Bishops Gate

About the service

Bishops Gate is a care home providing residential care for up to eight adults with learning disabilities. In particular they provide residential care for people with Prader-Willi Syndrome (PWS). Whilst independent with many areas of their daily lives, people living at Bishops Gate require a high level of support to enable them to manage risk and remain safe. The home was formed of one adapted residential building.

People’s experience of using this service and what we found

Right Support

Staff supported people to have the maximum possible choice, control and independence be independent and they had control over their own lives. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. One person said, “There are good choices, it's just great living here.” Staff enabled people to access specialist health and social care support in the community. Staff supported people to make decisions following best practice in decision-making. 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.

Right Care

People received kind and compassionate care. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right Culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People received good quality care, support and treatment because trained management and staff could meet their needs and wishes.

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 19 September 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bishops Gate on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This inspection took place on 11 August 2017 and was a full comprehensive inspection to check the provider met regulatory requirements. There were five people living at the home at the time of our inspection. One person was currently staying with family and another went to stay with family for a break during the inspection.

Bishops Gate was inspected in August 2016. Although no breaches were identified and it was rated as requires improvement as some recent improvements needed time to become embedded.

We asked the provider to continue to embed and sustain the improvements made. At this inspection we found this had taken place.

Bishops Gate had a manager registered with CQC. However they were no longer working at the service and had not been working in a registered manager capacity at Bishops Gate for some time. This meant that registration information did not reflect the current management structure at Bishops Gate. Since the inspection we have been informed that the process to de-register the registered manager and register the acting manager have been commenced. The acting manager worked full time at Bishops Gate and was supported by a senior carer/deputy manager who had just been appointed to this role.

An ‘in house’ and provider auditing and quality review system were completed, this included a number of regular audits and analysis of systems and processes. There were ongoing maintenance systems to ensure safety was maintained at Bishops Gate. Provider structure had been changed since the previous inspection and further improvements were planned to ensure a robust provider oversight was maintained.

Care documentation was reviewed to ensure it was relevant and person centred and people had been involved in the planning and review of their care. Risk assessments had been completed for identified risks and managed in a safe and consistent manner. These were varied and included environmental risks for people in relation to PWS. Risk assessments were individualised and person centred and had been reviewed and updated regularly, dependant on people’s health related conditions, behaviours and activities attended. Keyworker meetings took place to discuss changes in peoples care needs and to enable a review of documentation. Support plans had been reviewed and information had been discussed with people and their next of kin if appropriate. People had signed when they had read support plans and felt involved in how their care was provided. Staff were aware of confidentiality and documentation was kept securely.

There were systems in place to manage people’s medicines safely; this included a regular auditing of the medicines procedure People had chosen whether their medicines were stored in locked cupboards in their rooms or in the medicine room. Medicines were given in the privacy of people’s rooms or in the office as they chose.

Nutrition was managed effectively. Systems were in place to ensure people received appropriate nutrition to meet their individual needs. People had been involved in discussions at ‘Your Voice’ meetings regarding menus. Daily calorie intakes had been calculated for each person based on advice from health professionals and taking into consideration peoples specific health needs. Weights were monitored and changes made to nutritional plans if needed. Further changes to the menu were being introduced to facilitate healthier eating options.

Staff knew people’s needs and had a close bond with people, most of whom had lived at Bishops Gate for some time. People were involved in decisions and staff respected their personal space and privacy. Staff offered support whilst encouraging people to remain as independent as possible.

A varied activity programme was available for people. People had access to activities they enjoyed and were supported by staff to attend, when people wished to attend a new activity staff supported them to arrange this. If people declined to attend an activity staff were aware this was the person’s choice, however encouragement was given to try and ensure people were offered choices and alternatives to encourage them to participate.

Staffing levels were reviewed and staff felt levels were appropriate. Recruitment records demonstrated there were systems in place to ensure staff were suitable to work at the home and support was provided for staff in the form of regular supervision, appraisals and staff meetings.

An on-going training programme was in place to support staff; this included specific PWS training to ensure effective care for people. Mental capacity assessments (MCA) and Deprivation of Liberty Safeguards (DoLS) had been completed. Staff understood the restrictions in place for people in relation to PWS and individual needs and why these were in place.

A complaints policy was in place and complaints had been responded to by the acting manager or provider. Notifications had been completed for notifiable events. The provider and management were working to continually improve communication with relatives and next of kin. People and relatives felt the improvements made to the service had been positive.

There were five people living at the home at the time of our inspection. One person was currently staying with family for two weeks and another went to stay with family for a holiday during the inspection.

Bishops Gate was inspected in December 2015. A number of breaches were identified and it was rated as inadequate. The Care Quality Commission (CQC) took enforcement action and the service was placed into special measures. CQC issued two Warning Notices after the inspection in respect of safe care and treatment and good governance. We also found further breaches in relation to the numbers and skills of staff to meet people’s needs and a lack of support systems in place for staff.

We asked the provider to make improvements to ensure peoples risks were identified and responded to. Improvements were needed to medicines, staffing levels, training and support for staff, nutrition, person centred care and documentation, consent, dignity, maintenance and equipment checks, assessing the quality of the care and support provided, auditing and quality assurance systems at the service. The provider sent us an action plan stating they would be addressed by July 2016.

This inspection took place on 15 and 16 August 2016 and was a full comprehensive inspection to check the provider had made suitable improvements to ensure they had met regulatory requirements. We found that appropriate actions had been taken and issues had been addressed and the service no longer required to be in special measures.

Bishops Gate did not have a registered manager in post. 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.

An acting manager had been appointed and had worked at the service since the previous inspection. The acting manager told us they were in the process of registering with CQC and we saw evidence to confirm this. They were supported by a deputy manager to ensure a consistent management oversight at the home at all times.

Medicine procedures had been greatly improved. Daily checks had been introduced to ensure people received medicines safely. Further changes to the storage would be implemented once the refurbishment was completed. People were able to be involved in choosing where they received their medicines and were kept informed of any changes. Further changes to medicine procedures and how they are stored and given were in progress as refurbishment to the building was not yet fully completed. These would be reviewed at the next inspection to allow the changes time to become fully implemented and embedded into practice.

Care provision and documentation had been reviewed with a new format for care planning in place. This was person centred and involved people and their Next of Kin (NoK) in the planning and review of their care. Risk assessments were completed for identified risks, this included fire risk assessments and night staffing levels to ensure peoples safety could be maintained at all times. Risk assessments were reviewed regularly and updated when changes occurred. Care documentation had been updated to ensure it was clear, relevant and person centred to reflect peoples differing support needs.

A varied activity programme was available for people. People had access to activities they enjoyed and were supported by staff to attend. People were encouraged and supported to remain as independent as possible, for example arranging their activities and organising how they wished to spend their day. Staff were available to support people when needed.

Recruitment processes were in place to ensure appropriate checks took place before people began work at the home; some areas were being formulated and needed time to be reviewed as part of the on-going improvements to the home.

Staff had a good understanding of safeguarding and were able to tell us how they would report a safeguarding concern. Information was in place to support staff when dealing with behaviours that challenge.

Accidents and incident processes had been improved. People and staff involved were offered a debrief and discussions took place to show learning and on-going improvements taken forward.

People’s dignity and privacy were supported, people had keys to their own rooms and their personal space was respected.

Staff knew people well and displayed kindness and compassion when supporting people and when responding to behaviours that may challenge.

Inductions were in place for any new staff recruited. Staff told us they felt supported and received regular training, support and supervision. Staff felt that the consistent approach by the acting manager had improved communication and staff morale as they felt part of a team and could see the improvements which had taken place and the positive impact this had on the home and the people living there.

Systems and processes were in place to improve the quality of care. This included audits and checks carried out by the acting and deputy manager, and regular checks by the provider to ensure improvements took place and continued. Some improvements were still in progress including overall refurbishment of the building. This had been done slowly and sensitively to ensure that the impact on people was minimised as much as possible. There had been some delays which had been unavoidable; however the works were nearing completion. People had been involved in choosing new furniture and decoration and bedrooms had the addition of ensuite facilities and improvements to communal areas and hallways had improved the level of privacy for people.

A complaints policy was in place. When formal complaints were received correspondence and meetings were recorded and complaints responded to by the acting manager or provider.

There was no registered manager at the time of inspection. An acting manager had been in post since the last inspection and was in the process of registering with CQC. The acting manager or provider had completed notifications to CQC and the local authority for notifiable events when required.

Many improvements had taken place since the last inspection and the warning notices and breaches of regulations had been met. At the next inspection we will check to make sure the improvements are embedded and sustained. This is because there are currently five of a possible eight people at the home and we will need to see that as people are admitted the improvements continue, which is why the rating is requires improvement despite no breaches having been identified.

We found that care plans clearly documented the needs of people and how they should be met. Staff ensured that consent was obtained prior to providing care and support. Specialist advice and support was obtained to meet people's individual needs. There were safe systems in place for the management of medication.

Staff received training to enable them to fulfil their individual roles and responsibilities. There were systems in place to ensure that anyone who wanted to make a complaint could do so.