Berrystead Nursing and Residential Home provides accommodation, personal care and nursing care for up to 46 older people. The accommodation is on two floors of a converted building. There was a choice of communal areas including a conservatory. There were 32 people using the service at the time of this inspection.

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 feedb

We carried out an unannounced inspection visit on 20 September 2016.

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 u

This inspection took place on the 30 October 2014 and was unannounced. When we last inspected the service on 17 June 2013 we found the provider was compliant with the standards we assessed.

Berrystead Nursing and Residential Home provides accommodation, personal care and nursing care for up to 46 older people. There were 29 people using the service at the time of our inspection. The home is located in grounds that are set back from the main Leicester to Syston road.

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 told us they felt safe at the service and were able to speak with staff if they had any concerns. The premises were in need of some refurbishment and redecoration throughout. Bathing facilities did not meet the needs of some people who used the service.

People were supported to eat and drink sufficient amounts and were given choice. Staff managed people’s medicine in a safe way.

People told us and we saw that staff were kind, caring and respectful. Staff knew about people’s needs and the way they preferred to be supported.

People were able to pursue their hobbies and interests. There was a full and varied range of activities on offer.

During our inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010: Safety and Suitability of Premises. The premises had not been sufficiently maintained or refurbished. Bathing facilities did not meet the needs of some people who used the service. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with three people who used the service and relatives of two other people. We also observed most of the people who lived at the home. Every person we spoke with was positive and complimentary about their experience of the home. We found that staff were attentive to people's needs and supported people with kindness and reassurance.

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 carried out a responsive visit because we received information from two anonymous sources that some people who used the service had been made to get up as early as 5.30am in the mornings. We spoke with three people who used the service. We asked them whether staff had offered them a choice about when they got up each morning. Each person told us that they got up only when they wanted. One person said, "We choose when we get up. We only get up when we are ready." A visitor told us, "The care at this home is very good. No one living here has ever said anything to me about being made to get up early."

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 spoke to three people who used the service and to two relatives of other people who used the service. Everyone we spoke with was complimentary about the home. One relative told us that they and their family had been involved in decisions about their mother's care. Both relatives expressed that they were very satisfied with the care their parent received. One relative said, "The home is fantastic. I can't fault it. The care is good, the staff are lovely." Another relative who told us they visited the home every day said, "I can't speak highly enough of the home. I can see from my husband's wellbeing and appearance that he is well looked after." A person who used the service told us, "I get all the care I need. Staff check on me plenty of times to see how I am." Another person who used the service told us, "I'm quite happy here. The meals are good. We have a choice of what to eat and what to do. The staff are very polite." A third person said of the home, "It's very good, excellent, couldn't fault it. The staff are kind and considerate." Each of the residents we spoke with told us that they felt safe at the home. Relatives had no concerns about their parent's safety and told us that they knew how they could raise any concerns they had.

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

We spoke with people using the service, a visiting relative and the staff whilst on our visit. The relative we spoke with visits regularly and spoke on behalf of their spouse due to them being unable to communicate directly. They said they had ‘always been pleased with the care that they had received whilst living at the home’.

We observed staff speak with people in a friendly and respectful manner, and the overall atmosphere of the home was relaxed and homely.

We spoke with staff who were able to inform us about peoples’ care plans and support needs and how they ensure people are safe from abuse. They also spoke at length about their ongoing training, regular supervision, staff meetings, and the health and safety checks they undertake.