Bishop Herbert House 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.

Bishop Herbert House is registered to provide care and support for up to 14 adults with physical disabilities, some of whom may reside there on a respite basis. At the time of our unannounced inspection there were 14 people who used the service.

At our last inspection on 2 February 2016, we rated the service overall Good. The key questions Safe, Effective, Caring, Responsive and Well Led were rated good.

At this unannounced inspection on 8 October 2018, we found the evidence continued to support the overall rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff understood their roles and responsibilities in keeping people safe. They were trained and supported to meet people’s needs. Staff were available when people needed assistance and had been recruited safely.

Staff had developed good relationships with people. Staff consistently protected people’s privacy and dignity and promoted their independence.

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.

People continued to receive care that was personalised and responsive to their needs. They participated in meaningful activities and were supported to pursue their interests and hobbies. The service listened to people’s experiences, concerns and complaints and acted where needed.

People were enabled to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and access to healthcare services.

The management team were passionate and committed to delivering high quality care and support to people. They were accessible, supportive and had good leadership skills. Staff were aware of the values of the provider and understood their roles and responsibilities. Morale was good within the workforce.

Systems were in place to receive, record, store and administer medicines safely. Where people required assistance to take their medicines there were arrangements in place to provide this support safely.

The design and layout of the building was hazard free and met the needs of people who lived there. All areas of the home were clean and in a good state of repair with equipment maintained. Systems were in place to minimise the risks to people, including from abuse, accessing the community and with their medicines.

A system of audits ensured the provider had oversight of the quality and safety of the service and shortfalls were identified and addressed. There was a culture of listening to people and positively learning from events so similar incidents were not repeated. As a result, the quality of the service continued to develop.

This inspection took place on 2 and 3 February 2016 and was unannounced. At the last inspection on 25 June 2014 the service was meeting the legal requirements.

Bishop Herbert House is a service that provides accommodation for up to 14 people. It offers residential care for adults with a physical disability. On the day of our inspection nine people were permanently living in the service and five were on respite.

The service had a registered manager in post. 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 living in the service were safe and benefited from the support of sufficient numbers of staff, who were well trained, supported and felt valued in their work.

Staff and the management team understood their responsibilities in safeguarding people from harm. When appropriate they contacted the local authority to report concerns. The home knew how to support people’s needs without restricting their freedom.

Appropriate recruitment procedures were followed and pre-employment checks were carried out to ensure staff were suitable to work with people receiving care and support.

Medicines were managed and administered safely in the home and people received their medicines as the prescriber had intended.

Staff were skilled and motivated to support and care for people. Staff also knew people and their needs well. New members of staff completed an induction and all staff received appropriate training and were supported well by the manager.

The Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The manager told us that all people living in the home had capacity to make decisions for themselves. However, the manager and staff were knowledgeable about the MCA and DoLS and knew what to do if there was some doubt about a person’s capacity.

People had enough to eat and drink and the cook provided good quality food and catered for individual preferences. People also had access to local shops and had food and drinks in their rooms if they wanted.

People had regular access to healthcare professionals and were supported to attend appointments if needed.

All staff at the service were caring and supportive and treated people as individuals. The care provided was sensitive and person centred and people’s privacy, dignity and wishes were consistently respected. Friends and relatives were welcome to visit as and when they wished and people were supported to be as independent as possible.

People were happy living in Bishop Herbert House and their interests and aspirations were encouraged and supported by staff. There was a positive atmosphere in the service and people had access to the community. Assessments were completed prior to people moving into the home, to ensure their placement would be appropriate for them and would meet their needs. People were also involved in planning their care and were supported to live the life they wanted to.

There was an open and positive culture at Bishop Herbert House. People using the service and their relatives were given opportunities to raise issues about the quality of the care provided and knew how to make a complaint if needed. People’s comments were listened to, with appropriate responses and action was taken where possible.

The service was being well run and people’s needs were being met appropriately. The manager was approachable and communication between the manager and staff was frequent and effective.

There were a number of systems in place to ensure the quality of the service was regularly monitored and maintained. The manager carried out regular audits to identify an

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with two people who used the service, the registered manager and with two members of staff. We reviewed records relating to the management of the home which included, four care plans, daily care records, training records, staff recruitment records, quality surveys and audits.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

During our inspection we spoke with two people who used the service. They told us that they were happy with the care and support provided. One person told us they felt very safe and added, "If I felt something was wrong or someone else was unhappy, I would tell one of the staff or the manager."

We looked at four sets of care records which included individual risk assessments. Measures had been put in place to minimise any risks to people who used the service that ensured they were supported safely. For example, risk assessments were in place to ensure that the environment in which care was provided was safe, that any risk of malnutrition was assessed and managed and that the risks of acquiring pressure ulcers were also managed.

People who used the service were asked whether they felt safe and secure in an annual quality survey. 67% said that they strongly agreed with the statement, 33% agreed, a completely positive response

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care services. While no applications had needed to be submitted, policies and procedures were in place and under review. Relevant staff had been trained to understand when an application might be necessary and how to submit one.

Is the service effective?

People who used the service were treated with dignity and respect. They were supported in making choices. For example, what they wanted to wear or when they chose to go out. One person we spoke with said, "This is my home, I have plenty of choice in what I want to do and what to eat. I can come and go as I please, I just make sure I tell staff when I go out and when I will be back. I wouldn't want to be anywhere else."

Where people found it difficult to make choices for themselves, staff supported them in making decisions based on best interest principles. People we spoke with told us that staff discussed their care plans with them at least once a month.

Quality assurance measures were in place to identify the effectiveness of the service. This included questionnaires given to people who used the service, relatives and staff. We saw the results of a recent quality survey which showed that people who used the service and their relatives thought the service was effective.

Is the service caring?

We saw that people were cared for in an appropriate manner. Records we looked at showed that people’s needs had been assessed and details of likes, dislikes, routines and preferences were recorded.

During our inspection we spoke with two people who used the service. People we spoke with who used the service were happy with the care and treatment they received. One person said to us, “I am very well looked after, the care staff are excellent and it's not an easy job."

Is the service responsive?

The four sets of care records we looked at showed that people's needs, choices and personal preferences had been assessed and planned for. Records we looked at during our inspection detailed the needs of each person and their individuality.

People’s health and social care needs were attended to. Information was available to staff about individual medical conditions to ensure that staff had up to date knowledge and were able to respond to the person’s needs.

Is the service well-led?

There were monitoring and reviewing systems in place to ensure that the quality of the care and support provided was high. We spoke with two members of staff who told us that they had the training and support they needed to safely do their job, which they said they enjoyed.

Members of staff and family members of people who used the service were provided with opportunities to make suggestions and comments to improve the quality of people’s support and care. The staff we spoke to spoke highly of the manager and told us that they felt able to approach them with any problems or suggested improvements.

We observed that staff were attentive to people’s needs and treated them with respect and dignity, calling them by their name. We saw that staff sought people’s agreement before providing any support and assistance.

We saw that staff were knowledgeable about people’s needs and promoted their independence. During our discussions with staff we found that they had a good understanding and awareness of people’s care needs and preferences. One person told us "The staff are very good, I sometimes need help with eating and drinking and the staff provide me with that assistance when I ask for it."

We saw that the building was comfortable, clean and well maintained. We saw that equipment had been checked and serviced within expected timescales.

We saw that staff were considerate of people who were living in this home. They were able to respond to people's body language and limited verbal communication where their needs were more complex. We found that people's decisions and choices were respected and that the planning of their care was developed with them and reviewed with them on a regular basis. We were told that staff were kind and respected people's privacy.

We were satisfied that suitable arrangements were in place regarding medicines and that enough staff with appropriate skills were on duty at any one time.

One person who had received respite care at Bishop Herbert House said "All care is good and staff became friends"

Another person told us "The wellbeing of other residents and staff is important to me"

People we spoke with said that if they weren't happy about something that they would raise it with their key worker or the manager and one person said that they may prefer to do so in writing.