Archived: Bows

Bows is a residential care home providing accommodation for up to 5 people who require nursing or personal care. The service provides support to adults under 65 years and people who have a learning disability and/or Autism. At the time of our inspection there were 5 people using the service.

People had their own rooms and the use of communal rooms, such as a lounge, kitchen, sensory room and dining area. There was a large garden to the rear of the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance the Care Quality Commission (CQC) follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

Risks to people’s safety were not always managed safely and we observed staff not always following risk management plans. This placed people at risk of harm. People were not supported to engage in their social interests and there was limited opportunity for people to access their local community and services. Staff were not encouraging or supporting people to achieve their goals.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not support this practice.

People’s medicines were not managed safely.

Staff had been recruited safely and recruitment at the service was ongoing.

Right Care

People’s care was not person-centred and there was no evidence people had been involved in making decisions about their care. People’s known communication methods were not always used by staff to communicate with people.

People’s activity plans were not being used by staff to make sure people were occupied or engaged. People were not encouraged to carry out activities of daily living to maintain and develop skills.

There were not always enough staff available to support people in line with their funded care hours. This meant people were not able to go out at times as there were not enough staff on duty.

Right Culture

Changes in management had impacted on service delivery. There had been no leadership to guide and mentor staff to provide person-centred care. The service was easily identified as a care home from the road. There was a big banner on the fence advertising to the public the service was hiring staff. There were large industrial bins by the front gates and the front of the building had a sign with the providers name visible. This was not in line with the guidance Right Support, Right Care, Right Culture.

Safeguarding incidents had not always been reported to the local authority which placed people at risk of harm. Incidents and accidents had not been managed to make sure actions were taken to prevent reoccurrence. CQC had not been notified of significant incidents and events as required by law. Quality monitoring systems were not effective in identifying and driving improvement at this service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 12 August 2022) and there were 3 breaches of Regulations. 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 the provider remained in breach of regulations.

Why we inspected

This inspection was prompted in part due to concerns received about low staffing numbers which was preventing people from going out into the community, 1 person’s seizure not being managed safely and poor maintenance in bathrooms. We found evidence to substantiate some of the concerns received.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, medicines management, person-centred care, safeguarding and good governance at this inspection.

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.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 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.

Bows is a residential care home providing personal care to five people at the time of the inspection. The service can support up to five people.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

The service did not make sure people received support in a safe and hygienic environment. Refurbishment work was needed in the kitchen and bathroom to ensure infection prevention and control measures were effective. Staff did not always follow the provider’s infection control policy regarding nail varnish and extensions. This increased the risk that people would be harmed as a result of poor infection control practices.

Risk management plans regarding staffing levels were not always clear, up to date or followed. This increased the risk that people may not receive the support they needed.

People received the support they needed to take any medicines they had been prescribed. The registered manager had worked with people’s medical team to reduce medicines they were prescribed where appropriate.

Right Care

A relative told us they felt there were occasions when their relative had not been safe, following concerns about the way the person had been treated. The relative was confident the provider had taken the right action to keep people safe in response to the concerns.

We used a symbol-based communication tool with two people, who both indicated they were happy with, or liked living at Bows. Three other relatives told us they were happy with the support provided and were confident their relative was safe.

Right culture

Our observations and feedback from staff demonstrated a restrictive, task-focused culture; people were not supported in a person-centred way.

The home’s lounge was used for staff to sleep in from 10pm, which restricted people from using all of their home. A member of staff told us it was ‘staff choice’ whether they stayed up after 10pm to support people to use the lounge.

We observed staff working in ways that did not respond to what people were clearly communicating to them. This included insisting people did things they were communicating they did not want to do and failing to support a person with a choice of meal they were requesting. Staff did not consistently use people’s enhanced communication systems.

The provider did not have effective systems to assess, monitor and improve the quality of the service being provided. The systems that were in place had not identified the restrictive culture in the service or that staff were working in ways that were not person-centred.

Concerns raised with us about the way a person was treated had also been raised with a senior support worker. The senior support worker had not reported the concerns to senior managers or to the local authority safeguarding team, but had waited until the registered manager had returned from leave.

People were supported to take part in activities in their community and participate in local events. The service had worked to support people in different ways during the COVID-19 pandemic when they were not able to participate in their usual activities.

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 13 September 2019).

Why we inspected

We received concerns in relation to the way people were treated and the management response to allegations of abuse. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. We have found evidence that the provider needs to make improvement.

Please see the safe and well-led sections of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches of regulations in relation to person-centred care, safe care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bows is a care home registered to provide accommodation and personal care (not nursing) for up to five people with a learning disability. At the time of the inspection five people were living in the home.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes.

The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People received kind and caring support from compassionate staff who knew them well. Staff treated people with dignity and respect. People appeared relaxed and happy in staff presence.

People were kept safe and had risk assessments reviewed regularly which also enabled them to maintain a level of independence.

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 place supported this practice.

Staff were well trained and had the right mix of skills and experience to support people’s needs. Staff had specialist training in autism, learning disabilities and challenging behaviours.

People had the opportunity to access their local community and engage in activities of their choice.

The service worked closely with health and social care professionals to ensure people had appropriate access to services.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 6 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Bows is a care home for up to five young people. The accommodation is a detached bungalow in the town of Trowbridge. Bows is home for up to five young adults with a learning disability. All of the young adults have a severe learning disability. Three of the people who live at the home go to college with staff support two mornings per week.

There was a registered manager for the service. 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 system were in place that helped minimise risk to ensure people were safe. There were enough staff to support people and take action to reduce the risks of people experiencing harm. Staff had been trained about how to provide safe care and how to protect people if they had any concerns about their wellbeing.

People were helped by staff to manage their medicines safely. People were well supported to stay healthy and to have positive relationships. Individual support plans were produced with people and their relatives involvement .Care plans were reviewed regularly to make sure they were up to date and reflected people’s current range of care and support needs.

People were supported by staff that were well trained and properly supported. Staff went on regular training courses and were developed and supported in their work. This helped them to improve and develop their skills and competencies. Staff were properly supervised to help to ensure they were competent in their work. Staff spoke positively about working as a team and the good morale that existed among them.

Staff worked hard to promote people’s independence and support them to take part in activities they enjoyed. People told us they liked going out for example to attend College and other social events. Staff were kind and caring and the interactions we saw between people and staff were warm and respectful.

The views of people and our findings were summed up through what relatives and staff told us.

Relatives told us staff knew people's needs and ensured people were treated with privacy and dignity. Staff explained how they offered people choices, this showed an understanding of how people communicated. We found staff had a wide knowledge of people's interests and abilities, which was used to support people to maintain activities relevant to them, such as attending social clubs, swimming and shopping in the local town.

Comments from relatives included: 'Bows has a lovely calm and homely feel. A real home from home. The staff are very professional and caring, I cannot praise them enough.' Another relative said 'staff ensure privacy and dignity is maintained. We are more than happy with the care and support provided and staff keep us informed of anything relevant regarding the health and welfare of our relative.' They said 'the staff are experienced and know my relative very well. I am confident any concerns would be dealt with promptly and effectively.' Another relative said 'we are delighted with the level of care and support our relative receives, they are very happy and content here, and show this by their actions when we visit them.'

Both relatives explained they had plenty of opportunities to express their views regarding the care or treatment their relative received, and they felt listened to. They also agreed the staff have a good understanding of their relative's needs and had developed effective, professional relationships.

Staff told us they were confident in their understanding of, and ability to work with people's behaviours. They were clear about their safeguarding responsibilities and how they would respond to any suspicion of abuse.

Staff told us they worked well together and regular meetings and effective handover of information between shifts ensured they were kept up to date with changes. Staff told us they enjoyed going to work. Staff told us the training they received was very good and enabled them to support people with specific healthcare needs such as epilepsy.