Archived: Bowland Lodge

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.At the last inspection we rated this key question requires improvement. At this inspection the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

We found the provider was in breach of the legal regulation relating to person centred care, consent and good governance.

This service scored 33 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them. Staff could not explain the rationale for admissions to the service. Assessments, care plans and risk assessments were not fit for purpose and did not clearly explain how staff should support people. Records did not reflect people’s current needs and, in some cases, did not align with what staff told us about people living at the service. For example, staff told us some people had a learning disability or autism, but records only identified mental health needs, making it unclear whether people had been assessed appropriately or admitted under the correct service remit. Risk assessments were either absent or inadequate. This included for risks associated with fire-setting behaviours, restrictive practices and people going missing, where there was no clear guidance for staff on how risks should be managed safely and lawfully.

The service made some efforts to deliver care and treatment in line with evidence-based practice, but this was inconsistent and not embedded. Staff did not always plan and deliver people’s care and treatment with them. They needed to ensure the support provided was always delivered in line with legislation and current evidence-based good practice and standards. People’s nutrition and hydration needs were generally met. Staff demonstrated good knowledge of people’s food preferences and people appeared to enjoy the meals provided. However, beyond this, care delivery was not consistently informed by recognised guidance or evidence-based frameworks. Staff had not received training to support people with a learning disability or autism, including the mandatory training. This meant care was not aligned with best practice or national guidance for these groups. Medicines practices also did not reflect safe or evidence-based approaches, including poor understanding of alcohol maintenance programmes.

Staff worked together and with external professionals in some areas, but poor leadership and instability limited effective coordination. Staff told us they worked well together on a day-to-day basis and were committed to providing good care. Visiting professionals reported that staff contacted them in a timely way and were generally collaborative. However, the frequent changes in management and a lack of clear leadership resulted in inconsistent care delivery and poor communication. Agency staff were not provided with adequate guidance, which contributed to serious incidents, including people going missing when being supported in the community. A professional said, “The staff always share any concerns and seek advice.”

The service had limited arrangements in place to support people to live healthier lives, and opportunities to promote wellbeing were often missed. People were not always supported to maximise their independence, choice and control. Staff supported people with basic day-to-day health needs. However, low staffing levels and a lack of meaningful activity meant people were not consistently supported to engage in activities, develop independence or access the community safely. There was no structured approach to promoting healthier lifestyles, reducing harm from addictions or supporting people to build independent living skills, despite this being an aim for some people. People relied heavily on staff availability or external agency support, which was not always safe or effective. A person said, “We don’t do anything now, we just sit here.”

The service did not have effective systems to monitor outcomes or use learning to improve the quality of care. Accidents, incidents and safeguarding concerns were not routinely reviewed to identify learning or drive improvement. Audits were either not completed or were blank templates, and those that had been completed failed to identify significant risks, including medicines management and care planning failures. There was no evidence that people’s outcomes were monitored or reviewed in a structured way to improve their care or wellbeing. Staff told us they were not encouraged to reflect on practice or raise concerns, and they did not feel confident that raising issues would lead to meaningful change. A staff member said, “Since the [partner’s son] stopped staff coming in to take people out this has had a big impact on people’s well-being. For example, 1 person is not allowed out by themself as they are on a DoLS. [Person] has not been out to the social club for a few months now which I think is a huge shame, especially when the £100 a month activity money has not been paid and would cover the couple of hours for them to go out and see their friends and family.”

The service did not make sure people’s consent to care and treatment was sought and recorded in line with legal requirements. Staff did not understand the Mental Capacity Act (MCA) and associated codes of practice. They were unable to provide capacity assessments or best interest decisions. Restrictive practices were in place, including controlling people’s money, alcohol, cigarettes and movement, without evidence of lawful decision-making or consideration of less restrictive options. Staff believed just saying it was in a person’s best interests meant they could adopt any restrictive practices. Care records did not show that people had been supported to make decisions about their care or that consent had been obtained appropriately.