Bishops Way

We found the following examples of good practice:

The home had policies and procedures to manage any risks associated with the COVID-19 pandemic. This included the management of risks for people who had tested positive for COVID-19.

The home had a risk assessment in place for people who regularly declined COVID-19 testing.

The environment had been adapted to comply with guidance and ensured people and relatives were able to continue interacting safely.

Staff were using personal protective equipment (PPE) in the correct way.

Staff were observed correctly completing donning and doffing PPE.

There were sufficient supplies of personal protective equipment.

Hand hygiene points in bathrooms and along corridors were clean, accessible and fully stocked.

Provider ensured people were admitted into the service in line with admissions guidance for care homes.

People and staff participated in a regular testing programme.

Staff had completed training in infection prevention control and had understanding about their roles and responsibilities and the impact of the pandemic on the people.

Bishop's Way is a care home providing accommodation and personal care to 14 people at the time of the inspection. The service accommodates up to 15 people living with learning disabilities or mental health related needs in one building.

The service had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 15 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service

The outcomes for people did not fully reflect the principles and values of Registering the Right Support as people had limited inclusion. People using the service did not always receive planned and co-ordinated person-centred support that was appropriate and inclusive for them. For example, people did not always receive person-centred support with their activities. We received mixed feedback about activities within the home; some people felt there were activities to engage with, whilst other people told us activities displayed on the activity board were not always offered. Activities displayed on an activity board does not support the principle of meaningful lives that include control, choice and independence. Meaningful activity was not always provided and people did not receive their one to one commissioned hour’s.

There was a lack of accessible information displayed in the service to inform the people who lived there. For example, easy read versions of the provider’s complaints policy or safeguarding policy was not on display or readily available. We have made a recommendation about the provider considering best practice in relation to the Accessible Information Standard (AIS).

Governance systems required improvement and records were poorly maintained. Audit systems were not robust, they did not always identify the issues we found during the inspection, and where they did, enough action was not taken to resolve the issue.

The service lacked personalisation in particular to people’s bedrooms. The manager told us they were in the process of asking people how they would like their rooms decorated. We also found there was a lack of signs to identify communal areas and doors. We have made a recommendation about the provider considering signage for communal areas to ensure the premises meets the needs of people who lived there.

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

People told us they felt safe. Staff had a good understanding of how to safeguard people from abuse. Medicines were managed safely.

People were supported to express their views about their care. People’s independence was promoted. Staff gave us examples about how they involved people doing certain aspects of their day to day activities which supported them to maintain their independence. Staff had a caring approach to their work and they demonstrated kindness and respect when supporting and speaking with people.

Staff felt valued and supported by the management team. The service worked in partnership with other to meet the needs of people. The manager demonstrated how they worked in partnership with local hospitals, the local authority, safeguarding teams and other healthcare professionals.

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 good (published 04 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to good governance and person-centred care at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The accommodation is arranged mainly at ground floor level with a first floor flat which is used for assisting people towards semi-independent living. Another room had been converted to enable people to work towards independent living. All bedrooms were single and communal areas included a gym area, sensory room, pool table, dining room and communal lounge.

At the last inspection, the service was rated good.

At this inspection we found the service remained good.

Staff understood how to keep people safe through their knowledge of safeguarding procedures and people’s individual risk assessments. Medicines were managed well and people were assisted to take their medicines safely. Sufficient numbers of staff were deployed in order to provide safe care and support to people.

Staff received appropriate training to enable effective care and support to be provided. Ongoing supervision was evident. 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.

Positive relationships between staff and people who lived at Bishop’s Way were evident. Staff were respectful and mindful of ensuring people’s privacy was respected. People were supported to make their own decisions.

Care plans were person centred and this enabled personalised care and support to be provided. Some people accessed education and training and community amenities were utilised. Appropriate referrals were made to health care professionals when this was appropriate.

Systems and processes for improving the safety and quality of the service were in place and effective. People and staff told us they felt the home was well-led. Staff were clear of their responsibilities.

Further information is in the detailed findings.

We spoke to five people who use the service who said that they were given choices about how they spent their days. One person said '‘I can do what I want here. I have just been out to the shops and bought this. I go to see my family all the time’. My flat is the way I like it, I don’t like mess’'.

Each care plan had information on people’s needs and interventions in order to help them become independent. For instance one recorded that the person needed to develop budgeting skills and another that the person needed to develop problem solving skills on a day to day basis. The manager said that some people would move from the home to more independent living and that part of their role was to support people to do this.

All of the staff we spoke with during our visit were familiar with safeguarding procedures. When asked what constituted abuse staff were able to demonstrate their understanding and how to report an incident.

We looked at the training matrix for all staff and noted that not all staff were up to date with their training. The manager said she was aware of this and had plans to complete all mandatory training in the next three months.

We asked how the provider monitored the quality of care they delivered. We were told that the home carried out an annual survey which covered areas such as infection control, environment, quality assurance, policies and practices and education. There had been an overall score of 93% in February 20013 which demonstrated that the home had achieved a high quality standard and had improved on previous years.

People told us they were happy living at the home and were happy with the care they received. People said, "I really like it here, and they (staff) look after me." "It's a good place here." "I am happy, I like all the staff, and they are really nice."

People told us their views were taken into consideration when planning their care and staff respected their wishes. For example, the care documentation contained information such as, “What time I like to go to bed.” “How best to support me if I am anxious.”