Bishops Waltham House Care Home is a residential service providing care and accommodation for up to 36 older people requiring long stay, respite and re-ablement care, including those living with dementia. There were 31 people using the service at the time of this inspection.

The inspection was unannounced and was carried out on 21 and 23 June 2017.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People and their visitors told us they felt the home was safe. Managers and staff had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and these were recorded and actions identified to reduce those risks in the least restrictive way. The assessments were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to respond to and meet people’s needs.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and competency assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people in a patient and friendly manner.

Staff developed caring and positive relationships with people, were sensitive to their individual choices and treated them with dignity and respect. The managers and staff were skilled at supporting people at the end of their life and worked hard to ensure both the person and their relatives were looked after well at a difficult time.

The managers and staff understood the importance of involving people and their relatives in their care and providing support that was personalised to their individual needs. People were supported to maintain relationships and links with the community that were important to them.

The service was responsive to people’s needs and staff listened to what people said. Staff were prompt in raising issues about people’s health and people were referred to health professionals when needed. People were confident they could raise concerns or complaints and that these would be dealt with.

People were encouraged to provide feedback about the service they received, both informally and through meetings and a survey questionnaire.

People, their visitors and external professionals spoke positively about how the service was managed. Staff understood their roles and responsibilities and felt supported by the management to raise any issues or concerns. The quality of the care and treatment people experienced was monitored and action taken to promote their safety and welfare, as well as that of visitors and staff. Accidents and incidents were monitored and remedial actions taken to reduce the risk of reoccurrence.

We carried out an unannounced comprehensive inspection of Bishops Waltham House Care Home on 21 and 22 March 2016.

The service provides accommodation and support for up to 36 older people including people with dementia. At the time of our inspection 30 people used the service.

The service had a registered manager in place. 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 a 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 is required by a condition of its registration to have a registered manager.

The registered manager had taken on management responsibility for two services in the past six months and the deputy managers had taken over the day to day running of Bishops Waltham House Care Home. The registered manager would solely manage the service again from 1 April 2016.

Governance systems were in place to monitor the quality of the service and identify the risks to the health and safety of people. However, the audits completed by the provider and staff had not always been effective in identifying issues of concern. Where these systems had been effective in identifying shortfalls, action had not always been taken to improve the quality of care and ensure the safety of people.

People can be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA) 2005. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). During this inspection we found where people lacked the capacity to agree to the restrictions placed on them to keep them safe, the provider made sure people would have the protection of a legal authorisation and had made the appropriate DoLS applications to the local authority. However, records did not show restrictions were only placed on people as a last resort, after less restrictive approaches had been considered. We have made a recommendation to support the provider to ensure the management team and staff would fully implement the provider’s policy in relation to the MCA 2005 and DoLS.

The registered manager had not consistently followed the requirements of their registration to notify CQC of specific incidents relating to the service. We had not been notified of the outcomes of the service’s applications to deprive people of their liberty so that we could monitor whether the service met the DoLS requirements.

The provider had a staff recruitment process in place to identify applicants who were suitable to work with people. However, the registered manager had not always followed this process through to completion to ensure a full employment history would be readily available for all staff. We have made a recommendation to support the provider to improve the availability of staff recruitment information.

During our visit people using the service told us they felt safe. Staff were able to demonstrate their understanding of the risks to people’s health and welfare and people told us that they received care that met their needs. However, we found that care plans did not always reflect individual risks to people and offer guidance and support to staff on how these should be managed. Staff we spoke with were confident of how to manage risks to people on a daily basis. New staff or agency staff may not have all the information they needed to know how to keep a person safe and meet all of their needs, wishes and preferences if reliant solely on the care plans for this information.

People were protected from unsafe administration of their medicines because staff followed the provider’s medicines policy. Staff had received a programme of training to support them to effectively meet people’s needs. Staff told

We spoke with eight people who used the service and two relatives, the Registered Manager, Deputy Manager and six members of staff. We also met and spoke with the senior Service Manager who visited the home during the inspection.

We saw that systems were in place to gain and review consent from people who used the service, and to act on their wishes. A person who used the service said “the staff always ask if they can do my care and are very co-operative”. Care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. One person told us “I love it very much here, I am happy and safe. The staff look after me really well”. Another person said a senior member of staff “saw me the other day for my yearly review. We chat about my care and if I am happy here”.

We saw that appropriate arrangements were in place to protect people against the risks associated with medicines. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. A person who used the service told us “the staff are well trained. We get involved by sitting on the interview panels and we say whether we think they will fit in with us or not, we enjoy that”. We saw that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

During this visit we spoke with two of the people who used the service, the registered manager, two assistant unit managers and a member of the care staff. People we spoke with confirmed that their care and support was delivered in line with their agreed plans and that staff respected their individual preferences. One person commented: “Everything’s hunky-dory”. We saw evidence that demonstrated people were receiving appropriate care and that any concerns were identified and followed up, which meant that their health, safety and welfare were being protected.

During the visit we spoke with five people who used the service, three care staff, two assistant managers and the registered manager. Some of the people we spoke with told us about how they were involved in making decisions about their care and support. One person said that staff always involved them in discussions about their care plan, saying “every so often they go through it and update it”.

Four of the people we spoke with confirmed that their care and welfare needs were being met and made positive comments about the service. For example, one person said the staff “look after me very well. I would recommend this place to anyone”. They said that staff responded appropriately to their needs and “always get things sorted”, for example if they needed a doctor. However, other evidence did not support this. The service was not able to demonstrate that care and treatment was always planned and delivered in such a way that met people’s needs and ensured their safety and welfare. Audits and reviews were carried out but did not always show what action had been taken as a result of the findings.

The majority of the people we spoke with said that they felt safe using this service and were confident that the provider would deal appropriately with any issues. One person said the staff were “a good crew. I never hear them complaining. If they can’t do something for you they’ll ask someone else”.