We inspected Bishops Court Residential Care Home for Older People on 28 March 2018. The visit was unannounced. This meant the staff and the provider did not know we would be visiting.

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

The Inspection took place on December 8th 2015 and was unannounced. Bishop’s Court is registered with the Care Quality Commission to provide personal care and accommodation for up to 45 people. There were 40 people living at the service at the time of our inspection. Bishop’s Court consisted of five separate units which were used for long stay and short term placements. . People were usually cared for in a particular unit depending on their level of need..

Bishop’s Court is required by the CQC to have a registered manager, which they did have 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 at the service told us they felt safe. The provider had policies and procedures in place to protect people at risk of abuse. Staff could identify the different types of abuse and knew how to raise any concerns. However, we found two occasions when the service had not taken appropriate action in terms of escalating safeguarding concerns to the local authority and ourselves. We raised this with the registered manager and the relevant referrals were made. The service had responded to accidents and incidents but had not always taken action to keep people safe and reduce the risk. The building and environment were well maintained and suitable for the needs of people who lived there. Outside was a secure garden area with seating which people could access.

Staff were safely recruited and trained to ensure people received safe and appropriate care. Although the registered manager told us they were fully staffed on the day of our inspection we found that staff were sometimes not easily visible in all areas. People were left mainly unsupervised in some areas of the service. We shared our observations with the provider.

The service had a relaxed and homely atmosphere. Staff approached people in a caring way which encouraged people to say when they needed support. When supporting people with behaviours that may challenge, we noticed staff used techniques such as distraction and a calm approach. Staff had developed positive relationships with people and their families.

The CQC monitors the operation of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had followed the correct process to submit applications to the supervisory body for a DoLS, where it was identified this was required for people who lack capacity.

Staff enabled people to make their own choices and decisions about the care they received, where possible. When people were unable to make their own decisions staff followed the correct procedures. Staff involved relatives and other professionals when important decisions had to be made about their care.

Staff involved other professionals in a timely manner when relevant to a person’s needs, and formed good relationships with visiting professionals to give a better service to people.

We saw some people were encouraged to participate in activities, and the home had a full activities programme. However, on our inspection, we noticed that only a few people were involved in any activities. We found people’s nutritional needs were met and they had a choice of food and drink, including specialist diets where required. People’s preferences, routines and what was important to them had been assessed and recorded.

Staff told us they felt supported, and confident they could raise any concerns with the registered manager, and that they would be listened to.

People and their families told us they were aware of the complaints process and said issues that they raised were dealt with promptly. There were effective systems in place to monitor and improve the quality of the service provided.

The service gave people and their relatives opportunities to give feedback on the service to ensure quality is maintained.

This inspection was carried out to follow up on our previous inspection in September 2013 where we found the provider had not been compliant with the outcome - "records".

Prior to our visit we reviewed all the information we had received from the provider, including an action plan detailing how they would comply with the compliance action we set at the previous inspection. During the visit we spoke with the registered manager and looked at some of the records held in the service.

We found the provider had made the required improvements to become compliant with this outcome.

During the inspection we spoke with three people who used the service, four relatives, a kitchen assistant, a general assistant, a care assistant, a senior care assistant, the caretaker and the registered manager. We conducted a tour of the building and reviewed records relevant to the management of the service.

People we spoke with told us that staff gained their consent before providing care and treatment. One person who used the service told us, "They (staff) leave me to it, but are there if I need them, they talk to me about my care."

We saw that the food and drink provided met people's needs. A relative told us, “I’ve seen the quality of the food and it looks good. My family member is on a soft diet and they (staff) have made the necessary adjustments for them.”

The building was safe and met people needs. One person who used the service told us, “I feel safe here, especially when surrounded by other people.”

Staff were supported in their role and were well led by their manager. A member of staff we spoke with told us, “The manager leads us well; I have no qualms, if I need any help they are there for me.”

The personalised records for people who used the service were not always accurate and did not always reflect their day to day needs. Daily recording records did not include enough relevant information and in some cases information was not recorded at all.

On the day of the inspection we spoke with five people who were using the service and two members of staff. We also spoke with one relative of person who was using the service. This was to form an opinion about the quality of the service being provided at Bishops Court.

People told us that care staff involved them in their care, treatment and support programme. They also told us that they received input and treatment from visiting health care professionals when required.

People told us that they were encouraged to participate in a range of social activities if they wished to and were satisfied with the activities provided.

People told us that they felt safe in the home and felt that the staff would always promote their safety. They also felt that staff had the right qualifications, skills and knowledge to perform their duties in a safe manner.

People told us that they were provided with the opportunity to comment on the quality of service provision at residents meetings and within a quality assurance process.

We carried out this responsive inspection because we had concerns that this service had not been visited since 2009. During our visit to the service we spoke with a number of residents who told us that they were satisfied with the care and support they received from staff. One resident told us: “The staff are very nice and helpful, I enjoy every minute here.” Another resident told us that: “I felt poorly last night, I called the staff and they came to me very quickly.” Some residents told us that there were limited activities for them to get involved in, one resident told us: “Sometimes I get bored, we used to go on days out but these seem to have stopped.”

Residents told us that the quality of food was good. One resident we spoke with told us: “The meals are good we get three courses every day and a good choice.” Residents told us that their health needs are met and that the staff arrange church services on a regular basis.

The provider had a number of ways in which residents could give feedback about the services they receive. One resident we spoke with told us: “I have completed a form about how things need to improve.” Another resident we spoke with told us: “At the residents meeting everyone can have their say.”