Archived: Lower Bowshaw View Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service continued to be in breach of legal regulation in relation to people’s safe care and treatment. The service had taken enough action to meet the previous breaches regarding staffing and safeguarding.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The management team had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. The management team were keen to foster a culture of learning from safety concerns and incidents. Following any concerns, safeguarding, accidents and incidents, the management team completed a lessons learnt document to identify what went wrong and to improve the quality of care and risk management.

One visiting professional said, "When discussing identified concerns and issues of residents with the manager and [consultant] they understand their safeguarding role, actions needed to mitigate any further risk, and ensure they are quick to share lessons learnt with staff.Both will contact myself for advice and information where needed and are accepting of recommendations provided.Response to actions set [by the management team], for individuals and across the home are being actioned, completed and embedded.We have recently seen a number of actions being closed as a result."

The management team worked with people and healthcare partners to establish safe systems of care, in which safety was managed or monitored. Since our last inspection the management team had implemented a hospital discharge checklist to ensure there was continuity of care, including when people moved between different services. This included checking hospital discharge letters and asking relevant questions about people's care and ensuring care plans and risk assessments were updated. This process required embedding into practice. One visiting professional said, "Both the manager and [consultant] have worked with me to ensure resident safety, implemented new systems and processes, and are now embedding these.Handover documents are now in place, each shift changeover detailing relevant resident information.Sometimes information is not recorded but when bringing this to their [management team] attention, they were aware of it and had been brought it to staff attention.” Another professional said, “Over the past several months, concerns were raised regarding the accuracy and quality of documentation completed by staff and management in residents’ records. These issues were escalated appropriately and discussed with management, who acknowledged the problems and began to implement corrective actions. Initially, the service appeared to struggle with the scrutiny and the volume of work required to improve recording practices. However, in the last couple of months, I have observed a clear improvement, with management more able to action required changes and demonstrate increased organisational oversight. The improvements observed suggest strengthened internal systems for monitoring safety, validating that corrective measures are becoming embedded in practice and contributing to safer, more consistent care pathways.”

The management team worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. At the last inspection the provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that.At this inspection we found improvements had been made. The management team had a safeguarding policy and completed a record of any safeguarding concerns. This showed the management team had identified lessons learnt and made changes to practice to ensure improvements were made. Staff were knowledgeable about the safeguarding process. One staff member said, "If I suspected abuse, the first action I would take is to make sure the person is safe. Then I report it to our manager or nurse in charge and also record it. I am confident the management team would take appropriate actions and follow safeguarding procedures if not then I would go further by contacting the local police or safeguarding team." People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place, when needed, to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. At our previous inspection, the management team were unsure which people had an authorised DoLS in place and did not have an oversight about conditions attached to DoLS. At this inspection we found the management team knew who had a DoLS in place and understood any conditions attached to them. We saw evidence conditions were monitored and recorded.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risks associated with people's care were not always identified to keep people safe. Care plan documentation did not always provide clear instructions that were aligned to people’s current needs. For example, 1 person’s care plan stated bed rails were not suitable for the person and could potentially cause more risk. However, bed rails were in place on the person’s bed. On the second day of our assessment this issue had been resolved. People who required the use of a hoist, had limited information in their care plans to ensure this was carried out safely. For example, the size and type of sling to use was not always documented and loop configuration was not included in care plans we viewed. Some people required support to reposition due to being at risk of developing pressure wounds. Care plans and supporting documentation did not always show that people were repositioned in line with their assessed needs. People told us they felt safe living at the home. One person said, "I have all the equipment I need. I feel comfortable with my walker." Staff knew people well and were able to explain how they minimised risks. One staff member said, “I ensure risk assessments are completed and reviewed regularly, considering the person’s physical health, emotional wellbeing, and daily routines.”

The management team and staff detected potential risks in the care environment. They made sure equipment, and technology supported the delivery of safe care. However, the provider did not always make sure facilities were safe. For example, the passenger lift sensor was not a full-length sensor and therefore people could only use the lift safely if they were accompanied by a member of staff. Checks were carried out to monitor the safety of domestic systems, including water temperatures, emergency lighting and call bell systems. The home was purpose-built and corridors and doors were wide enough to enable people to move about safely with walking aids or wheelchairs.

The provider made sure there were enough qualified, skilled and experienced staff. However, they did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs. Communication between staff had improved but there was still room for further improvements. Staff did not always receive regular supervision sessions or annual appraisals. The manager had recognised this and put a new system in place to ensure all members of staff received supervisions and appraisals. However, nurses and senior staff assigned this task had not carried it out. The manager and consultant had identified this and recognised that the new system would need closer monitoring and review. Since our last assessment, staff training statistics had improved however, practical training for moving and handling had still not been carried out, this was due to lack of funding. The management team had started completing competency checks with staff to identify any immediate concerns. One visiting professional said, "When offered resources to evidence mitigating risks of moving and handling competency of staff, they [management team] were receptive to this and eager to implement." At our last assessment the provider could not evidence that staff had been recruited safely. At this assessment we found this had improved. Staff files were well organised and maintained. Pre-employment checks completed appropriately.

The management team assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Since our last inspection the provider had made some improvements, and we found the home was predominantly clean. However, we identified some issues which required attention. For example, we saw 1 fridge seal which was worn and dirty, and toilet brushes and holders which required attention. The management team took action to address these concerns. Staff had plentiful supplies of cleaning materials, products, and PPE available to them and we observed staff to use PPE appropriately.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Medication administration records (MARs) checked on the day of our assessment did not showanymissed dosesand stock levels were correct.When people were given an ‘as and when required’ (PRN) medicine this was clearly documented on the back of the MARchartto show why and when it had been given.However,accompanyingPRN protocols were not always in-depth andsome had incorrectdosage instructions on them which could pose a risk of staff administering the wrong dose.For doses that were variable,for example,take 1 or 2 tablets, itwasn’talways clearly documentedunder which circumstances to givewhich dose.

For people that were prescribed a patch,site rotation charts were in place to ensure staff were correctly applying these to different areas of the body.Thepatcheswere being checked daily toconfirm theyhad not fallen offthe skin and were still intact.Similarly, people that were prescribed creams had body maps in place to show staffwhereto apply these.Some creams were not applied as often as prescribed, but improvements had been made since the last inspection.

People who were prescribed thickener to be added to their food or drink, to minimise the risk of choking,had the relevant documentation in the care plans. However,staff did not always record in the daily notes when thickener had been added to drinks. As a result, we could not be assured that thickener was being used consistently and as prescribed.

Since the last inspection, the two fridges in the treatment room had clear separated temperature monitoring sheets in place. However, there were still some gaps in recording daily temperatures of the medicinal fridgeand room temperatures where medicines were stored.It was also noted that the fridge temperature had gone outside therecommended range with no escalation process followed. Therefore,we could not be assured that medicines had been stored in the correct environment.