28 March 2018
During a routine inspection
Bishops Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Bishops Court provides residential care for up to 45 people over the age of 65, some of whom are living with dementia. The home is divided into four units and comprises an assessment unit, two short stay units and a unit for people who require long - term care. There is also an assessment flat which can be utilised for people requiring assessment with the aim of returning to live in their own home. All of these are located in one building. On the day of the inspection there were 27 people using the service.
At the last inspection on 11 February 2016, the service was rated as good overall. It was rated good for effective, caring, responsive and well led and was rated requires improvement for safe. At that inspection we found improvements were needed in the reporting of incidents and also in relation to the number of staff available to support people at mealtimes. During this inspection we found the issues had been addressed, but we identified some new concerns with the management of medicines. As a result, we rated the service as good overall, with a rating of requires improvement for safe.
The service had a registered manager in place at the time of our 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.
People using the service told us they felt safe living at Bishops Court. Relatives we spoke with agreed they were safe living there. The staff team were aware of their responsibilities for keeping people safe from avoidable harm and knew to report any concerns to the management team.
Staff assessed people risks in relation to people’s daily lives, but formal nutritional risk assessments were not always completed. The registered manager told us a risk assessment was in the process of being introduced and staff always monitored people’s weight and took action if a person started to lose weight.
People were supported by enough staff to ensure they received care and support when they needed it. Appropriate pre-employment checks had been carried out on new members of staff to make sure they were safe and suitable to work there.
People were supported to receive their medicines safely, but staff did not always lock the medicines trolley when it was left unattended, which increased risk people might access medicines without permission. Liquid medicines and ointments were not always labelled with the date of opening to ensure they were not used longer than the manufacturer’s guidelines.
Staff had the knowledge and skills to provide safe and appropriate care and support. The manager had systems in place to observe practice and staff received supervision and appraisal.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice The staff team supported people to make decisions about their day to day care and support. Where a person did not have the capacity to make a decision for themselves the principles of the Mental Capacity Act were followed. Where appropriate, applications were made to the Local Authority in relation the Deprivation of Liberty Safeguards (DoLS) and the requirements were followed.
People lived in a service which met their needs in relation to the premises and adaptions were made where needed. People had access to information in a format which met their needs.
Staff assessed people's food and drink requirements to ensure a balanced diet was being provided. Staff monitored people’s food and fluid intake and kept records of these when they were identified as being at risk from not drinking or eating enough to keep them healthy.
People were supported to maintain their health. They had access to relevant healthcare services such as doctors and community nurses and they received on-going healthcare support.
The staff team were kind and caring and people's privacy and dignity was respected and promoted. People were involved when staff were planning their care, but this was not always documented.
We saw some excellent examples of initiatives to increase people’s sense of well-being and increase their independence. Staff and people had access to a wide range of resources to enable them to participate in activities that interested them.
People had plans of care that, on the whole, reflected their care and support needs. Whilst the care plans for some people receiving long - term care would have benefited from more detail about their personal choices, the staff team were aware of these and there was additional personal information in “This is me” booklets.
The service was well-led by a registered manager. People using the service, their relatives and staff were unanimous in their praise of the registered manager and the support they provided. People and staff were encouraged to contribute to the development of the service. Effective auditing processes were in place to monitor the quality of the service. The registered manager carried out their role in line with their registration with the CQC.