Bishops Way

Bishops Way is a residential care home that provides accommodation and personal care support for up to four adults with learning disabilities. The service specialises in providing support to people with Prader Willi Syndrome (PWS). Prader Willi Syndrome is a rare genetic condition that causes a range of physical symptoms, learning difficulties and behavioural problems. People with PWS have an excessive appetite which can easily lead to dangerous weight gain.

Bishops Way is a semi-detached house located in a residential area of Saint Leonards. The service was over two floors. People had their own bedrooms and bathrooms and shared the communal areas and garden. At the time of our inspection three people were living at the service.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People’s support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People’s experience of using this service

There were high levels of satisfaction amongst people who used the service. Everyone we spoke with said they would recommend the service to others. People repeatedly told us that staff had made a difference in their lives and ensured people were happy and safe. A relative described the management of the service as 'excellent'' and staff as 'fantastic and quite wonderful'.

Care was personalised to meet people’s care, social and well-being needs. Care plans provided detailed information and guidance for staff. Staff knew people well and provided support in line with people’s preferences. People’s diverse needs were catered for and they were treated with dignity and respect. People were supported with community connections through activities and social events.

People were treated with dignity and compassion by a kind, caring staff and management team who understood people's individual needs, choices and preferences well. People told us that staff had a good understanding of Prader Willi Syndrome and how this impacted on their lives and they felt supported and valued. One person said of a staff member “He understands me and is just a very pleasant person and lovely to talk to”. A relative told us people were treated with fantastic respect, dignity and care.

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. Staff completed a range of training and had the skills and knowledge to deliver effective care and support

The culture of the service was positive, and people and staff were complimentary of the management and provider. Systems and processes were in place to monitor the quality of the service being delivered. Staff told us it was a good place to work and the enthusiasm from the team impacted positively on the people using the service. One said, “It’s a good service, I would recommend it to other people. It’s a real home, it’s a family”, a relative said " [name] genuinely sees this service as their home – no better recommendation".

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 6 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This comprehensive inspection was undertaken on 7 March 2017 and was unannounced.

Since the last inspection the registered manager had left and the home did not have a registered manager in post. Currently a manager registered at a sister service was in charge of the home supported by senior staff within the organisation. Recruitment was in progress for a new manager to work at Bishops Way. A registered manager is a person who has registered with the 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.’

At a comprehensive inspection in January 2016 the overall rating for this service was Requires Improvement with four breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 identified. We asked the provider to make improvements to ensure care and treatment met people’s needs and reflected their preferences; that care was provided in a safe way for people and risk had been assessed. Systems and processes needed to be improved to enable the provider to assess, monitor and improve quality and safety of services and ensure that accurate, complete and contemporaneous records were in place for each person. The provider needed to ensure that a system as in place to review risks based on people’s individual needs and ensure staff were appropriately trained and supported to enable them to carry out their role safely.

The provider sent us an action plan stating they would have addressed these breaches of regulation by April 2016. At this inspection we found that improvements had been made and the provider was now meeting all regulations.

Although there was currently no registered manager at Bishops Way the acting manager had ensured there was clear and consistent leadership at the service.

All areas of documentation had been reviewed and new systems implemented if needed. Care documentation was person centred and included relevant information about people and their care needs. Systems and processes were in place to assess and continually improve the quality of care. Care planning was now done by people’s keyworkers and the individual was involved and people signed the documentation to show they agreed to the information and any changes or updates. Care planning was written in association with risk assessments for individual or environmental risks identified. This included risks in association with specific health needs and nutrition.

Medicine procedures had been improved this included daily and monthly checks. Medicines were now stored in locked cupboards in people’s bedrooms. People told us they liked this way of having their medicines as they were able to talk to staff about them and were involved in the procedure throughout. Staff felt that this had improved communication and meant that people could be involved as much as was possible.

Plans were in place for an overall refurbishment of the home. Maintenance issues were reported and minor concerns had been addressed. Regular checks had taken place to ensure that water systems, electrical appliance and gas systems were safe and equipment servicing completed annually as stated. A fire risk assessment was in place and personal emergency evacuation plans (PEEP’s) had been completed for people if an emergency evacuation was required.

Staff had a good understanding of safeguarding and the acting manager was aware of their responsibility for reporting concerns. There was a clear system in place in the event of accidents and incidents. Incident forms were completed and any information shared with the provider and reported to CQC or local authorities as required.

Staff felt there were enough staff to keep people safe and meet people’s needs. Recruitment was on-going and clear systems were in place to ensure appropriate checks took place before people began work at the home. New staff completed a period of induction and all staff received regular support via staff meetings and one to one supervision. A training programme was in place, this included specific PWS training to ensure effective care to people. Mental capacity assessments (MCA) and Deprivation of Liberty Safeguards (DoLS) training had been completed. Staff understood the restrictions in place for people in relation to PWS and individual needs and why these were in place. Staff told us that they felt they received the training they needed.

People were involved in the development of menu choices. Nutrition was monitored and managed to ensure that people received appropriate nutrition and support in relation to PWS. This included regular weight monitoring and reviews of people’s daily calorie requirements.

Staff knew people well and displayed kindness when supporting people. People’s dignity and privacy were protected. People’s personal space was respected and staff did not enter people’s rooms without knocking first. People were encouraged and supported to remain as independent as possible with staff were available to support people when needed.

A varied activity programme was available for people. People had access to activities they enjoyed and were supported by staff to attend. This included work placements, trips out and in house activities supported by the homes activity co-ordinator and staff.

A complaints policy was in place and complaints had been responded to by the acting manager or provider as required.

This location is registered to provide accommodation and personal care to a maximum of four people with learning disabilities. Four people lived at the service at the time of our inspection.

People who lived at the service were adults with learning disabilities. We talked directly with people and used observations to better understand people's needs.

The home did not have 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. The manager of the service had been in post since September 2015. They were manager for two services within the provider group. They spent their time working between the two services. They told us they were in the process of applying to become a registered manager of this service.

Medicines were stored and administered safely and correctly. Staff were trained in the safe administration of medicines. However staff had not kept relevant records that were accurate in all cases.

Some records to include a business continuity plan and fire procedures needed to be updated. These procedures did not robustly support continuity of the service in adverse conditions or support people to safely evacuate the premises in the event of a fire.

Staff received on-going training to monitor their performance and professional development. However not all staff had attended necessary training to safely meet the requirements for their role. Measures had not been implemented to address this shortfall.

Staff had received regular supervision to monitor their performance and development needs. However supervision records did not provide detail of staff performance and development needs and evidence of progress in meeting these needs.

Staff did not consistently responded to people’s individual needs and support people to meet their individual goals and aspirations. The provider had obtained people’s feedback about the service. However they had not routinely evaluated the feedback and recorded their actions in response to this feedback to develop the service and meet people's individual needs.

There were audit processes in place to monitor the quality of the service. However, audits were not sufficiently robust. Shortfalls we found on the day of the inspection for medicines and maintenance issues had not been identified as part of the provider’s audit process. There was no service improvement plan in place to determine how the service would continuously develop and improve.

People’s care plans were reviewed with their participation and relatives were invited to attend the care reviews and contribute. However not all care plans were up-to-date to reflect people's most current care and support needs.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns.

Risk assessments were centred on the needs of the individual. Each risk assessment included clear control measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Risk assessments took account of people’s right to make their own decisions.

Accidents and incidents were recorded and monitored to identify how the risks of reoccurrence could be reduced.

There were sufficient staff on duty to meet people’s needs.

There were safe recruitment procedures in place which included the checking of references.

The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager understood when an application should be made and how to assess whether a person needed a DoLS.

Staff supported people to have meals that met their needs and choices. Staff knew about and provided for people’s dietary preferences and needs.

Staff communicated effectively with people, responded to their needs promptly, and treated people with kindness and respect. People were satisfied about how their care and treatment was delivered. People’s privacy was respected and people were assisted in a way that respected their dignity.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities.

People were provided with accessible information about how to make a complaint and received staff support to make their views and wishes known.

We found a number of 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.

Below is a summary of what we found. This summary describes what people and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Most of the staff team had attended training on report writing and further training was also being arranged. Records of accidents and incidents were detailed. There were systems that ensured that the management team monitored the quality of record keeping ensuring that it was clear and accurately described events that occurred.

Below is a summary of what we found. There was only one person at home on the day of inspection. This summary describes what they and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw that management had completed recent training on the subject and DoLS applications had been made when needed.

Incident records did not always contain detailed and accurate information of events that occurred in the home. This meant that the provider was not always able to demonstrate that people had been supported appropriately and in line with their assessed needs.

Is the service effective?

Staff spoken with had a good understanding of people's support needs. One person told us that they were happy with the care they received and felt their needs had been met. They said there were enough activities and although they had a set activities through the day that they took part in, they could opt out at times if they chose to. We saw that when people needed specialist advice and support, arrangements were made for this to happen.

Is the service caring?

People were treated with respect and staff were courteous. We saw that staff showed patience and understanding when supporting people. One person told us, 'I like living here and I get along with everyone.' We asked if staff discussed their care plan with them and they said, 'Yes, X tells me what is in it and I sign it if I am happy to.'

Is the service responsive?

We saw that people's needs were regularly reviewed. Records confirmed that people's preferences, interests and diverse needs had been recorded. We saw that people had been supported to maintain relationships with friends and relatives. One person who was away for a few days contacted the home during the inspection to speak with a person and with staff.

Is the service well led?

We saw that the organisation had developed a range of measures to monitor the quality of the service provided at Bishops Way. One person told us that they had regular residents' meetings. They said, 'We meet to talk about menus and if we want to make any changes.'

We spoke with three of the four people living in the home. One person said, 'I like living here.' Another said, 'We chose the furniture for the lounge.' One person said that they liked their day time activities and they were keen to show the arts and crafts work that they had produced on the morning of inspection. People said that they discussed issues like menus and holidays at their residents meetings and they were able to raise their individual views.

We were told that people contributed to the organisation's website by writing about various activities that they had participated in. They also enjoyed putting photographs of their activities on this site.

Care plans included detailed information about the needs and abilities of people. There was evidence that people were involved in making decisions about their care.

The home was well maintained and was clean. Staff received training and support that enabled them to meet the needs of people.

The provider had systems in place to continually monitor and improve the service.