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Archived: Bishop's Court Requires improvement

Reports


Inspection carried out on 28 May 2015

During a routine inspection

This unannounced, comprehensive inspection took place on 28 May 2015 and was conducted following receipt of information of concern. The service was registered to provide accommodation for 41 people, there were 23 people living in Bishops Court at the time.

The service is located in a single storey building and provides nursing and personal care, predominantly for people living with dementia. It is situated in the Sefton Park area of Liverpool and is close to local amenities, such as shops and local transport links to Liverpool city centre. There is a large car park at the front of Bishop's Court and the building has gardens which are fully accessible to people using the service and their visitors.

The home was registered to provide accommodation and care to people who may have nursing needs and a registered manager was employed.

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. At the time of the inspection the manager had been away from the service since 23 April 2015. A senior manager from the organisation had been managing the service since 24 April 2015 but has not submitted an application to the CQC to become the registered manager. People spoke positively about her saying she was ’’really approachable.’’

We found that there was little signage around the service to identify different areas such as toilets and dining rooms. In order to support people living with dementia we have made a recommendation in relation to this.

We found that there were sufficient numbers of staff on duty in the daytime but some staff had expressed concerns about staffing levels at night.

Medicines overall were managed safely but some improvements were required. This was because for some people there was not sufficient information recorded around the administration and review of medicines to be given when required (PRN) and a care plan was not always in place to support this. We also saw that discontinued medications were not always supported by a signature from a nurse or G.P. The service provided information at a later date to show that they had sufficient safeguards to ensure that discontinued medication was verified by an appropriate professional.

People living in Bishops Court, staff, relatives and professionals that we spoke with were all positive about the service provided. The people living at the home and relatives told us they felt safe.

We saw there were effective recruitment procedures in place and staff performance issues were addressed appropriately.

The staff in the home knew the people they were supporting and the care they needed. The staff were trained and competent to provide the support required by the individuals.

There was a calm, relaxed atmosphere within the home and we observed good interaction between people living at Bishops Court, staff and visitors.

The care plans that we reviewed showed that preadmission assessments had been conducted and consent forms to care plans had been completed and signed by either the people using the service or their representatives. This showed that people using the service and their representatives had been involved in their care planning. There was adequate information available in the care plans to ensure people using the service to be supported in an individualised way that met their needs.

There was a complaints policy available, and there was evidence that complaints were dealt with effectively.

Inspection carried out on 12 March 2014

During an inspection to make sure that the improvements required had been made

We had previously inspected this service on 3 November 2013. During this inspection we found there had been improvements at Bishop’s Court since our last visit.

We used a number of different methods to help us understand the experiences of people living at Bishop’s Court, because the people using the service had complex needs which meant they were not able to tell us their experiences. During our inspection we observed that staff were attentive and treated people in a kind and caring way and were respectful towards the people they cared for. We also saw evidence that medicines were managed safely and effectively and the organisation monitored the quality of the service provided on a regular basis.

Inspection carried out on 3 November 2013

During a routine inspection

We had previously inspected this service on13 June 2013 when we found areas of non-compliance for which compliance actions were set. We carried out this inspection to see whether improvements had been made.

We used a number of different methods to help us understand the experiences of people who lived at Bishop’s Court, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. During our inspection we observed staff being kind and caring in their interactions with the people who used the service. We were able to speak to six people who lived at Bishop’s Court who told us, “It’s OK” and “Staff are OK and they are kind.” We also spoke with three relatives of people who used the service, none of whom were happy with the level of care and support provided at Bishop’s Court. One relative told us,” It’s improved a bit lately but I don’t feel confident that xxx would get all the care they need if I wasn’t constantly keeping an eye on things.”

During our visit we found evidence that the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. However, the care plans we viewed for the people who used the service did not always contain enough relevant information for people to be cared for safely and effectively.

We found that appropriate arrangements were not in place for the management of the medicines. We also found that there were insufficient quality assurance systems in place to ensure people received safe and appropriate care, treatment and support.

Inspection carried out on 13 June 2013

During a routine inspection

During our visit we spoke with four people who used the service, a relative and nine members of staff in a range of different roles. At the time of our visit, there were a number of people living at Bishop’s Court who were not able to tell us about their experiences directly. However we spent time observing the support and care they received from staff at the service. People living at Bishop’s Court were well presented and we observed staff interacting with people appropriately throughout the day. Staff were knowledgeable about the people they supported and were able to discuss how they try to meet people’s needs.

One relative we spoke with said, “I have nothing but praise for this place, my mother is much more settled now”.

We found that people’s privacy and dignity were respected and that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. However, people’s care and treatment was not planned and delivered in a way that ensured their safety and welfare. Medicines were not safely managed and there was not an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

Inspection carried out on 11 October 2012

During a routine inspection

We had previously inspected this service on 23rd March 2012. During our visit we found that there had been significant improvements at Bishop's Court since our last inspection.

We used a number of different methods to help us understand the experiences of people living at Bishop's Court, because the people using the service had complex needs which meant they were not able to tell us their experiences. We were able to speak with two people who used the service who told us the care they had received at Bishop's Court had been, “good” and they had been “well looked after”.

During our visit we observed that staff treated people in a kind and caring way and were respectful towards the people they cared for. There were enough skilled and experienced staff on duty to be able to meet the needs of the people who lived at Bishop's Court in a timely manner. Staff we spoke with told us, “Most of the time there are enough staff, it’s a lot better than it used to be”. We also saw evidence that the organisation was monitoring the quality of the service provided on a regular basis.

Inspection carried out on 23 March 2012

During an inspection to make sure that the improvements required had been made

We spent time with people who live at Bishop’s Court. They told us that they liked the meals and got enough to eat. They said they enjoyed the singing and music in the lounge.

The relatives and representatives we spoke with had mixed views of the quality of care. Some we satisfied with the care and said the staff were kind and caring. We heard that staff communicated well and sought the involvement of relatives with reviewing care plans.

Others were not satisfied with the care and told us that personal care was not always of a good standard. They said clothing was often ruined in the wash or not laundered well. Some relatives and/or representatives did not think there was always enough staff on duty to meet the needs of everyone living there. They told us that information about care needs had not always been communicated between staff. We heard that improvements had been noticed recently but some people thought the improvement was not enough.

Inspection carried out on 16 February 2012

During an inspection in response to concerns

We spent time with people who live at the home who told us they liked living at the there. We observed that staff were responsive and attentive to people's needs. Staff and volunteers were facilitating group and individual social activities throughout the day. The people living there appeared to enjoy the activities.

Inspection carried out on 23 March 2012

During an inspection in response to concerns

We spent time with people who live at the home who told us they liked living at the there. We observed that staff were responsive and attentive to people's needs. Staff and volunteers were facilitating group and individual social activities throughout the day. The people living there appeared to enjoy the activities.

Inspection carried out on 28 November 2011

During an inspection to make sure that the improvements required had been made

We spent time in the lounge areas with people who lived at Bishops Court.

We observed two incidents where members of the staff team did not support people in a respectful and dignified manner. The Deputy Manager dealt with these issues during the inspection visit. The Area Manager reported these practice issues would also be raised during supervisions and team meetings to ensure all staff were aware of their roles, responsibilities and the conduct required by the organisation.

Overall observations showed support workers were respectful towards the people who used the service.

We observed a member of staff spending time with a person who was agitated and distressed. The care worker sat with the person until they clamed down and then took them to assist in setting the tables for lunch.

On a previous visit we found people who used the service spent long periods of time on their own without staff support. On this visit we found at least one care worker in the communal areas at all times. This meant care workers were able to engage with people on a social level more often and to monitor peoples’ safety.

As part of this review of compliance Liverpool City Council contracts and commissioning team were contacted. They raised no specific issues of concern about how people were supported or cared for.

Inspection carried out on 15 August 2011

During a routine inspection

We spent time in the lounge areas with people who live at Bishops Court. We observed that people who use the service spend long periods of time on their own without staff support.

In one of the lounges we noticed a person sitting directly under the television which had been attached to the wall. This person could not see the television but would have been able to hear people talking and loud noises. This person was quite agitated. We highlighted this to the acting manager who moved the chair to a more suitable position.

We spoke with people who use the service and their relatives. Some comments made were;

“The staff are very good they help me when I need it”.

“I like to read and watch films I can watch them here or in my room”.

“Dad found it hard to settle here because he wanted to go home but the staff where great with him and he has settled now”.

“I think they need more staff on duty”.

“If I was unhappy about anything I would talk to the manager or one of the nurses”.

We observed people being provided with meals on plastic plates and cups which were not age appropriate. Members of the staff team supporting people to eat were not chatting with them to make the meal a social occasion.

We spoke with people who use the service their relatives and members of the staff team. They told us the quality of the meals provided varied and the menus were very repetitive.

We noticed there where not enough lounge chairs for all the people to use. We discussed this with the area manager who agreed to purchase more chairs.

Relatives spoken with during our visit felt the staff team worked very hard but more staff where needed.

Reports under our old system of regulation (including those from before CQC was created)