Archived: Prince Bishop Court

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

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

In July 2014 we completed an inspection and issued a formal warning to Positive Approach Services Limited telling the provider that they must improve in the following area by 7 August 2014:

Regulation 11, (Outcome 7): Safeguarding people who use services from abuse as the service was failing to take reasonable steps to identify and prevent the possibility of abuse and/or failing to respond appropriately to allegations of abuse.

Whilst completing this visit we reviewed the action the provider had taken to address the above breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We found that the provider had ensured improvements were made in this area and had led to the home meeting the above regulation.

Is the service safe?

Safeguarding procedures were now in place and were being properly used. This included where the provider reported adult protection incidents to the local authority safeguarding team and CQC. There was evidence that the providers safeguarding adult's procedures were being used by staff and training had taken place to give them awareness about when these procedures should be considered / used.

The staff that we spoke with understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

However we found that the provider subjected people to material and / or emotional sanctions in response to their demonstrating challenging behaviour. This practice was unlikely to resolve challenging behaviour incidents and does not follow best practice guidance.

Is the service effective?

People all had an individual care plan which set out their care needs. Where possible people had been involved in the assessment of their health and care needs and had contributed to developing their care plan. Assessments included needs for any equipment and specialist dietary requirements.

People had access to a range of specialist health care professionals and staff were involved in working together with specialist advisors.

Although intended to help people manage people who had behaviour which challenged the service, some peoples' care plans failed to protect their rights. For example some peoples activities were restricted if they did not follow conditions imposed by the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people. One person told us, 'I'm very happy here ' it's my house.'

There was an advocacy service available if people needed help or support to speak for themselves.

We observed that peoples individual wishes for care and support were taken into account and respected and we saw these were regularly discussed with them and recorded in their care plans. However the provider had carried out restrictive sanctions where service users had displayed behaviour which challenged the service in an attempt to prevent further challenges.

Is the service responsive?

There were well planned and well organised routines at the home to make sure peoples' personal care and lifestyle needs were supported. Staff duties were co-ordinated to provide this service at busy periods and peoples' care plans including risk assessments were detailed. Staff showed they were very knowledgeable of peoples' needs preferences and dislikes some of which needed to be provided in very specific ways. For example we observed that individual staff described how an activity was going to take place using the same language which gave the person reassurance and consistency.

Is the service well-led?

At the time of our visit the provider did not have a registered manager in post at this home who would guide staff practice and give leadership and support to them. 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 provider had not monitored the appropriateness of service user sanctions following instances where they had behaviours which challenged the service. The oversight and review of these sanctions by the provider was not robust and did not reflect good practice guidance. This meant that people who lived at the home had restrictions placed on their opportunities and lifestyle which were inappropriate and did not support their best interests.

Below is a summary of what we found. The summary is based on our observations during the inspection, talking with people who use services, speaking with the staff supporting them and from looking at records.

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

Is the service safe?

People were not properly safeguarded from abuse by the agency. This was because the provider did not report adult protection incidents to the local authority safeguarding team or follow their own safeguarding adult's procedures.

Is the service effective?

Procedures which should have safeguarded people at the home from abuse were not used effectively.

Is the service caring?

The provider failed to respond appropriately when serious incidents occurred involving the health and wellbeing of service users.

Is the service responsive?

The agency did not respond appropriately to two recent incidents which directly involved the safety of vulnerable service users. We looked at how safeguarding incidents had been dealt with and found that responses had not been thorough and had not followed the providers' policies. People could therefore not be assured that their safety would be maintained and all necessary action taken.

Is the service well-led?

At the time of the inspection the service had a registered manager in post however both the registered manager and provider had failed to follow the providers agreed safeguarding procedure and inform the local safeguarding authority when incidents occurred.

We found records were not made where significant incidents had taken place which hampered further investigation and did not promote learning from mistakes.

One person told us, "I go out with staff on the bus to different places and do shopping and have lunch". Another said that they were going to Scarborough for a holiday.

During the visit we looked at people's rooms and found that they were personalised with pictures and some had their own television or radio.

Everyone we spoke to said that they felt safe at Prince Bishop Court. We found that the building was clean and comfortable and people looked as though they were well cared for.

We spent time looking at records and found that there were care plans in place which were regularly reviewed with involvement from people using the service.

We found that Prince Bishop Court provided opportunities for people to comment on the service provided and saw responses to a survey which had recently been circulated to people living there. We saw minutes from meetings held with people living in the service.

We observed interaction with staff and people living in Prince Bishop Court and found that people were treated with respect and listened to.