Bowland Lodge

Updated 9 March 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

This was a targeted inspection to check people were receiving safe care and treatment after we received concerns about infection control, medicines management, safeguarding, the assessment of risk and the overall governance of the service

Inspection team

The inspection was carried out by 2 inspectors, a medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Bowland Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Bowland Lodge is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection the registered manager had left their employment and applied to CQC to deregister. A new manager had been in post for just over 2 weeks. They planned to apply to register with CQC once the necessary DBS application had been received.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we held about the service, including the statutory notifications we had received from the provider. Statutory notifications are reports about changes, events or incidents the provider is legally obliged to send to us. We contacted the local authority commissioning and safeguarding teams, the Integrated Care Board [ICB], the local NHS infection prevention and control team, fire service and Healthwatch to request feedback. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

We spoke with 9 people who used the service about their experience of the care provided. We spoke with 8 members of staff including the manager, deputy manager, senior staff, care staff, kitchen assistant and domestic staff.

We reviewed a range of records, this included care documentation for 9 people and multiple medicines records. We looked at a variety of records relating to the management of the service, including policies and procedures. We also received feedback from 2 visiting professionals.

Following the inspection site visits we requested additional information by email and continued to seek clarification from the provider to validate the evidence we found.

Updated 9 March 2024

About the service

Bowland Lodge is a residential care home providing accommodation for up to 36 people who require personal care. The service provides support to people living with mental health conditions and dementia. At the time of our inspection there were 26 people using the service. The registered manager told us that 25 people received personal care. This meant that 25 people received the CQC regulated service of both accommodation and personal care.

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

A system to ensure regulatory requirements were met was not in place. The provider had not implemented robust governance procedures to improve the quality and safety of the service. The provider has been in breach of the regulations since 2015 and sustained improvements have not been made. Whilst action had been taken to improve in certain areas since our last inspection, additional shortfalls were identified which had been raised at previous inspections. There was a lack of evidence that lessons had been learned following each inspection to ensure a robust and effective system was in place to improve the management of risk.

We identified shortfalls with the assessment of risk relating to people’s care and support, the cleanliness and maintenance of the premises, including the outdoor space, fire safety and infection control including food hygiene. Risks relating to eating and drinking, including allergy information, had not always been fully assessed. The refurbishment plan discussed at our previous inspections was still ongoing.

Records did not always evidence that safe recruitment procedures were followed. An effective system to manage medicines was not fully in place.

Action had been taken to improve care planning. However, further improvements were required to ensure care plans and risk assessments reflected people’s needs.

We observed positive interactions between people and staff. However, due to the concerns identified during the inspection, we could not be assured people received a high quality, compassionate and caring service. In addition, the environment, furnishings and cleanliness did not promote people’s privacy, dignity and wellbeing.

There was a safeguarding system in place. However, we had not been notified of one safeguarding allegation in a timely manner. Following our last inspection, the local authority had placed the home into 'organisational safeguarding.’ This meant the local authority was monitoring the home and supporting them.

There were enough staff deployed to meet people’s needs. An activities coordinator had been recruited since our last inspection and an administrator was now in post.

A staff support and training system was in place. Additional training had been carried out since our previous inspection. Staff spoke positively about the support they were receiving from the registered manager.

Staff had been liaising with the local integrated care board with regards to training. They had also worked with health and social care professionals regarding people’s care and support.

Improvements had been made in relation to meeting people’s social needs. An activities programme was in place. People were supported to access the local community and take part in activities which interested them such as arts and crafts. An entertainer visited on our 2nd visit which people enjoyed.

The registered manager gave us examples of how being at the service, with the support of staff, had led to an improvement in people's independence and wellbeing. They also explained how several people had moved onto independent living.

Following our feedback, the registered manager wrote to us and explained that action had/was being taken to address the shortfalls identified and new systems/records had been implemented.

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 inadequate (published 21 March 2023). There were 5 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment; person-centred care, need for consent; good governance and duty of candour. We also identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009; notification of other incidents.

Whilst action had been taken to improve in certain areas, not enough action had been taken and the provider remained in breach of the regulations relating to safe care and treatment and good governance. We also identified a new breach in relation to the premises and equipment.

This is the 2nd consecutive time the service has been rated inadequate and the 3rd time it has been rated inadequate overall since 2018. The service has been rated requires improvement 3 times since 2017.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Enforcement and Recommendations

We identified 2 continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment and good governance. We also identified a new breach in relation to the premises and equipment.

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

The overall rating for this service remains ‘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 the 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.