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Inspection carried out on 4 September 2017

During a routine inspection

Bishops Corner is a care home providing residential care for up to nine adults with learning disabilities. In particular they provide residential care for people with Prader-Willi Syndrome (PWS).

This comprehensive inspection was undertaken on 4 September 2017 and was unannounced.

At the inspection in January 2017 a number of breaches were identified and the service was rated requires improvement. The Care Quality Commission (CQC) took enforcement action and issued a Warning Notice after the inspection as the provider had not ensured good governance. We also found four further breaches in relation to person centred care, dignity and respect, safe care and treatment, and meeting nutritional needs. This inspection took place on 4 September 2017 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. The provider was now meeting the regulations.

There was no registered manager at Bishops Corner. 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.’

A new acting manager had begun working at Bishops Corner and was starting the process of registering as manager with CQC. Staff told us the current acting manager had made positive changes and impact during their time at Bishops Corner. The acting manager had previously worked at a number of services owned by the organisation so they knew staff and people living at Bishops Corner well. The acting manager was going to be registering as manager over three services owned by the provider. A clear structure was in the process of being implemented to provide consistent management cover. The acting manager had a timetable to ensure staff knew where they were and to enable them to provider management support at each of the three services. However, there needed to be a clear structure to support them with this and to make sure this was consistently maintained. At the time of the inspection some of the support roles had not yet been fully recruited. Therefore this is something that will need to be monitored to ensure continued improvement.

The provider had safe recruitment processes and appropriate checks took place before people began work at Bishops Corner. New staff completed a period of induction and all staff received training including safeguarding and PWS specific training to ensure they were able to meet the needs of people living at Bishops Corner. Supervision was taking place to support staff, as well as staff, resident and relative meetings and questionnaires to improve communication. There were enough staff to meet people's needs.

People’s confidentiality was maintained and records were kept securely. People received care which was assessed, planned and reviewed to ensure their needs were met and to reflect their preferences. Support plans included advice about people’s nutrition, medicines and support needs. Staff had access to relevant information about people; this meant they knew people and their care needs well. Staff communicated with people in a caring and supportive manner. Staff knew people well and people were treated with respect and dignity. People’s nutrition was monitored and reviewed based on their individual needs. Changes were introduced slowly to ensure this did not cause undue anxiety for people.

People were involved in decisions and choices when it was appropriate. Mental Capacity Act 2005 (MCA) assessments were completed as required and in line with legal requirements. Staff had attended MCA and Deprivation of Liberty Safeguards (DoLS) training.

People told us they enjoyed the activities provided and people were supported and

Inspection carried out on 5 January 2017

During a routine inspection

Bishops Corner is a care home providing residential care for up to nine adults with learning disabilities. In particular they provide residential care for people with Prader-Willi Syndrome (PWS).

This comprehensive inspection was undertaken on 5 and 6 January 2017 and was unannounced.

Since the last inspection the registered manager had left and the home did not have a registered manager in post. Senior staff had been responsible for the management of the service and there had been a number of changes in leadership. Currently a deputy manager was in charge of the home supported by senior staff within the organisation. A new manager had been appointed and started their induction during the inspection. We were told that the newly appointed manager would be registering with the Care Quality Commission (CQC). 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 October 2015 the overall rating for this service was Requires Improvement with two breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. We asked the provider to make improvements to ensure accurate, contemporaneous records were maintained in relation to peoples care and welfare. To ensure systems were in place to assess, monitor or improve the quality of services provided and to ensure people were safe living at Bishops Corner by assessing and reviewing risks based on their individual needs. Improvements were needed to peoples care and support documentation and we asked for improvements regarding the management of nutrition, ensuring peoples dignity was maintained and fire evacuation procedures.

The provider sent us an action plan stating they would have addressed these breaches of regulation by April 2016.

At this inspection we found although improvements had been made in relation to the fire safety, and improvements were on-going in relation to accident and incident process. Further concerns were identified which demonstrated that that the provider had not addressed issues previously found.

There had been a lack of consistent leadership at Bishops Corner. The provider had not maintained adequate oversight during this time. Although quality assurance systems were in place this had not identified all areas of concern found during inspection. When issues were identified actions had not been documented to show a timely response. There had been a high staff turnover and this had impacted on people and staff. Changes to management at Bishops Corner had led to inconsistent leadership and staff felt this needed to improve. People told us that they found the number of staff changes caused anxiety as they liked to receive care from people they knew and trusted.

Accident and incident processes needed to be further improved to ensure management were aware of all incidents that occurred within the home. We found incidents had occurred that had not led to the completion of an incident form which meant that management were not aware of the issue.

Care and support documentation needed to improve to ensure people received appropriate care and support at all times. Accurate, up to date documentation was not in place to ensure people received safe and appropriate care. We found issues which had not been addressed form the previous inspection. For example details around people requiring one to one support had not been updated to ensure staff had clear guidance in place regarding how this should be carried out. One to one support was not consistent and the decision making around how this was supported and provided to ensure people were safe at all times was not clear.

Improvements to nutrition had not been completed. People’s individu

Inspection carried out on 19 and 20 October 2015

During a routine inspection

Bishops Corner is a care home providing residential care for up to nine adults with learning disabilities. In particular they provide residential care for people with Prader-Willi Syndrome (PWS).

This comprehensive inspection was undertaken on 19 and 20 October 2015 and was unannounced.

The home had an acting manager who had been in post for approximately two weeks. The manager had applied to register with CQC as registered manager and received confirmation this had been approved during the inspection. 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 newly registered manager was in day to day charge of the home. People and staff told us that they felt supported by the manager and told us they were always available on call to support them when needed.

The provider had not ensured that audits and systems had been maintained to ensure that issues identified were responded to in a timely manner. Good governance had not been maintained.

With the exception of medicines and activities all areas of documentation needed to be improved. This included identifying people’s choice and involvement in decisions. Generic care, support plans and risk assessments. In particular PWS information had not been written for each individual to ensure it was person centred and based on their individual care and support needs. People requiring one to one support did not have documentation in place for staff giving clear guidance regarding this.

People’s nutrition had not been clearly monitored. Information was generic around nutrition and not based on people’s individual health needs.

Peoples dignity had not always been maintained, we saw that people were weighed in the dining room in front or others and within ear shot of anyone in the vicinity. There was no documentation in place to show this had been discussed with people and they agreed to this.

It was not always clear if people had been involved in care planning decisions, or how consent to care and treatment had been sought.

Recruitment checks were completed before staff began work, however, not all references were available. Inductions for new staff were not clear. Supervisions had not taken place regularly. Appraisals had been completed in the last 12 months.

Environmental risk assessments had been completed. This included fire and legionella checks.

Fire evacuation procedures needed to be improved to ensure they remained appropriate following building and redecoration work.

Notifications had been completed by the provider to inform CQC and the local authority when notifiable events had occurred.

All staff received service specific training to ensure they had the knowledge and skills to meet the needs of people living at the service. Staff had received safeguarding training and were aware how to recognise and report a safeguarding concern. Staff had received safeguarding training.

Staff knew people well and displayed kindness and compassion when supporting people. Staff had a clear affection for people and responded promptly when people showed anxiety or became upset.

People told us they enjoyed the varied activity programme and that they were able to do activities they enjoyed and risk assessments were completed before people went out on trips, or carried out planned activities.

Medicines administration and procedures were safe. Policies and protocols were in place for all ‘as required’ medicines.

Referrals were made appropriately to outside agencies when required. For example GP appointments, dental appointments and hospital visits.

Feedback was gained from people this included questionnaires and meetings and a complaints procedure was in place. The manager told us there were no on-going complaints.

We found breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.

Inspection carried out on 4 September 2013

During a routine inspection

We spoke with four of the eight people living in the home. People spoken with said that they met regularly with their key workers to discuss their care plans. One person said, �I like my work, I�ve been going there a long time now.� Another person said, �I like doing word puzzles, they keep me busy.� One person said that they had completed a lot of artwork and that it was going to be displayed at an exhibition soon.

The home had a robust recruitment procedure in place to ensure that they employed suitable staff to work in the home. There were safe systems in place for the management of medication.

The home had systems in place to assist people with raising concerns. People knew who they would talk to if they had any concerns or worries.

Inspection carried out on 25 October 2012

During a routine inspection

We spoke with three of the eight people living in the home. People spoken with said that they met regularly with their key workers to discuss their care plan. They said that the meetings are used to talk about any concerns they had and the activities they wanted to do. One person said �I like my room, I like visiting my friends and inviting my friends to visit me here.� Another person said �I like having a pet, staff help me if I ask for help but I like to do it myself.� We found that the new format for care planning clearly documented the needs of people and how they should be met. Care was based on the individual needs of people and where appropriate, specialist advice and support was obtained. The provider had systems in place to continually monitor and improve the service.

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