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Bowland Lodge Requires improvement

Reports


Inspection carried out on 5 March 2019

During a routine inspection

About the service: Bowland Lodge provides care and accommodation for up to 36 people. There were 27 people using the service during our inspection. People who used the service had enduring mental health needs or dementia type conditions.

People’s experience of using this service: Improvements had been made since our last inspection with regards to fire safety and the premises. A new snack kitchen had been built, which when open, would be available for people and relatives to use. A hydration station had been introduced. People were able to access drinks when they wanted. A new entry gate had been fitted at the bottom of the drive. Further work was being carried out to ensure the security of the garden, so people could access the garden safely.

There were structures and systems in place to support people’s health and wellbeing, such as helping them reduce their alcohol intake. However, some people told us they would prefer to live at home without the organised supervision and therefore their answers to our questions were not as positive as others.

People received individualised care, however, further action was required to ensure that care plans reflected people’s needs and identified risks. There was an activities programme in place. People were supported to access the local community.

The management and governance of the service had been strengthened. Audits and checks were carried out on all aspects of the home. These however, had not identified the issues with the maintenance of records. In addition, the systems and changes which had been introduced, were still in the process of becoming embedded into practice.

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

Rating at last inspection: Inadequate (previous report published 28 January 2019). We identified multiple breaches of the regulations. We took urgent enforcement action and placed conditions upon the provider's registration, including the suspension of admissions. We asked the provider to complete an action plan to show what they would do and by when to improve.

This service has been in Special Measures. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

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

Enforcement: We identified a breach in relation to 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 also meet with the registered manager and provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Inspection carried out on 24 September 2018

During a routine inspection

Bowland Lodge 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. The home accommodates up to 36 people in one building. There were 33 people using the service during our inspection. People who used the service had enduring mental health needs or dementia type conditions.

The home consists of two large three storey Victorian semi-detached houses joined together. The provider had used the land behind the home and built a new care home extension. Staff told us this had been built for a number of years but it was not fully completed. Therefore, it was not in use and the provider had not applied to us to vary their conditions and add an extra number of places.

This inspection took place on 24 September 2018 and was unannounced. We carried out two further announced visits on 3 and 9 October 2018 to complete the inspection.

At our last inspection in December 2017, we identified three breaches of the regulations. These related to safe care and treatment, premises and equipment and good governance. Risks to people had not been fully mitigated. Water temperatures exceeded recommended limits and there were concerns regarding infection control. The home had not been adapted to meet the needs of people with dementia type conditions and the provider did not have any monitoring or oversight arrangements in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of people.

Following our inspection, the registered manager sent us an action plan which stated what actions they were going to take to improve and meet the regulations.

We brought forward our planned inspection because we had received several anonymous concerns about the environment, staff conduct and a dangerous dog on the premises. Concerns about the environment were corroborated during the inspection; however, no concerns were identified regarding staff conduct. The registered manager brought in their puppy who was a Cockapoo. He was very friendly and people appreciated seeing him.

There was a registered manager in post at the time of our inspection. 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.

At the inspection, we found that action had been taken to address some of the issues identified at the previous inspection. A representative of the provider now carried out finance audits and special valves had been fitted to limit water temperatures. However, we found continued and new shortfalls and omissions with certain aspects of the service.

Systems for ensuring the premises were safe and clean were not effective. The provider had not fully checked and addressed all the shortfalls identified by Tyne and Wear Fire and Rescue Service on 14 June 2018. Not all window restrictors conformed to the Health and Safety Executive guidelines because they could be overridden. Fixtures and fittings were not always well maintained and due to damage, some areas could not easily be cleaned. Following our inspection, the registered manager wrote to us and stated that these issues had been addressed. She explained that all issues raised by Tyne and Wear Fire and Rescue Service had been checked and action taken where required. She stated that the fire alarm system and risk assessment already met the required regulations and no further action was required.

Risks to people’s safety were not fully assessed and staff did not always have access to written plans of care relating to meeting the needs of people who displayed behaviour which the service found challenging,

There were shortfal

Inspection carried out on 6 December 2017

During a routine inspection

This inspection took place on 6, 7 and 19 December 2017. We visited the home on 6 and 7 December and contacted relatives and other professionals for their views of the service on 19 December 2017. The inspection was unannounced.

At our last inspection in 2015 we found the provider was not meeting the requirements of Regulation 9 of the Health and Social Care Act Regulations 2014 - Person-centred care. They had not always carried out an assessment of the needs and preferences for the care and treatment of people; and had not always designed their care and treatment in line with such needs and preferences. During this inspection we found improvements had been made in this area.

During this inspection we found breaches of Regulations 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not done all that was reasonably practicable to mitigate risks to people including responding to high water temperatures and ensuring the cleanliness of the home. The home had not been adapted to meet the needs of people with dementia type conditions. The provider did not have any monitoring or oversight arrangements in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users.

Bowland Lodge 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. The home accommodates up to 36 people in one building. There were 30 people using the service during our inspection. People who used the service had enduring mental health needs or dementia type conditions.

There was a registered manager in post at the time of our inspection. 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.

Before the current registered manager came into post people who used the service had been the victims of theft in the home. Lessons had been learnt by the current registered manager who developed new systems to prevent thefts happening again. However, the provider failed to carry out reasonable checks to ensure people’s finances were being managed correctly.

The registered manager had arrangements in place to monitor the effectiveness of the service. We found the provider failed to have oversight of these arrangements to ensure improvements were made to the service.

We checked on records of health and safety checks. Whilst staff were given guidance on bathing temperatures for people we found people who used the service had access to basins where the water temperatures were in excess of those recommended by the Health and Safety Executive to minimise the risk of scalding. A plumber was called to the service during our inspection to assess the situation.

We found cleaning took place in the home, however due to the condition of some of the equipment and flooring cleaning could not be carried out to an acceptable standard to reduce the risks of cross infection.

Some people who used the service were living with dementia type conditions. We found the home had not been adapted to meet people’s needs. People could not access the garden independently as there were no front gates to ensure people could be kept safe.

We found window frames which had rotted and some windows could not be opened. The registered manager showed us an email from a builder who having received a payment from the provider was preparing to start work on the windows.

The service had appropriate systems in place to protect people from harm. Staff were trained in how to safeguard vulnerable adults and told us they felt ab

Inspection carried out on 28 and 29 July 2015

During a routine inspection

This inspection took place on 28 and 29 July 2015 and was unannounced.

We last inspected this service in September 2014. At that inspection we found the service was meeting all its legal requirements.

Bowland Lodge is a residential care home for adults and older people, some of whom may have a dementia-related condition and others with alcohol-related conditions. It does not provide nursing care. It has 36 beds and had 30 people living there at the time of this inspection.

The service did not have 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. The current manager told us they were in the process of applying to be registered as manager.

People told us they felt safe and well-protected in the home. Staff had been trained in recognising and responding to any suspicions of abuse. Safeguarding issues were reported promptly to the appropriate authorities.

Risks to people were assessed and actions taken to minimise the possibility of people coming to harm.

There were sufficient staff to meet the needs of people promptly and safely. All new staff were properly vetted to make sure they were fit to work with vulnerable people.

People’s medicines were safely managed.

Staff were experienced and skilled, and understood people’s various needs. People told us the staff met their needs effectively.

The staff team was well-trained and was given good support, in terms of supervision and appraisal.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. Staff had been trained in this important area and were aware of their responsibilities regarding protecting people’s rights.

People were asked to give their written consent to their plan of care, and told us staff members always asked for their verbal permission before carrying out any care tasks or other interventions.

People’s nutritional needs were assessed. If a person needed a special diet this was provided. People were given good choice regarding their meals and their personal preferences were known and respected. They told us the food was very good.

People told us the staff were always exceptionally caring in their approach, and protected their privacy and dignity. People said they were treated with sensitivity, compassion and respect at all times and were helped to make their own decisions and remain as independent as possible. Professionals told us they were highly impressed with the caring nature of the manager, staff team and service as a whole. They told us many people with long-term, complex needs had benefitted significantly from the therapeutic nature of the service and that staff established very positive relationships with people who had previously had been withdrawn and uncommunicative.

Staff involved people in assessing their needs and in deciding how those needs were best met. People’s wishes and preferences about their care were known to staff and were acted upon. Regular reviews of people’s care took place, to give them the opportunity to comment on their care.

Activities and entertainment was arranged to give people social stimulation and avoid the risks of social isolation. People were supported to use local community facilities.

Few complaints were received, but any concerns expressed were taken very seriously by the service and resolved to the satisfaction of the person, wherever possible.

The service worked well with other professionals and services to ensure people received the care they needed, in the ways that they wanted. Professionals were complimentary about the attitude and skills of the staff team.

The service was well-managed. The manager was new in post but had gained the respect of people living in the home and of the staff team. The manager demonstrated good values and was working hard to improve the service in all areas. The service was open to suggestions for improvements and regularly asked people for their views about their care.

Although staff were aware of people’s needs and how to meet them, some people’s care plans did not fully reflect this. Care plans were not always updated to reflect changes in people’s needs and preferences. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 5, 12 September 2014

During an inspection in response to concerns

In this report the name of a registered manager appears who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We carried out this inspection in response to anonymous concerns received that the home did not have sufficient staff to meet the care needs of the people living there.

We spoke with staff and people living in the home, checked with the local authority safeguarding and commissioning teams and looked at staff records.

We found the home was being staffed at an appropriate level and that people's needs were being met. We found suitable arrangements were in place for determining the necessary level of staffing to meet people's needs, and found that the home was routinely staffed to meet those needs. We found that appropriate arrangements were in place for covering staff sickness.

We also looked at outstanding areas of non-compliance from the previous inspection in June 2014. We found that significant improvements had taken place in the cleanliness of the home and in the arrangements to prevent infection, and that people now lived in a clean and hygienic environment.

We also found that all the issues of poor maintenance and lack of repair to the facilities and the fabric of the building identified at the previous inspection had been addressed. This meant people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

Inspection carried out on 24 June 2014

During an inspection looking at part of the service

In this report the name of a registered manager appears who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We carried out this inspection to check that areas of non-compliance identified at our last inspection had been addressed.

We found that people living in the home were now being given the necessary information about what they were being required to pay towards their care, and what services they could expect in return for their fees. This included information about how their benefits were calculated. People who were privately funded had been issued with appropriate contracts. This meant people were clear what they were responsible for paying towards their care.

We found that people living in the home had also been given written information about their financial benefits, including the amount of �personal allowance� (pocket money) they were entitled to each week. We saw improvements to how such personal allowances were recorded and accounted for, with better book-keeping and evidence of any purchases made on a person�s behalf. This meant people were being given improved protection against the risk of financial abuse.

We saw that there was a greater awareness that significant events needed to be reported to the appropriate authorities, including the Care Quality Commission. We saw appropriate arrangements were now in place to make sure such events were reported promptly.

In addition, we looked around the building. We found the home had not been well maintained and had many areas of neglect and disrepair. Some of these issues posed risks to the safety of people living in the home and to staff and visitors. Other issues involved inadequate cleaning resources and inappropriate furnishings that were difficult to keep clean. This had resulted in cleanliness and odour problems in some areas of the home and the risk of cross-infection. We have asked the provider to tell us how they will address these issues. We were told the necessary resources have already been made available, and that remedial work had already started.

Inspection carried out on 9 April 2014

During a routine inspection

We considered our inspection findings to answer questions we always ask;

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well-led?

Below is a summary of what we found.

Is the service safe?

People were cared for in a safe environment. Equipment at the home had been well maintained and serviced regularly. People�s needs had been assessed and their care was planned to meet their needs. There were enough staff on duty to meet the assessed needs of the people living at the home, and staff were experienced and skilful in meeting those needs. People living in the home were treated as individuals. Staff were encouraged to take up all training opportunities, but did not always have access to systems to keep fully up to date with their training needs. Staff were alert to any signs of abuse and were trained to report any concerns. People we spoke with told us they felt safe in the home. The provider had failed to make suitable arrangements to prevent the possibility of financial abuse in that the the provider had not given people a clear written statement of what levels of personal allowances they were entitled to receive.

Is the service effective?

Care records showed most people�s health and well-being had improved since coming into the home, and most people we spoke with confirmed they felt well cared for. Chronic health conditions were managed appropriately and people were properly nourished. Appropriate referrals for specialist professional assistance were made, and advice and guidance followed by staff. This resulted in improvements in people's independence and a reduction in behaviours that caused distress to the person, or others around them. We saw comments in a survey carried out by the home in 2013 included, �Bowland Lodge is an excellent home with a good care team and management team� (from a visiting professional) and, �We cannot recommend Bowland Lodge highly enough� (from a relative).

Is the service caring?

People told us they were happy with the care and support they received, and had no complaints. Most people said they were settled and contented in the home. They all spoke highly of the manager and staff. People�s comments included, �We�ve got no problems, here�; �The staff are fine � they treat you well�; �I like it here�; and, �I�m settled.� No one told us they had any worries about their care, and all those we asked said they knew how to raise any concerns they might have. We saw that staff were kind, attentive, and knew their residents well. The atmosphere in the home was relaxed and calm, and people said they felt free to come and go as they wished. Relatives and visiting professional had made positive comments about the care in the home in a recent survey.

Is the service responsive?

No one told us they had any worries about their care, and all those we asked said they knew how to raise any concerns they might have. The manager operated an �open door� policy to people living in the home, and we saw she responded promptly and with great care and sensitivity to people�s comments and requests. This meant any possible complaints were dealt with swiftly and informally, and people felt listened to. Staff knew people�s personal preferences and worked proactively to meet their wishes. An annual survey was carried out of the views of people living in the home, their relatives and representatives, and of visiting professionals. We noted the manager responded positively to any issues raised.

Is the service well-led?

Staff members told us they felt involved and supported by the manager in their work, and told us they took pride in their caring duties. Staff were clear about their roles and what was expected of them. They received regular supervision and appraisal of their work and told us they felt valued. The manager set a clear example for good values, good care and encouraged her staff to contribute ideas for improving practice in the home. Since recently taking up her post as manager, she had kept CQC informed of all significant events. However, prior to her being appointed as manager, the provider had failed to notify CQC of a significant event relating to the previous manager. We also found that people�s fees and levels of personal contributions to those fees had not been clearly set down in writing by the provider. Compliance actions have been set in relation to these two issues and the provider must tell us how they intend to improve.

Inspection carried out on 11 September 2013

During an inspection in response to concerns

We carried out this inspection in response to anonymous concerns we received. These concerns related to the storage of food, staffing levels, and safe recruitment of staff.

We found that food was being used within its 'use by' dates, although labelling was not always consistent.

We found there were enough staff to meet the assessed needs of the people living in the home, and there were appropriate systems in place for covering staff sickness.

We found the home was carrying out appropriate checks before employing new staff.

Inspection carried out on 24 July 2013

During an inspection looking at part of the service

At our last inspection of Bowland Lodge in May 2013 we found problems with cleanliness and infection control, and with staffing levels at certain times of the day.

This was a 'follow up' inspection to check that the provider had carried out the necessary actions to become compliant in these areas.

We found that the kitchen had been properly cleaned and that kitchen cleaning schedules were being closely monitored.

The availability and accessibility of protective clothing such as disposable gloves and aprons had been improved in toilets and bathrooms, and, where assessed as being necessary, in people's bedrooms. Paper towel and liquid soap dispensers were being kept stocked.

Better use of staff at peak times such as meal times meant that more staff were available to meet people's needs, and their mealtime experiences were improved.

Inspection carried out on 17, 20 May 2013

During a routine inspection

Before anyone was admitted to the home, their needs were carefully assessed by their social worker and by the home manager, to make sure that the home could meet all their needs. If it could, then care plans were drawn up to guide staff on how to meet those assessed needs.

People told us they were happy living in the home. They said they were well cared for and were treated with respect by the staff. One person told us, "I like living here"; another said, "I'm very well looked after, indeed. It's alright, here." Visiting healthcare professionals confirmed that the quality of the care was good.

There was a risk of cross-infection due to the lack of protective clothing available to staff in bedrooms, bathrooms and toilets.

There were concerns that the kitchen cleaning schedules were not effective in maintaining adequate levels of cleanliness and hygiene.

Appropriate arrangements were in place to manage medicines.

The home had appropriate processes in place to make sure that unsuitable people were not employed as members of staff.

There were enough staff to meet people's needs, except at meal times.

Inspection carried out on 19 June 2012

During a routine inspection

Those people able to express their opinions told us that they felt they were well cared for in the home. They said they were encouraged to be as independent as possible, and were given plenty of choice in their daily lives.

People said they were treated with respect by the staff, and that their privacy and dignity was respected. They said they felt safe in the home, and were confident they could tell the staff of any concerns they might have. People told us the manager and staff listened to what they had to say and acted upon their views.

Comments included, ��I like it here. I�m well settled. The staff are OK�;

�We�re well looked after. The staff are very caring. There�s nothing I don�t like�;

�I like the girls [staff], and the manager is very nice�.

Visiting professionals told us the home provides very good standards of care. They said the staff were very caring and were knowledgeable about the needs of the people living there. They said they had seen nothing to cause them any concerns about the care and safety of residents. They told us the home was well managed, and that the manager and staff were very approachable, and followed professional advice.

Comments included, �The staff at Bowland are extremely caring, and they know their residents very well�;

�I have no issues at all with the care � it�s very good�;

�The home is good at informing us of any issues and we have generally very positive relations with the home�;

�I have seen nothing that has caused me concern in the home�; and

�Bowland is not an easy home to run, but the manager does a really good job�

Inspection carried out on 15 July 2011

During an inspection in response to concerns

We were told that there were concerns that the siting of a pool table in a lounge used by very dependant people might lead to physical injury to them.

Reports under our old system of regulation (including those from before CQC was created)