We carried out an unannounced inspection of the service on 19 April 2018. Berry Hill Care Home is a ‘care home’. People in care homes receive accommodation, nursing and 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.

Berry Hill Care Home is registered to accommodate up to 66 older people in one building. Some of these people were living with dementia. At the time of the inspection, 38 people were using the service.

At the last inspection on 7 September 2017, we asked the provider to take action to make improvements to the safety of the service, the assessment and management of the risks associated with people’s care, the support people at risk of dehydration received, care planning documentation and overall governance of the service. During this inspection we found the required improvements had been made however, further work still needed to be done to ensure all care planning documentation was reflective of people’s current needs.

During the home’s previous inspection on 7 September 2017, we rated the home overall as ‘Requires Improvement’ with the question, ‘Is the service well-led?’ rated as ‘Inadequate’. Because of the improvements made at this home since their last inspection, the overall rating has now changed to ‘Good’ although the question, ‘Is the service responsive?’ remains rated as ‘Requires Improvement’. The details of the reasons why are explained in the summary below and in the body of the main report.

A registered manager was present during the inspection. 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 felt safe living at the home. The risks to people’s safety were now appropriately assessed and acted on. The process of investigating accidents and incidents and reducing to the risk to people’s safety had improved. Medicines were now stored and handled safely. There were enough staff in place to support people. Staff understood the processes for protecting people from avoidable harm. Robust recruitment procedures were followed to ensure people were protected from unsuitable staff. The home was clean and tidy and staff understood how to reduce the risk of the spread of infection.

People were now supported to remain hydrated and records used to record the amount people drank was recorded and monitored. People’s health needs were assessed and provided in line with current legislation and best practice guidelines. People told us staff knew how to support them. Staff were well trained, although some staff required refresher training to ensure their practice met current best practice guidelines. Staff felt supported by the registered manager. The registered manager had built effective relationships with external health and social care organisations and people’s health was regularly monitored. The environment had been adapted to ensure people were able to lead fulfilling lives. However, more directional signage was needed to support people with independent movement around the home. 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, although some best interest decision documentation required more detail.

People felt staff were kind, caring and compassionate. Staff treated people with respect and dignity. People’s privacy was respected and staff spoke discreetly when discussing people’s personal care needs. People felt listened to and staff understood how to communicate effectively with people. People were encouraged to do things for themselve

We inspected Berry Hill Care Home on 7 September 2017. The inspection was unannounced. Berry Hill Care Home is a situated in Mansfield in Nottinghamshire and is operated by HC-One Limited. The service is registered to provide accommodation for a maximum of 66 older people who require personal care. There were 38 people living at the home on the days of our inspection visit. The service is split across two floors, each with communal living areas.

At our previous inspection, on 22 and 23 May 2017, the service was rated as requires improvement and multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found. Following our last inspection we took action against the provider and issued a Warning Notice to ensure that improvements were made in relation to the governance of the home. The provider was required to be compliant with this notice by 1 August 2017. In this inspection we found that the provider had not made the required improvements in this area and remained in breach of this legal regulation. During this inspection we also found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment and person centred care. You can see what action we told the provider to take at the back of the full version of the report.

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. The registered manager was relatively new to the service and had been in post for a period of four months at the time of our inspection visit.

During this inspection we found that the systems in place to reduce risks associated with people’s care and support were still not always effective and this exposed people to the risk of harm. Although we found that people received their medicines as prescribed, medicines were not stored safely at all times. Safe recruitment practices were followed to ensure that staff were suitable to work with people who used the service.

People’s day to day health needs were met, however, there was a risk that people may not receive appropriate support with specific health conditions due to a lack of information in their care plans. Systems in place to ensure people had enough to drink were not always effective and this placed people at risk of dehydration. People were supported to have enough to eat and were given choices and assistance as needed.

People were enabled to make decisions. Where a person lacked capacity to make a certain decision they were protected under the Mental Capacity Act 2005. There were enough staff available to keep people safe and meet their needs. People were supported by staff who received training, supervision and support.

People were not treated with dignity and respect at all times and their right to privacy was not always respected. People could not always be assured that they would receive support that was based upon their individual needs and preferences as care plans did not consistently reflect people’s current needs. Improvements were underway to ensure that people were provided with compassionate, dignified care at the end of their lives.

The majority of staff were kind and caring in their approach. People felt involved in day to day decisions about their care and were offered the opportunity to get involved in planning their support. Staff understood how people who used the service communicated and supported them to maintain their independence. People had access to advocacy services if they required this to express their views. There were systems in place to respond to and investigate complaints. People were provided with

We inspected Berry Hill Care Home on 22 and 23 May 2017. The inspection was unannounced. Berry Hill Care Home is a situated in Mansfield in Nottinghamshire and is operated by HC-One Limited. The service is registered to provide accommodation for a maximum of 66 older people who require personal care. There were 46 people living at the home on the days of our inspection visit. The service is split across two floors, each with communal living areas.

At our previous inspection, on 11 October 2016, the service was rated as requires improvement and multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found. During this inspection we found that although some improvements had been made there remained concerns in relation to the quality and safety of the service. This resulted in us finding new and ongoing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, staffing and good governance. You can see what action we told the provider to take at the back of the full version of the report.

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.

During this inspection we found that the systems in place to reduce risks associated with people’s care and support were not always effective and this exposed people to the risk of harm. Risks in relation to people's care were not planned for appropriately to ensure people received safe care and people's care records did not always contain sufficient guidance for staff to minimise risks to people. Medicines were not always stored or managed safely.

Staff were not deployed effectively to meet people’s needs and keep them safe. People could not be assured that action would be taken to protect them from harm or abuse as staff were not sufficiently skilled in identifying and acting upon concerns.

Safe recruitment practices were followed and people were supported by staff who received training, supervision and support. We found staff had limited knowledge in some areas and the registered manager took swift action to address this.

People were enabled to make decisions. Where a person lacked capacity to make a certain decision they were protected under the Mental Capacity Act 2005. We found there was a risk that some people may not be supported in the least restrictive way possible.

People’s day to day health needs were met, however, there was a risk that people may not receive appropriate support with specific health conditions. People were supported to have enough to eat and drink.

People could not be assured that they would be treated with dignity and respect at all times. People were not always offered the opportunity to be involved in the planning or reviewing of their care plans. However people felt involved in day to day decisions about their care and support.

People could not always be assured that they would receive support that was based upon their individual needs and preferences. People were not consistently provided with the opportunity to discuss and plan for the end of their life. In addition to this care plans did not all contain accurate, up to date information about the support people needed.

Staff were kind and caring and respected people’s right to privacy. People were provided with some opportunity for social activity and were supported to maintain relationships with family and friends.

People were supported give feedback about the service, raise issues and concerns and there were systems in place to respond to complaints. Staff were also involved in giving their views on ho

This inspection took place on 11 and 12 October 2016 and was unannounced.

Accommodation for up to 66 people is provided in the home over two floors. The service is designed to meet the needs of older people. There were 56 people using the service at the time of our inspection.

A registered manager was in post and she was available during the 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.

Sufficient numbers of staff were not on duty to meet people’s needs. Staff did not always safely manage identified risks to people. However, people felt safe in the home and staff knew how to identify potential signs of abuse. The premises were managed to keep people safe. Staff were recruited through safe recruitment practices. Safe medicines practices were followed.

People’s rights were not fully protected under the Mental Capacity Act 2005. However, staff received appropriate induction, training, supervision and appraisal. People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate. People’s needs were met by the adaptation, design and decoration of the service.

Staff were kind and compassionate and knew people well. There was some evidence to show that people had been involved in the care planning process and improved documentation had been put in place to prompt staff to better involve people. Advocacy information was made available to people. People’s independence was promoted and visitors could visit without unnecessary restriction. We observed two instances where dignity was not fully respected but at all other times, staff treated people with respect and protected their dignity and privacy.

People did not always receive personalised care that was responsive to their needs. Activities required improvement. Care records did not always contain sufficient information to support staff to meet people’s individual needs. However, a complaints process was in place and staff knew how to respond to complaints.

There were systems in place to monitor and improve the quality of the service provided, although they were not fully effective. People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident in raising any concerns with the registered manager and that appropriate action would be taken.

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

We had received concerns from some people that used the service. They reported that staff did not attend to them quickly enough when they used the call bell and this had caused considerable distress.

When we visited we spoke with six people who used the service and observed the care of others. We found staff were working continuously to meet people's needs and there was often a delay in responding to people's requests for assistance. One person said, "It can be five minutes or it can be 50 minutes. It depends how busy they are." A visitor told us, "They just don't answer the call bells straightaway, because they are so busy."

We observed people sitting in wheelchairs in the dining room waiting for assistance to move back to their rooms or to the lounge. They said they had to wait a long time for staff to be available to take them.

We concluded that there were not enough staff to meet people’s needs.

During our previous inspection of this service on 30 April 2013, we were concerned that people were not fully protected from the risks of inappropriate care and treatment, because information to plan and record their care was not all present. During the current inspection visit we looked at a sample of care plan files relating to people using the service and we found improvements had been made in the recording of care planning.

We looked specifically at the records of three people who had been prescribed creams and lotions. The care plans for these were clear about the assistance needed from care staff. We found that charts were available in the bedrooms for staff to complete, but staff told us they did not always remember to complete the chart after applying creams. One person confirmed that their cream was usually applied each morning and the condition had improved.

Following this inspection visit we contacted the provider's quality assurance manager for the area and they assured us in writing that systems to regularly check the records had been put in place immediately to ensure all records were fully maintained.

We spoke with two relatives and four people who used the service. We also spoke three care staff, the activities worker, the handyman, the chef and the registered manager.

People that used the service were very pleased with the quality of meals and told us there was always a good choice. One person said, "They bring my meals to me in my room and there's always something I like." People could choose to eat in the dining rooms or in their own rooms.

Regular visitors to the home told us the premises were always kept very clean. We found staff were very aware of how important it was to follow the infection control policy and this helped to protect people from the risk of infection.

People who used the service and some of their relatives told us they thought there were always enough staff available to assist when needed. One person said, "They come and help me when I use my buzzer even if I have to wait a bit sometimes."

A relative told us, "The care staff all do a very good job. They work hard and they pop in when I'm here to check all is well."

Some people were aware of the information about their care in files in their own rooms. One relative told us they check what my (relative) has had to eat and I know they write down when they have been in." We found appropriate records were maintained regarding staffing and the maintenance of the premises, but not all information was available about how the staff should meet people's individual needs.

We spoke to six people who use the service and two relatives. One person said, "I like to stay in my room and be private. The staff show me respect and bring my meals to me.” Another person told us that they liked to join in all activities and always put their name down straight away for outings. We saw that people had three options to choose from at lunchtime and people told us there was always a good choice of meals.

We saw a sample of individual rooms and found that they were clean and furnished to individual preferences.

One person told us that staff knew how to help them with washing and getting dressed each morning and always carried out these tasks in the way they had agreed. People told us that there were always activities going on.

We asked people if they felt safe at the home and one person told us, "Of course its safe here! We're not in any danger." A regular visitor told us that people seemed safe and there were no concerns. This person said they were quite happy that they could go home knowing their relative was being properly cared for and protected.

People told us that the staff seemed to know what they were doing and some people knew the staff were trained. They were aware that there was always a qualified nurse on the premises.

We inspected the service on 2 and 3 September 2015. Berry Hill Care Home is registered with the Care Quality Commission to provide accommodation for up to 66 people with varying levels of support and nursing care needs. On the day of our inspection there were 47 people living at the home.

The home’s registered manager (as detailed on CQC’s website at the time of the inspection) had recently left their employment and an interim manager was in place. This person was in the process of becoming the registered manager of the home. 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 in April 2014 we found that improvements were required in relation to the care and welfare of people who used the service and assessing and monitoring the quality of the service provided. The provider sent us an action plan following that inspection detailing what action they would take to become compliant. Prior to the inspection some people had raised concerns with us anonymously about general communication, staffing levels and the length of time people had to wait to have their requests for assistance met by staff. We looked at all of these issues as part of our inspection.

Overall we found that people who used the service felt safe and well looked after. However we did find that some improvements were required.

People did not always get the care and support they needed in a timely manner. The manager had increased staffing levels and made other changes within the home to improve this situation however there were still occasions when delays occurred and these could compromise people’s safety and welfare. This was particularly evident in relation to people receiving prescribed medicines when required.

People’s needs and support were met, but this depended on the staff member assisting to their care. Care plans contained insufficient details to ensure individual need, preferences and decisions were met.

People were treated with respect at all times, however staff did not always notice when a person’s dignity was compromised. Staff were kind and compassionate.

We found that staff understood what constituted poor or abusive practice and were all confident to recognise it and report concerns to senior staff. The manager was aware of their role in relation to reporting allegations of abuse and of working with outside agencies to investigate and implement systems and changes to keep people safe.

Staff received appropriate induction, training and ongoing supervision. This enabled them to support the people who used the service effectively.

Systems were in place for staff to identify and manage risks and take actions when people’s needs changed. Staffing levels were currently adequate to meet the needs of the people who used the service. Overall staff recruitment files reflected safe recruitment practices.

Communication had improved both within the staff team and with outside agencies. Various systems had been put in pace to achieve this.

People were not always protected against the risks associated with medicines. Although the provider had appropriate arrangements in place processes were not always being followed.

People were offered a varied and balanced diet although people sometimes had to wait for assistance and support at meal time. Most people liked the food on offer.

People were supported to receive any health care they needed and any advice provided by professionals was acted upon. Health professional shared mixed experiences of working with staff at the home.

A structured activity programme was in place. Not everyone wanted to take part in group activities so arrangements were in place to offer more one to one opportunities.

Staff were knowledgeable about the Mental Capacity Act and its implications. Their understanding of Deprivation of Liberty Safeguards was good and records reflected that training had taken place. No one was currently having their liberty deprived however some records did not reflect certain advanced decisions.

People knew who to speak to if they wanted to raise a concern and there were processes in place for responding to any complaint raised.

There were effective systems in place to monitor and improve the quality of the service provided and these were seen to have been used effectively. People living at the home and the staff team had opportunities to be involved in discussions about the running of the home and felt the manager provided good leadership. People had been consulted and involved in plans to refurbish the home.