A comprehensive inspection took place on 1 October 2018. The inspection was unannounced.

Bishops Lodge is a home registered to provide accommodation and personal care to a maximum of six people with learning disabilities, specialising in support for people with Prader-Willi syndrome. Prader-Willi syndrome is a rare genetic condition that causes a wide range of physical symptoms, including an excessive appetite and overeating, learning difficulties and behavioural problems. At the time of the inspection there were four people living at the service. The home was a converted house that provided accommodation for people over two floors.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the 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 remained kind and caring and had developed good relationships with people. People's privacy was respected and staff supported people to be as independent as possible.

Systems remained in place to protect people from abuse and staff received training in their responsibilities to safeguard people. Risks relating to people's care were reduced as the provider assessed and managed risks effectively.

People were supported with their nutritional needs by staff who had very good knowledge of the additional considerations needed to manage this prominent symptom of Prader-Willi syndrome. Adaptions had been made to the premises to ensure that peoples safety with their syndrome was protected.

People's medicines were managed safely by staff. People were supported by staff who had been assessed as suitable to work with them. Staff had been trained effectively to have the right skills and knowledge to be able to meet people's assessed needs. Staff were supported through observations, supervisions and appraisals to help them understand their role. The provider had ensured that there were enough staff to care for people.

People continued to receive care in line with the Mental Capacity Act 2005 and staff received training on the Act to help them understand their responsibilities in relation to it. People’s capacity to make decisions had been carefully assessed. 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’s needs continued to be assessed and person-centred care plans were developed, to identify what care and support was required. People received personalised care that was responsive to their needs.

People were encouraged to live healthy lives and received food of their choice. People received support with their day to day healthcare needs.

People were informed of how to complain and the provider responded to complaints appropriately. The provider communicated openly with people and staff. Staff worked closely with professionals and outside agencies to ensure joined up support.

People and staff spoke highly of the leadership of the service. Quality assurance and information governance systems remained in place to monitor the quality and safety of the service. Staff worked well together and were aware of their roles and responsibilities.

Managers and staff learnt from feedback and took action to improve service delivery following incidents, accidents and audits.

Further information is in the detailed findings b

This inspection took place on 11 February 2016. This inspection was unannounced.

This location is registered to provide accommodation and personal care to a maximum of six people with learning disabilities. Six people lived at the service at the time of our inspection. People who lived at the service were adults with learning disabilities. We talked directly with people and used observations to better understand people's needs.

The home 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.

Staffing levels were adequate and were flexibly deployed to ensure people received appropriate support at all times to meet their individual needs.

Staff were trained in how to protect people from abuse and harm. Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns.

Risk assessments were centred on the needs of the individual. Each risk assessment included clear control measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Risk assessments took account of people’s right to make their own decisions.

Accidents and incidents were recorded and monitored to identify how the risks of reoccurrence could be reduced. There were safe recruitment procedures in place which included the checking of references.

Medicines were stored and administered safely and correctly. Staff were trained in the safe administration of medicines.

The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff had received training in the MCA and how to implement this in practice. DoLS were not required for people at the service.

Staff received on-going training and supervision to monitor their performance and professional development. The registered manager had ensured that staff had access to different training methods used effectively met their learning needs.

Staff responded to people’s individual needs and supported people to meet their individual goals and aspirations. People’s care plans had not been regularly reviewed to ensure they were up-to-date and met people’s individual preferences and needs.

The provider had obtained people’s feedback about the service. They had evaluated the feedback and recorded their actions in response to this feedback to improve the service.

Staff supported people to have meals that met their needs and choices. Staff knew about and provided for people’s dietary preferences and needs.

Staff communicated effectively with people, responded to their needs promptly, and treated people with kindness and respect. People’s privacy was respected and people were assisted in a way that respected their dignity.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People were provided with accessible information about how to make a complaint and received staff support to make their views and wishes known.

There were audit processes in place to monitor the quality of the service and promote continuous service improvements.

There was an open culture where staff put people at the centre of their care and support. Staff held a clear set of values based on respect for people, ensuring people could make choices and have support to be as independent as possible.

We spoke with five of the six people living in the home. People told us that they liked living at Bishops Lodge. They said that their keyworkers helped them to make plans to do the things they wanted to do.

One person told us, “We are kept busy with activities, we have plenty to do during the day and we like to chill out in the evenings.” People told us that they had recently had their Christmas party and they had all thoroughly enjoyed it. One person told us, “There was a travelling pantomime, it was very good.”

We found that care plans were comprehensive and clearly documented the needs of people and how they should be met. Staff ensured that consent was obtained prior to providing care and support. Specialist advice and support was obtained to meet people's individual needs. There were safe systems in place for the management of medication.

The home had a robust recruitment procedure in place to ensure that they employed suitable staff to work in the home. There were detailed systems to ensure that the quality of care provided was monitored and reviewed on a regular basis.

We spoke with all of the people living in the home. People said that they met regularly with their key workers to discuss their care plans. People knew how to make complaints. One person said, “I have no complaints. If I raise an issue it’s sorted.”

People said that they liked their rooms. One person said, “We decided not to have a smoking room, so anyone who smokes now goes outside.” People were asked if this was working well and they said it was.

We observed staff interacting positively with people. Where appropriate, specialist advice and support was obtained to meet people’s needs.

There were sufficient numbers of staff on duty and staff told us they felt well supported. Staff were clear about what they should do if they suspected abuse.