About the service:

• Berkeley House is purpose built nursing home for people with an acquired brain injury, learning disability or mental health need. The home has 18 en-suite bedrooms across three floors with lift access to all floors. The service offers short respite and long-term care for people aged between 18 and 65 years. There were 17 people living at the home at the time of inspection.

People’s experience of using this service:

• People living at the home received outstanding care which was responsive to their needs. People's confidence and independence had increased since living at Berkeley House. People were encouraged to live full and active lives and were empowered to participate in value based activities and pursue educational and employment opportunities. The service ethos was to fulfil people’s aspirations and support them to achieve their goals. Activities were meaningful and reflected people’s interests and personal preferences.

• We received excellent feedback from people, their relatives and healthcare professionals regarding the quality of care provided to people living at the home. A relative said; “It’s unbelievable what goes on here. It’s made such a difference to our lives, we can’t sum it up in to words our feelings for this home and what they have achieved for our [persons’ name].”

• People had comprehensive risk assessments in place and support plans that were focused on empowering people to achieve their goals and aspirations. People's support plans were tailored to them and had been developed with involvement of their families. People received multidisciplinary input from a range of professionals which included, physiotherapy, occupational therapy, psychiatry and psychology. Staff benefitted from specialist training and people were working with psychology to complete formulation work which focussed on their life journey.

• Staff consistently demonstrated the values of the service and put people at the heart of everything they did. Staff were clear they worked as a team and for the benefit of people living at Berkeley House. Staff provided enthusiastic and individualised support to people over daily tasks such as meeting their personal care needs and tidying. People and their relatives spoke highly of the support people received and attributed their progress, enhanced sense of wellbeing and quality of life to the staff and support they provided. People were motivated to achieve and their accomplishments were celebrated.

• The service had a strong leadership presence with a compliance manager and registered manager who had a clear vision about the direction of the service. There were strong, person centred clinical leadership and governance arrangements with people and staff being encouraged to influence service change. Quality improvement plans had been developed and aligned with the key lines of enquiry (KLOE’s). Each team was assigned a KLOE and the lead was responsible for ensuring comments and feedback was incorporated into the action plan to ensure continuous improvement of the service. People and staff spoke favourably of the quality assurance plans and felt empowered to make a difference to the home that was meaningful to them. People and staff were motivated to continue to raise standards and achieve outstanding care and facilities for everybody living at the home.

Rating at last inspection: GOOD. (The last report was published 14 April 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remains Good but responsive had improved to outstanding.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Good.

The inspection was unannounced and carried out on the 05 January 2016.

The service was last inspected on 30 August 2013 and we found action was required with regards to the old essential standard ‘supporting workers’. We re-inspected on 15 November 2013 and found the home had met all the actions and was compliant with the regulations.

Berkeley House is a purpose built acquired brain injury, learning disability and mental health unit; located in Pemberton, near Wigan. The unit has 18 en-suite bedrooms across three floors with lift access to all floors. The service offers short respite and long term care for adults between the ages of 18 and 65 years.

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, relatives and visiting healthcare professionals without exception spoke positively about the staff and management at the home. It was clear throughout the inspection; staff knew and understood people’s needs well and went out of their way to provide flexible, tailored support. Staff went through a robust recruitment process before starting work. Sufficient staff were deployed which was responsive to people’s needs and preferences and enabled people to lead busy and fulfilled lives.

People had comprehensive risk assessments which were reviewed regularly and changed timely to meet people’s needs. People and their relatives were involved in the assessments and planning of their health and social care. Regular reviews were undertaken collaboratively and relatives expressed feeling involved. People’s views and decisions they made about their care were listened and acted upon.

We found the home had suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse. The management of medications, promoted people’s safety. Medication records were well maintained and detailed policies and procedures were in place.

Staff were trained and the management demonstrated a commitment to continued professional development to maintain skills and deliver best practice. Staff were supported through induction, supervision and training to promote better outcomes for people.

People’s healthcare needs were regularly assessed and monitored. Contact was made with other health care professionals timely and links were established with; community nurses, social workers, Huntington’s team, opticians, specialist learning disability services, dentist, tissue viability nurses and GP’s.

Staff understood the Mental Capacity Act 2005 (MCA) regarding people who lacked capacity to make a decision. They also understood the Deprivation of Liberty Safeguards (DoLS) to make sure people were not restricted unnecessarily.

We saw staff assessed peoples’ nutritional needs and varied menu’s had been developed. People were offered choice and the dining experience was interactive and relaxed. People’s records were accurately maintained and completed timely.

We saw genuine relationships between staff and people who used the service. Staff were caring and compassionate. We noted frequent, appropriate physical contact between staff and people which were natural and symbolised the familiarity and relationships that had developed between people and staff. People were put at ease and we saw staff approach people’s distress with empathy and provide appropriate reassurance and contact to provide support. People were supported by staff that were compassionate and treated them with dignity and respect.

The home was warm and welcoming. It was clean, free from offensive odours and was decorated and maintained. People had personalised the environment with murals and pictures of activities and

The issues with the induction process and staff training particularly in relation to acquired brain injury [ABI] and learning disability identified at the previous inspection that had taken place on the 30 August 2013 have now been addressed. Staff members were now receiving an appropriate induction prior to starting work at the home and they had received training relevant to the needs of people who may have an acquired brain injury or a learning disability.

We received positive comments about the home and staff members from the family members we spoke with. One of them told us; “Nothing is too much trouble. The staff are very patient and I am not worried now he is here.”

Although care plans were personalised and reflected the needs of the individual they did not always provide enough information to explain what support a person needed. We discussed this with the manager who will look at how this could be improved.

The staff members had a good understanding of the people they were supporting.

We identified some general concerns that could possibly impact on the service being provided. These included the location of the care plans and that there was no fax or dedicated email available to the nursing staff in order for them to send or receive information about the people using the service.

There were effective safeguarding and recruitment procedures in place.

There were sufficient numbers of staff on duty across the three units to meet the needs of the people living at the home.

We identified issues with both the induction process and staff training in general particularly in relation to acquired brain injury [ABI] and learning disability. These are both important areas for the service being provided.

The manager and staff members were able to react quickly to any issues that arose. These could include support or care needs, medication issues, falls or any problems with the facilities.

We found a new, well maintained, warm homely property that had 18 single ensuite rooms across three floors. All rooms had been furnished to meet the persons' own needs.

We found during the inspection that staff had a friendly manner and treated all tenants with dignity and respect. Staff and people who used the service addressed each other by first name and were relaxed together.

We found that care files were in depth, informative and well maintained, care plans had been updated if there were any changes. Plans were reviewed on a monthly basis, according to dependency and need.

Care staff had attended safeguarding vulnerable adults training as part of the induction programme provided by the service and annual updates were undertaken.

People who used the service told us: "I was a menace to society before I came here and with their help I am reformed now. This has not been easy for either them or me but they listen to me and then we work together and we have got to where we are now. I am ready now to move on but will miss them all especially X the manager". "I moved here after having to leave my last place, here is better for me as they don't laugh at me, at the other place people laughed at me. Here they treat me well". "I don't really want to move on from here but know I can now manage. I will always be coming back". "We had a 'come dine with me' evening it was good, X is a good cook and the staff helped too".