This inspection took place on 9 and 29 May and 13 June 2018 and all the visits were unannounced.

Handsale Limited - Bierley Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home accommodates 40 people on two floors. There are three units and one unit specialises in providing care to people living with dementia. At the time of our inspection there were 27 people living in the home.

Following our last inspection, the service was rated ‘inadequate’ and placed in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At the last inspection we found the provider was in breach of four regulations; one of these was in relation to staff (Regulation 18) and was a continued breach from the previous inspection in May 2016. The other breaches were in relation to safe care and treatment (Regulation 12), meeting people's nutritional needs (Regulation 14) and governance (Regulation 17). We imposed conditions on the providers registration which required them to send us specific information every month about the actions being taken to improve the service. The provider complied with these conditions.

During this inspection we found the provider had made improvements and there were no breaches of regulations. We gave the service an overall rating of ‘requires improvement’ because there were areas which required further improvement. In addition, the provider needed to demonstrate they could sustain the improvements over time so that we could be assured people would consistently experience good care and treatment in line with the fundamental standards.

The service has 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.’

There were enough staff deployed to meet people’s care needs. Staff were trained and supported to work safety and deliver care which met people’s needs.

Improvements had been made to the way risks to people’s safety and welfare were managed. We saw lessons had been learned when things had gone wrong. Further improvements were needed to ensure the actions taken to reduce risks were clearly recorded as soon as possible after incidents.

People told us they felt safe. Staff knew how to recognise and report any concerns about people’s safety and welfare. Robust recruitment procedures were followed and this helped to protect people from the risk of being cared for staff unsuitable to work in a care setting.

The home was safely maintained. The provider was making improvements to the environment to make sure it was suitably adapted to the needs of the people who lived there.

People received their medicines as prescribed.

Improvements had been made to the way people were supported to meet their nutritional needs. People told us they were always offered a choice of food and drink. However, they also told us the quality of the food was inconsistent. The provider was addressing this and a new chef had been appointed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice

We found the service worked in partnership with other age

The inspection was carried out on 15 August and 6 September 2017 and was unannounced on both days.

Handsale Limited - Bierley Court provides accommodation and personal care to a maximum of 40 people. There were 34 people living at the home when we carried out our inspection. Most of these people were older people and people living with dementia.

The last inspection was in May 2016 and the service was rated good overall. There was one breach of regulation in relation to staffing, (Regulation 18). During this inspection we found the provider had not made the required improvements and they remained in breach of the regulation 18. We identified other concerns and three additional breaches of regulation. We found people were not experiencing good quality outcomes. The overall rating in now inadequate and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

There was a registered manager but they had not been at the home since January 2017. They were working at another service operated by the provider. 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.

There was a new manager at Bierley Court but they were not registered with CQC at the time of our inspection.

People living at the home and relatives told us they felt the service was safe. We were concerned that people would not consistently receive safe and appropriate care because there were not always enough staff on duty.

The new manager had stared to make changes to the way staff were deployed which meant they could work anywhere in the home rather than being based on a particular unit. We found some people living in the home, relatives and staff were anxious about this change. In addition we found the change was not always supported by good communication systems which meant staff did not always have the information they needed to make sure people got the right care.

Accidents and incidents were recorded but it wasn’t always possible to find out whether or not they had been investigated and if action had been taken to protect people from harm.

For the most part people received their medicines as prescribed. However, when errors had been identified it wasn’t always possible

We inspected the service on 17 May 2016. This was an unannounced inspection.

At our last inspection on 14 October 2014 we found no breaches of legal requirements. However, we asked the provider to make a number of improvements to the quality of care provided.

Handsale Limited - Bierley Court provides accommodation and personal care to a maximum of 40 people. On the day of our visit there were 38 people living at the home. Most of these people were older people and people living with dementia

The accommodation is arranged over two floors linked by a passenger lift. The home is divided into three units which include a general residential unit, an early stage dementia unit and an advanced dementia unit. All bedrooms are single rooms with en-suite toilet facilities. There are communal lounges and dining areas for people to use.

A registered manager was 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 the home provided them with a safe environment and raised no concerns about the way they were treated. Staff were aware of action they would take to keep people safe such as in the event of an emergency or if they were concerned someone was at risk of abuse.

Our observations, discussions with people and the layout of the building led us to conclude that although staff worked hard to try and meet people’s needs, there were not sufficient numbers of care staff to ensure people were provided with consistently safe and effective care.

Care records were detailed, well organised and person centred. We saw that risks to people’s health, safety and welfare were identified and action taken to reduce risk.

People told us the food was good and they were offered choices to ensure they had a varied diet. Nutritional risk was being assessed, monitored and managed.

Medicines were managed in a safe way. Records showed people received their medicines at the times they needed them and in line with the prescriber’s instructions. Further improvements were needed to ensure decision making around covert medicines was clearly evidenced and regularly reviewed.

Staff received appropriate training, support and development so that they could provide safe and effective care. Robust recruitment checks were in place to ensure only staff who were suitable to work with vulnerable people were employed.

Staff had a good understanding of the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005 and their role in protecting the rights of people with limited mental capacity. Staff sought people’s consent before they delivered care.

Where appropriate staff made referrals and worked with other health and social care professionals to ensure people maintained good health. Healthcare professionals told us care staff had worked hard to improve communication and ensure collaborative working.

Staff explained care and support to people so they could make informed decisions and understood potential risks in relation to their day to day care. Staff encouraged people to maintain their independence and respected people’s privacy and dignity.

Staff knew people well and used this information to deliver personalised care. People and their relatives were involved in how their care was planned and delivered and their individual preferences and wishes were respected.

We saw staff worked hard to ensure people received appropriate interaction and stimulation that was appropriate to their needs, specific hobbies and interests.

A system of quality assurance was in place to ensure the provider and registered manager monitored the standard of care provided. We saw examples to show that these audits were effective in identifying areas for improvement

We inspected the service on 14th October 2014. This was an unannounced inspection.

Handsale Limited - Bierley Court provides accommodation and personal care to a maximum of 40 people. On the day of our visit there were 38 people living at the home. Most of these people were older people and people living with dementia

The accommodation is arranged over two floors linked by a passenger lift. The home is divided into three units which includes a general residential unit, an early stage dementia unit and an advanced dementia unit. All bedrooms are single rooms with en-suite toilet facilities. There are communal lounges and dining areas for people to use.

The home has 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 and associated Regulations about how the service is run.

Whilst there were appropriate procedures in place to ensure the safe management of medicines; the processes in place where people received covert medicines were not robust. We recommend that the provider considers The National Institute for Health and Care Excellence (NICE) guidance ‘Managing Medicines in Care Homes’ to ensure all covert administration of medicines takes place within the context of existing legal and best practice frameworks.

Overall staffing levels were adequate to ensure people’s individual needs were met. However, we found staffing arrangements required improvement. For example, additional senior staff needed to be recruited to ensure there were consistent levels of staff on duty at all times and the dependency assessment used by the service needed updating.

People and staff spoke positively about the manager and said they were approachable. People told us they knew how to make a complaint and were asked for their feedback about how the service was run. However, some aspects of the management of this service had not been consistently delivered. We found there were not robust arrangements in place to ensure joined-up care was delivered when working in partnership with health care professionals. Improvements were also required with regard to how other incidents were investigated and recorded. The service had quality assurance systems in place to monitor whether the service was providing high quality care. However, the provider’s checks and audits of the service were not being recorded.

Staff had a good awareness of what to do in the event of an emergency. However, clearer guidance was required about what staff should do in the event of a medical emergency.

People who lived at the home and their relatives consistently told us the standard of care provided was good. They told us the food was, “Tasty”, they felt safe and comfortable around staff and felt involved in making decisions about the care and support they received.

From our observations and discussions with people we saw that staff treated people with dignity, respect, warmth and kindness. Staff knew people well and had appropriate training and support to enable them to provide safe and effective care. Staff had a good awareness of how to keep people safe and report abuse.

Care plans were easy to follow and provided staff with sufficient information. We saw examples where the care provided was in line with the requirements in people’s care plans.

Staff were aware of their duties under the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005 (MCA) and how to ensure the rights of people with limited mental capacity when making decisions was respected. Systems were in place to monitor and manage any situations where people’s freedom may have been restricted.

During the inspection we had the opportunity to speak with people who used the service, a community matron, the chef, the maintenance lead, the deputy manager, the manager and care staff.

The people who used the service told us they were looked after very well and felt safe with the care and treatment provided. Their comments included: "I like it here", “They are all very nice” and “It’s my home”.

We found the service had appropriate systems in place to ensure consent was gained before staff proceeded with personal care.

We saw that there was an appropriate system in place for listening to and acting on people’s comments and concerns.

We spent time observing care in the three lounges and dining areas during the day of our inspection. We looked at how people spent their time and how staff interacted with people.

The interactions we saw between staff and people who used the service and visitors were respectful.

We carried out this inspection because we had been provided with information that people had not always received the care and treatment they needed.

We used a number of different methods to help us understand the experiences of people who used the service. This was because some people had complex needs which meant they were not able to tell us about their experiences. We spoke with a relative, who told us they were satisfied with the care and treatment their relative received but they had found when they provided information about their relative to staff it was not always followed.

We sat in the both of the lounges and observed the support and care people received. We saw the staff talked to people regularly, they explained their actions, and they asked people’s consent. We saw their approach was kind and respectful.

We used a number of different methods to help us understand the experiences of people using the service. This was because some of the people using the service had complex needs which meant they were not able to tell us their experiences. We visited the service and talked with six people using the service, two relatives, the Registered Manager and three members of staff. We observed how staff interacted with people living at Bierley Court.

Six people explained the staff were aware of there care needs and personal preferences. For example they explained how the staff knew there preferred bath times. Five people told us they were satisfied with the care and treatment provided. Comments made were “Excellent”

We asked six people living in the home and two relatives about the staff, all made very positive comments about the staff, explaining they were “Helpful” and “kind”. They all said staff responded to them if they asked for help. One provided an example of when they had needed help in an emergency. They told us they felt reassured because the staff had “Responded quickly and care was excellent”.

Six people and two relatives told us they would make their views known if they had any concerns about the care, treatment and service provided.