Bishopstoke Park

Bishopstoke Park is a retirement village consisting of privately owned apartments and a registered residential care home. The retirement village includes a wellness centre and spa, restaurant, café, a general store and a library. The provider (Anchor Hanover Group) is registered with CQC to provide a personal care service to people living in their own apartments in the retirement village. The residential care service is registered separately with CQC. This inspection relates only to the personal care service provided for people in the retirement village.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

At the time of our inspection the service was providing personal care to 18 older people with a variety of care needs, including people living with physical frailty or memory loss due to the progression of age.

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

Based on our review of safe and well-led, we received some mixed feedback about the service from people, their relatives and staff. Some concerns were expressed about the level of staffing, particularly during the evenings. We have made a recommendation about staffing.

Robust systems and governance had not been in place. For example, there had been a lack of formal review processes and audits, and some staff training needed updating. The new manager had started to identify and address shortfalls in quality monitoring. Comments from staff and people’s relatives acknowledged that the new manager “Had a difficult task and was doing her best” and, "Understands risk and she really cares.”

Some staff felt that communication between the management team and staff could be improved. They told us they did not always feel they were getting clarity and support from the management team. The new manager was working to an action plan, identifying areas for improvement. However, action was still needed to ensure all areas were addressed and any changes were well understood and embedded by all staff.

Staff were not always clear about what the provider’s policy was regarding people’s medicines. We have made a recommendation about medicines management.

Staff had received training in the safe handling of medicines, and this was followed by an assessment of their competency to administer medicines. Safe recruitment practices were followed before new staff were employed to work with people. Staff demonstrated a good understanding of infection control procedures and had received training in infection control. Assessments were undertaken to assess any risks to people and to the care workers who supported them. Staff were aware of people’s risk assessments and contributed to monitoring for any changes to these.

People and their relatives gave positive feedback about the care provided by staff. For example, they told us staff were always willing to discuss their support needs and were flexible in their approach. “They are incredibly accommodating. The staff are so dedicated.”

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 on 15 February 2020). At this inspection we found improvements were needed and so the rating has changed to requires improvement.

Why we inspected

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

Follow up

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

Bishopstoke Park is a retirement village consisting of privately owned apartments and a

registered residential care home. The retirement village includes a wellness centre and spa, restaurant, café

a general store and a library. The provider (Anchor Hanover Group) is registered with CQC to provide a

personal care service to people living in their own apartments in the retirement village. The residential care

service is registered separately with CQC. This inspection relates only to the personal care service provided

for people in the retirement village.

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

At our last inspection, whilst we found most people received a service which met their needs, two people who had more complex care needs, particularly as they needed help to be assisted to move, had received an inadequate service. At this inspection there were no people who currently required this level of support and staff were providing a good service to people in line with their assessed needs.

At our last inspection we found the service was not well managed and people and staff raising concerns were not taken seriously. At this inspection a new registered manager had been appointed who had improved the culture of the service. They were clear about their role and responsibilities and had acted to address quality issues within the organisation.

At this inspection we found people received care which was provided in a safe way. They were protected from abuse and avoidable harm as the service listened to people's concerns and followed agreed safeguarding procedures. There were enough numbers of appropriately trained staff employed to keep people safe. Where necessary staff managed people’s medicines safely. They followed appropriate infection control procedures.

People received care and support which enhanced the quality of their lives. Staff knew people’s needs and provided effective care, working as necessary with other health and social care professionals to achieve this. Some people had requested additional support at weekends and the service was actively recruiting to provide this. People were informed about progress in this respect.

The service provided was caring. There was a small staff team who knew people they supported well. People were supported to express their views and to be involved in making decisions about their care. Privacy, dignity and independence was respected and promoted.

People’s needs were met in the way the service was organised and delivered. The service needed to review the way they dealt with complaints to ensure people were properly informed about how to complain and to ensure they addressed them in a timely way.

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.

Rating at last inspection and update

The last rating for this service was Inadequate (published 03 June 2019) and there were five breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when, to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations although we did recommend they reviewed their complaints process to help to ensure it was accessible to all and to review the way they managed complaints made to respond to people’s needs when concerns arose.

This service has been in Special Measures since June 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the time of our inspection nine people were receiving the personal care service.

The registered manager’s responsibilities had recently increased as they had also become registered for a new Anchor service. This service was in the process of being developed but in the future it was planned that her time would be spent between the two services with a team leader taking day to day management responsibility for each site.

People’s experience of using this service:

Most people using the service described it in very positive terms. They described a caring and helpful staff team who provided them with reliable care in line with their expectations. Seven people required one member of staff to support them. Assistance required included some help with washing and dressing, prompting them or assisting to take medications, preparation of hot drinks and meals and escorting to and from the dining room. People told us staff managed these tasks well and that they were supportive and reliable. We found a good service was being provided to people who needed this level of support.

The service did not provide safe care to people who required greater levels of support, particularly those who needed assistance to move.

This was the current experience of two people.

Whilst one person who needed this amount of support was full of praise for the service provided the other person said they did not always feel safe when they were being assisted to move.

We found the lack of clear guidance regarding how to assist people to move safely was of such concern we notified the local authority under safeguarding protocols. The local authority has the lead responsibility for ensuring individuals are kept safe. The local authority involvement is ongoing at the time of this report.

We found six breaches of The Health and Social Care Act 2008 during this inspection.

Systems and processes to safeguard people were not effective as people had contacted CQC to raise concerns and they felt these had not been acted upon by the provider.

The provider had not taken all reasonably practical steps to mitigate risk, particularly when they assisted people to move.

There were not sufficient staff deployed to meet peoples' collective assessed needs.

Staff were not provided with suitable training and support in a timely way to enable them to carry out the duties they were employed to perform.

Concerns raised had not been investigated and appropriate action had not been taken to rectify any shortfall identified.

Governance systems in place were ineffective and feedback given was not used to evaluate the service and to drive improvement.

Rating at last inspection: The service was rated as Good at the last inspection in March 2017.

Why we inspected: This was a planned inspection which was brought forward due to concerns raised to CQC

Follow up:

As we have rated the service as inadequate, the service will be placed in 'special measures'. Services in special measures will be kept under review and, if we have not already taken immediate action to propose to cancel the provider's registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services, the maximum time for being in special measures will usually be no more than12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The service provides care to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People’s care and housing are provided under separate agreements; this inspection looked at their personal care arrangements. At the time of our inspection the service was providing personal care to five older people with a variety of care needs, including people living with physical frailty or memory loss due to the progression of age.

A registered manager was not in post 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. The service was currently in the process of registering the manager for the regulated activity of personal care.

Most people’s care plans and risk assessments provided comprehensive information and were reviewed regularly. However, these did not include information about people’s health conditions such as diabetes plans were not always adequate to support people appropriately.

People and their families told us they felt safe and secure when receiving care. Relevant recruitment checks were conducted before staff started working at Bishopstoke Park to make sure they were of good character and had the necessary skills.

Staff received training in safeguarding adults. They completed a wide range of training and felt it supported them in their job role. New staff completed an induction designed to ensure staff understood their new role before being permitted to work unsupervised. Staff told us they felt supported and received regular supervision and support to discuss areas of development. There were sufficient numbers of staff to maintain the schedule of care visits to meet people’s needs.

People who used the service felt they were treated with kindness and said their privacy and dignity was respected. People received their medicines safely. Staff had an understanding of legislation designed to protect people’s rights and were clear that people had the right to make their own choices.

Staff knew what was important to people and encouraged them to be as independent as possible. People were supported to lead full and varied lives and encouraged to make choices and had access to a range of activities.

Staff were responsive to people’s needs which were detailed in people’s care plans. Care plans were regularly reviewed to ensure people received personalised care. People felt listened to and a complaints procedure was in place.

Staff felt supported by the manager and could visit the office to discuss any concerns. Procedures were in place to investigate complaints and learn from any accidents or incidents. There were systems in place to monitor the quality and safety of the service provided.

Bishopstoke Park provides personal care to older adults living in their own homes on an assisted living development. At the time of our inspection two people were receiving personal care from Bishopstoke Park.

The service had a registered manager. 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.

There were enough staff to support people effectively and staff were knowledgeable about how to spot the signs of abuse and report it appropriately. People said they felt safe with care staff and were complimentary about the staff caring for them. The registered manager took immediate action to ensure missing information for essential pre-employment checks was available. Medicines were managed safely and people received their medicines when they needed them.

People said they were satisfied with the service. They told us care was provided with respect for their dignity. Staff, and the registered manager, knew how the Mental Capacity Act 2005 affected their work. They always asked for consent from people before providing care

People’s care plans were person-centred and their preferences were respected. Care plans were reviewed regularly and people felt involved in the way their care was planned and delivered. People were asked for feedback on the service they received and any concerns were addressed promptly.

Staff had completed training appropriate to their role and an on-going plan of training was in place.

People said staff were caring and that they promoted a friendly atmosphere with them. Staff spoke about people in a kind and caring manner.

Staff said they worked well as a team and that the managers provided support and guidance as they needed it. Procedures were in place to investigate complaints and learn from any accidents or incidents.