

The consent order required the provider to provide documentation on a legionella risk assessment. We observed that this risk assessment had been completed. The provider had then arranged for some required refurbishment works to reduce the risks of legionella. The provider explained that they intended to complete a follow up legionella risk assessment to assess the effectiveness of the refurbishment work.

The consent order required the provider to provide documentation on health and safety processes. The provider provided a list of intended health and safety audits, for example how they will oversee fire safety in the home. The provider had blank care plan records. These were ready to be filled in with people’s details. So, staff would know how to support people safely and effectively.

The consent order required that the provider must provide documentation on maintenance policies and procedures. They provided this documentation showing that procedures were in place.

The consent order required the provider to have a contract with a maintenance provider and have documentation of other contractors and suppliers. We observed that this documentation was in place. We saw a contractor in the building at the same time, making improvements to the care home.

The consent order required the provider to have a new nominated individual. This person must receive mentoring and training to complete their role. We saw evidence that the new nominated individual had received external mentoring and training.

The consent order required the provider to provide systems, processes, and procedure documentation on how the provider responds to safeguarding concerns. We saw that a procedure was in place. New staff had been recruited and had undergone safeguarding training.

The consent order required the provider to provide documentation on staff training. We observed that staff had been recruited and had undergone online training. The provider told us that further face to face training would occur before the service started to support people.

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 inadequate (published 20 May 2022) We also inspected on 29 November and 1 December 2022 to review whether the court-imposed consent order had been met. This inspection resulted in an ‘inspected but not rated’ outcome.

Why we inspected

We undertook this targeted inspection to check whether the court-imposed consent order had been met. The overall rating for the service has not changed following the last targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check 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.

Enforcement

At our inspection completed in January 2022 (published in May 2022), we identified breaches of regulation. As there were no people using the service, we were unable to identify if these breaches of regulation have been improved. These breaches therefore remain in place.

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.

Special Measures

This report has not resulted in a change of the overall rating of the service. The overall rating for this service remains ‘Inadequate’ and the service therefore remains 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.

Berrystead Nursing and Residential Care Home is a residential care home. They can support up to 46 people at the service. However, at the time of the inspection no people were living at the care home.

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

At the time of the inspection, no people were using the service. We are therefore unable to comment on people’s experiences of using Berrystead Nursing and Residential Care Home.

This was a targeted inspection to consider the provider’s compliance with the court-imposed consent order. A consent order is a court-imposed judgement, that has been agreed in advance by both parties (In this case, the agreement was between the CQC and the provider of Berrystead Nursing and Residential Care Home)

The consent order required the provider to not admit new people to Berrystead Nursing and Residential Care Home without prior agreement from the CQC. The provider had not requested permission to admit new people to the home. We found that the provider had complied with this part of the consent order, as no one was living at the care home.

The consent order required the provider to create a dependency tool to inform the staff team. We found the provider had created a tool to calculate a suitable number of staff to care for people safely. The registered manager explained how they intended to use this tool to guide safe staffing levels. As no people were living at the care home, we were unable to fully assess how this tool was used.

The consent order required the provider to provide evidence of a proposed induction plan for new staff. The provider had created a proposed induction plan. However, we were concerned that the processes for this plan were not clearly recorded. For example, the policy did not provide clear guidance on how long the induction process lasted. We raised this with the registered manager, and they took steps to improve the policy.

The consent order required the provider to complete refurbishment and provide documentation on this refurbishment for; the wet room (bathroom), the kitchen and compartmentalisation of fire safety. We saw the provider had begun to complete this refurbishment. However, the wet room remained an unsafe standard as people would be at risk of scalding from the shower and burns from the radiator. The provider had also refurbished other areas of the property. This refurbishment was ongoing and may present a risk to people if they moved in. The provider had a refurbishment plan in place to ensure further refurbishment was completed in a planned way.

The consent order required the provider to provide documentation on a legionella risk assessment. We observed that this risk assessment had been completed. The provider had then arranged for some required refurbishment works to reduce the risks of legionella. The provider explained that they intended to complete a follow up legionella risk assessment to assess the effectiveness of the refurbishment work.

The consent order required the provider to provide documentation on health and safety processes. The provider provided a list of intended health and safety audits, for example 'medicine'. The provider advised that these areas would be audited using the same audit documentation as was used in the home previously. Our previous inspection found that auditing processes at the care home were not good enough to ensure safe care. We recognise that there is now a new management team in place to use this same documentation, but as there were no service users in the building we are unable to report on whether this will ensure a safe oversight of the service. The provider was considering the use of electronic care planning systems. However, had not decided which electronic system to use. Until this was finalised they intended to use paper care plan records, that were in place at the last inspection.

The consent order required that the provider must provide documentation on maintenance policies and procedures. They provided a policy, however, the policy and procedures were not detailed enough to be effective as a guide for staff to follow. We were told this would be improved.

The consent order required the provider to have a contract with a maintenance provider and have documentation of other contractors and suppliers. We observed that this documentation was in place. We saw contractors were in the building at the same time, servicing pieces of equipment.

The consent order required the provider to have a new nominated individual. This person must receive mentoring and training to complete their role. We saw evidence that the new nominated individual had received external mentoring. We found the nominated individual had received minimal training to ensure they were suitably skilled. They explained their plan to complete further training.

The consent order required the provider to provide systems, processes and procedure documentation on how the provider responds to safeguarding concerns. We saw that a procedure was in place. It focused on the registered manager processing any allegation of abuse. We expressed concern that other management roles (like the nominated individual) were not listed in this procedure. The nominated individual is responsible for supervising the management of the service on behalf of the provider. The registered manager agreed to add this information.

The consent order required the provider to provide documentation on staff training. We observed that there was planned training for staff. However, as no care staff had been recruited, we could not see that all staff had been trained yet.

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 inadequate (published 10 March 2022)

Why we inspected

We undertook this targeted inspection to check whether the court-imposed consent order had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check 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.

Enforcement and Recommendations

At the previous inspection we identified breaches of regulation. As there were no people using the service, we were unable to identify if these breaches of regulation have been improved. These breaches therefore remain in place.

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.

Special Measures

This report has not resulted in a change of the overall rating of the service. The overall rating for this service remains ‘Inadequate’ and the service therefore remains 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.

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

People were not always safe because risks within the environment were not identified or managed effectively. People were not protected from the risk of infection. The environment was poorly maintained and not fit for purpose in multiple areas. There was only one working shower in the building and this shower was not clean or fit for purpose. This meant people did not have access to suitable and accessible baths or showers. These issues had been identified at our last inspection on the 5 & 9 of November 2021 and were ongoing.

Hot water supply temperatures in 16 people’s rooms were in excess of safe limits, this put people at risk of scalds and burns. There was no management of water storage or legionella risk. Risks were not identified or not managed in a safe way. People were not protected from the risk of abuse because staff did not follow the correct procedures and did not report concerns to the local authority safeguarding team as they are required to.

Staffing numbers were not sufficient to meet people’s needs or keep them safe. People with high dependency needs or identified risk of falling were unsupervised and alone for the majority of the time. Care was task orientated and not person centred or based on people’s individual needs and preferences.

There was a lack of oversight and support at director level. Quality monitoring and governance was not taking place. There were no opportunities for people to be involved with or feedback about their care and support. There were many risks in the environment and many areas of the home were poorly maintained, unsightly and not fit for purpose. A fire risk assessment had been carried out In December 2021, However the report was not available to view at the time of this inspection. The provider sent us the fire risk assessment following this inspection. There remained a number of high and moderate risks identified requiring action.

Some people were distressed and had difficulties communicating their needs and were not always offered reassurance because staff did not have the time. Some people did not receive personal hygiene to acceptable standard, they were visibly unclean and looked dishevelled.

Staff were recruited in a safe away. Most people said they liked the staff.

Rating at last inspection and update.

The last rating for this service was Inadequate (report published 7 January 2022)

The overall rating for the service has remained the same. This is based on the findings at this inspection.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. At this inspection, improvement had not been made and the provider was still in breach of regulations.

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 have identified breaches in relation to the premises and equipment, safety, protecting people from abuse, staffing and governance.

The provider is required to adhere to conditions imposed by way of a consent order agreed at the First Tier Tribunal on 19 April 2022. The provider must inform CQC when they believe the conditions have been complied with and the CQC will check by conducting a further inspection. There is no one living at the service and the provider cannot admit any service users until the conditions are met.

We found the following examples of good practice.

• Visiting times were restricted and risk assessments were in place to allow one specified visitor.

• There was a specific visiting plan for the families of people who were near the end of their life.

• The registered manager had introduced a ‘booking in desk’ for all visitors. Visitors were provided with information and were asked to complete a visit questionnaire for a track and trace programme.

• When visiting resumes each visitor will have to book a one hour slot through the appointment system. Visitors will then be escorted to and from the visit area by staff, and the area thoroughly cleaned following the visit.

• Visitors were all contacted by phone and were made aware of the visiting restrictions and now, the ongoing plan of temperature testing and track and trace information was to be used.

• People newly admitted to the service or those returning from hospital were ‘barrier nursed’ for 14 days, and the completion date clearly recorded to inform staff.

• All PPE equipment was stored outside each bedroom where isolation was taking place.

• A secure donning and doffing process was in place with foot operated pedal bins for used PPE located in each person’s en suite bathroom.

• People in the home and staff had their temperature recorded twice daily. Guidance was in place for staff intervention if their infection symptoms or a high temperature became apparent with an immediate swab test and isolation for the person concerned.

• The dining and lounge areas were all marked out to enable social distancing.

• Staff travelled to work in normal clothes and changed into their uniform in the home.

• The registered manager and lead carer received additional IPC training from the World Health Organisation and that was then demonstrated to staff.

• There was a clinical lead who coordinated all the IPC information.

• Staff adhered to the current IPC policy and none were observed to have false or painted nails in place.

This unannounced inspection took place on 19 October 2017.

At our last inspection on 20 September 2016 we found that improvements were required in the management of people’s medicines and quality monitoring were not effective. At this inspection we found that the improvements had been made.

The service had a registered manager in place at the time of our inspection. 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.

Staff understood their responsibilities to protect people from abuse and avoidable harm. Staff knew how to recognise the signs of abuse and what action to take should they suspect it. People felt safe and able to raise any concerns they may have. Risk was assessed and managed. People’s freedom to make choices and take risks was respected.

Most people felt that there were sufficient numbers of staff on duty to meet people’s needs. Staffing numbers were calculated based on the dependency levels of people who used the service and these were monitored. Checks were carried out before staff were offered employment so that so far as possible only staff with the right skills and characteristics were employed.

People received their prescribed medicines in a safe way. The receipt, administration and disposal of medicines was recorded so that staff could check and monitor the management of people’s medicines. Medicines were stored safely and securely.

Staff received the training and support they required to meet people’s needs. Induction and on-going training was based on up to date and ‘best practice’ guidance. Staff consulted with other professionals and authorities for advice and further training where this was required. People had access to the healthcare support they required such as physiotherapists, doctors and nurses. People had enough to eat and drink. Staff and catering staff understood people’s dietary needs and how to meet them.

Staff sought people’s consent before providing care and support. People had their capacity to make decisions assessed. Where people had their liberty deprived in order to keep them safe, this was only done with assessment and authorisation from the local authority team. The registered manager had identified shortfalls in the recording of mental capacity assessments and best interest decisions and had arranged for staff to receive further training about this.

Staff were caring and compassionate. Staff knew people well and had developed positive relationships. They knew about the things that were important to people and how best to communicate and provide emotional support. People were able to make choices and were involved in planning and reviewing their care and support needs. People had their privacy and dignity maintained and independence was encouraged.

People had their needs assessed before they moved into the service. Important information about people’s unique social history and cultural needs was recorded so that staff could provide care that was personalised. There was a range of social and recreational activities on offer. People were able to pursue their hobbies and interests.

People knew how to make a complaint and felt that they would be listened to and action would be taken. Complaints were recorded along with the action taken.

People and staff felt supported and included by the management team. Meetings were held and satisfaction surveys were used to gather feedback and make improvements. There were effective quality monitoring systems in place.

Berrystead Nursing and Residential Home provides accommodation, personal care and nursing care for up to 46 older people. Forty three bedrooms have an ensuite bath or shower and all have a wash basin. At the time of the inspection there was one bathroom and two shower rooms in use. The home has a communal dining room, a lounge, an activities room and large conservatory. There is a small courtyard garden and a large landscaped garden. Accommodation is on two floors, the first floor is accessed by a lift or stairs. The home is located in grounds that are set off from the main Leicester to Syston road.

The service had a registered manager. 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.

At our last inspection on 30 October 2014, we found that bathrooms had not been adapted to meet the needs of people who required support with their mobility or who had a physical disability. We also found that some maintenance of the premises was required to make the environment safer for people using the service, staff and visitors. We asked the provider to make improvements. We received an action plan from the provider. At this inspection we found that a refurbishment programme was in progress and that the home environment was safer. No work had been carried out to adapt bathrooms but the provider was in discussion with structural engineers about how such work could be carried out within the physical constraints of the existing structure of the building.

Staff knew how to identify and report concerns about people’s safety. Risks associated with people’s care and support were identified and managed to protect people from avoidable injury or harm. The provider’s recruitment procedures ensured as far as possible that only staff suited to work at the service were employed. Staff were suitably deployed to be able to meet the needs of people using the service. They attended to people’s needs promptly.

People usually received their medicines at the right times, though medicines administration records were not always signed. There was no system to provide documented assurance that medicines were administered as prescribed. Medicines were stored securely but arrangements for ensuring medicines were stored within recommended temperature ranges were not consistently followed. An out of date medicine had not been disposed of.

People were supported by staff with the right skills and experience. Staff were supported through training and supervision.

Staff at all levels understood the relevance of and acted in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards when they supported people.

People were supported with their nutrition. People with special dietary requirements were supported with their specific needs. People were supported to access health services when they needed to.

We observed that staff demonstrated care and compassion when they supported people. Staff engaged in meaningful conversation with people and showed an understanding of their needs. The registered manager promoted `dignity in care’ and was one of ten dignity champions at the service.

People using the service and their relatives were involved in making decisions about their care and support. People and relatives we spoke with told us they received information they needed about the service before and after they began to use it.

Staff respected people’s privacy and dignity. They were discrete when they provided care and support. People were able to spend time where they wanted, including when they had visitors.

Although there were five bathrooms, only three were in use. Two were being used as storage areas. Only one of the three bathrooms in use was big enough to accommodate the use of a hoist. The other two were `shower / wet rooms’. This meant that bathing facilities were limited for people with limited mobility. Those people had `bed washes’. The provider was looking into modernising and adapting the bathroom facilities.

People’s care plans were focused on their individual needs. People were supported to maintain their independence and were supported to follow their hobbies and interests. An activities coordinator excelled at providing a range of stimulating activities for people using the service. People’s relatives were able to participate in activities.

People using the service and their relatives knew how to raise concerns and their views were acted upon.

People using the service, their relatives and staff were involved in developing the service. The provider acted upon their feedback. The registered manager had procedures for monitoring the quality of the service which included seeking people’s views about their experience of the service. However, the monitoring had not identified shortfalls in medicines management that we identified. The registered manager took action to make improvements in areas identified as requiring improvement at our previous inspection and they had the provider’s support in implementing improvements.

One person who used the service told us, "I'm well looked after. There are nice people here that I've got to know. It's pleasant here, we have good meals. We go out to interesting places. We have interesting things to do here." Another person told us, "When i came here they explained to me how they could help me. I get the care I need. I feel at home here. I like my room. I spend my time the way I want. We go out to places and we have concerts here." A third person we spoke with told us, "I like it here. I know the staff by their names. They look after me and I get the care I need. I can choose how I spend my time."

A relative told us, "Staff go beyond the call of duty. My wife is very well looked after. I've been involved in decisions about her care. I know how I can make requests or raise concerns and I'm confident that I'd be listened to." Another relative told us, "We chose this home above other homes we looked at. We liked the atmosphere here. I don't think we could get better care anywhere. The staff obviously care. I'm confident that staff carry out what is in the care plan. They go over and above what I'd expect."

We spoke to kitchen staff who were involved in making people's breakfasts. Both told us that very few people, usually only two or three, were awake and in the lounge or breakfast room when they arrived at work between 5.30am and 7.30am.

A nurse we spoke with told us that none of the people who lived at the home had nursing requirements that necessitated them being woken up before 6am. They told us, "People have a choice about when they get up. There is no pressure from the manager or nurses to get people up earlier than they want to be woken. Some people are woken if their continence pads need changing." A care assistant told us that they had never been instructed to wake people up before their preferred time for getting up. Records we looked at confirmed what staff told us.

We found that the concerns raised by whistleblowers were not substantiated.

We found that what people told us was consistent with evidence of our observations and review of documentation.