Archived: Bowlacre Home

We last carried out a comprehensive inspection of this service on 28 September 2016. At that inspection we found five breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. The breaches related to the safe management and administration of medicines, capacity and consent, infection control, improvements to the environment and good governance. A recommendation was also made with regards to the development of an activity programme. The service was given an overall rating of ‘Requires Improvement’.

Following the inspection, we required the provider to complete an improvement action plan to show how they would improve the key questions; safe, effective, responsive and well led to at least good.

Prior to the inspection we had been made aware of two concerns about the safe care and treatment of people living at Bowlacre. These matters were currently subject to investigation by the local authority.

At this inspection we looked to see if the required improvements had been made. We found three repeated breaches in relation to management and administration of medication, capacity and consent and good governance. A further five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were also identified. These relate to recruitment procedures, fire safety, safe water temperatures, staff training and support and care records. We have also made three recommendations, advising the provider to refer to good practice guidance in relation to legionella, dementia friendly environment and activities and opportunities for people.

Bowlacre Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

The home is a large detached property set back from the main road in its own well-maintained grounds. The building has been adapted and extended over the years to provide accommodation for 37 people. The home is owned and managed by a voluntary housing association. At the time of our inspection there were 26 people living at the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We again found the provider did not have effective governance systems in place to continually monitor and review the service so that required improvements, as found during this inspection, could be identified and acted upon.

Whilst some improvements had been made to the management and administration of people’s prescribed medicines, some issues remained and did not demonstrate a safe and effective system was in place.

The provider did not carry out all necessary recruitment checks prior to new staff commencing employment to ensure that people were kept safe.

Suitable arrangements were not in place to help maintain the safety and protection of people using the service particularly in relation to fire safety and risk of scalding.

Following a recent accident, no action had been taken to minimise potential risks to other people living at the home. We recommend the provider refers to good practice guidance to help identify and mitigate risks so that people are kept safe.

Improvements were being made to enhance the appearance of the home. Whilst some consideration had been given to developing a ‘dementia friendly’ environment, we have recommended the provider should refer to good practice guidance so that facilities help encourage people to maintain their independence and movement around the home.

Suitable arrangements were in place to ensure people were protected against the risks of cross infection. We have recommended the provider refers to guidance on the management of legionella in hot and cold-water systems.

Relevant authorisations were in place where people were being deprived of their liberty. However, care records did not show that capacity and consent had been considered when planning people’s care and support.

Care plans were not always updated to reflect people’s current and changing needs as well as their individual needs, wishes and preferences.

Staff said there was good teamwork within the home and that sufficient numbers of staff were available to meet people’s needs. However, we found staff had not received all the necessary training and support essential to their role so that the current and changing needs of people could be met in a safe and consistent way.

Whilst some activities and opportunities were made available, further consideration was needed to help encourage and support those people less able or living with dementia. We have recommended the provider explores more meaningful activities so that people have a sense of purpose to their day and are actively engaged.

People told us they were happy and well cared for. Whilst some of our observations of staff interactions with people were positive, at times support was task focused and did not always demonstrate people were treated in a dignified manner.

Staff were aware of their responsibilities and knew what to do to protect people from abuse.

People were offered adequate food and drink throughout the day. People told us they were happy with the quality and variety of meals offered.

Staff worked in co-operation with healthcare professionals to ensure that people received appropriate care and treatment.

People and their visitors told us they could raise any issues or concerns with care staff and felt these would be dealt with.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not, enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

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.

Bowlacre Home is a large detached building set back from the main road in its own well maintained grounds. The building has been adapted and extended over the years to provide accommodation for 37 people. The home is owned and managed by a voluntary housing association. There were 33 people living at the service on the day of the inspection.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

People did not always receive there medicines safely and in line with their prescriptions. Medicines at the service were not well managed. Concerns were raised in relation to storage, recording, administration and auditing of medicines. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered provider did not have effective systems in place to monitor and manage the prevention and control of infection and areas of the premises were not properly maintained. Pressure cushions, mattresses and some items of furniture were dirty and stained and some areas of the service including the bathrooms and shower areas had deteriorated and were impossible to effectively clean. This was a breach of Regualtion12 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.

We found that the premises were unsuitable for people living with a dementia related condition. This was a breach of Regualtion15 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.

The registered manager was able to demonstrate they had an understanding of Deprivation of Liberty Safeguards (DoLS). However, we found that Mental Capacity Act (2005) guidelines were not always followed. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found the registered provider had some audits in place to check that the systems and processes at the service were being followed, however they had failed to identify concerns in relation to expired maintenance certificates, medicines, infection control, care planning, the environment and activities. This was a breach of a Regulation 17 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.

People were offered some activities that included arts and crafts and monthly entertainers. However, the frequency of activities had decreased in recent months and the choice on offer was limited. We made a recommendation about this in the report.

We found that staff had a good knowledge of how to keep people safe from harm and there were enough staff to meet people's assessed needs. Staff had been employed following appropriate recruitment and selection processes.

We saw that staff completed an induction process and they had received a wide range of training, which covered courses the service deemed essential, such as, safeguarding, moving and handling and infection control.

People's nutritional needs were met. People told us they enjoyed the food and that they had enough to eat and drink. We saw people enjoyed a good choice of food and drink and were provided with snacks and refreshments throughout the day.

People told us they were well cared for and we saw people were supported to maintain good health and had access to services from healthcare professionals. We found that staff were knowledgeable about the people they cared for and saw they interacted positively with people living in the service. People were able to make choices and decisions regarding their care.

People had their health and social care needs assessed and care and support was planned and delivered in line with their individual care needs. Care plans were individualised to include preferences, likes, dislikes, and contained detailed information about how each person should be supported. However, some aspects of care lacked detail.

People's comments and complaints were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided. We saw that any comments, suggestions or complaints were recorded; however, actions were not always taken in response to suggestions.

Full information about the CQC's regulatory response to any concerns found during this inspection will be added to the report after any representations and appeals have been concluded.

This inspection was undertaken by one inspector. This summary addresses five key questions: is the service safe; is the service effective; is the service caring; is the service responsive; and is the service well led?

The full report contains the evidence to support this summary.

Is the service safe?

We saw that people were treated with dignity and respect by staff. We spoke with several people who lived at Bowlacre Home, whose comments included: 'The service is very good here. The food is wonderful, the staff obliging and my room comfortable, what more could you want? I do feel safe living here' and 'I'm safe, well looked after ' it's a good place to live'. We also spoke with two regular visitors to the service, who told us they had no concerns about the care being provided to their friend who lived in the home.

Is the service effective?

A full and comprehensive assessment of needs was carried out by the manager of Bowlacre Home for those people considering using the service.

There were effective systems in place to assess, monitor and regularly evaluate how well the service was operating. Information was available to demonstrate that regular reviews of care plans and peoples assessed needs were carried out. This meant that the management team could make changes to people's support needs quickly and effectively.

Everyone who we spoke with was positive about the service and support provided. Comments included 'a great service', 'there are always plenty of girls [staff] around, you never have to wait' and 'the staff are obliging and my room comfortable, what more could you want?'

Is the service caring?

Throughout our visit to the service we saw staff treat people kindly, with respect and allow people time to be as independent as they could be. Careful consideration had been given to people's likes and dislikes and this was respected during daily routines. This was supported by the positive views expressed by the people using the service and their visitors.

Is the service responsive?

A quality monitoring system was in place. The manager told us that such systems helped to identify areas of concern, good practice and potential areas for further development and improvement.

We looked at information contained in the complaints log, although we did not specifically look at the service's complaints procedure. The majority of people using the service we spoke with told us they knew how to make a complaint or raise a concern and said they would tell [senior team leader] or [senior team leader].

A visiting healthcare professional told us 'this is a responsive service'.

Is the service well led?

There were clear lines of accountability within the service and those staff spoken with understood their roles and responsibilities.

Communication between senior team leaders and care workers was good. The majority of people using the service that we spoke with knew who to speak with if their needs changed or were not being met. This enabled people using the service to feel confident that their needs would be met in a timely manner.

All staff spoken with confirmed they received regular support and supervision and described their managers as approachable, supportive and accessible. One care worker commented 'the senior team leaders are great'.

"I think it's great here. Meals are always on time. I'm very funny about what I eat, and here I find if there's anything I don't like there are always plenty of alternatives on offer."

"The staff are wonderful. They listen to me. They are very flexible. If I want to get up early you can, or sleep in longer if you want to."

"I notice that the staff know everyone, their likes and their dislikes, the only thing missing is more outings."

"The staff are so good, we have entertainment, but I wish we could have more."

When we spoke with staff they had a good knowledge and understanding of individual care needs and we saw them supporting people in a way that promoted their independence and dignity.

The service had robust policies and procedures to ensure that all areas of the home were clean and tidy.

We saw that staff had access to ongoing training and development opportunities and this mean that people living in the home could expect to receive care and support from a well trained staff team.

There was a complaints procedure in place, and people living in the home told us that although they had never had cause to raise a concern they felt confident that they could do so and that it would be addressed.