Bowburn Care Centre

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

People were looked after safely in a home that had a welcoming, positive atmosphere. The registered manager had implemented and sustained a range of improvements to the service, which meant people received a better standard of care.

Staff worked together well to keep people safe. They understood their roles and worked hard as a team.

Risks to people's health and safety were assessed and regularly reviewed. These assessments were person centred and detailed.

The provider had safeguarding and whistleblowing training, policies and systems in place. Staff understood how to identify potential signs of abuse and were confident in the registered manager acting on any concerns.

Staff worked well with external partners to keep people safe.

The registered manager, regional manager and senior staff demonstrated good awareness and oversight of systems and process. Audits were effective.

The environment was well maintained and clean. The registered manager agreed that the outdoor space would benefit from being reviewed to ensure it better met the needs of people living with dementia.

Staff were recruited safely. Their competence was regularly assessed and they were supported to complete relevant refresher training.

Medicines were stored and administered safely by competent, experienced staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Activities were varied and well planned. People’s individual cultural and spiritual needs were respected and acted on.

The registered manager led by example and was well respected by staff and external partners. Feedback from relatives and external specialists was positive regarding the leadership of the service.

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

Rating at last inspection

The last rating for this service was requires improvement (published 11 August 2021)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Bowburn Care Centre is a care home registered to provide accommodation for up to 80 people. The home has two floors and can specialise in providing care to people living with a dementia. At the time of this inspection 57 people were living at the service.

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

The current manager was appointed to the post at the beginning of February 2021 and they have applied to become the registered manager. The feedback we received was positive about the new manager. Staff and people felt the provider and manager had made improvements. They were confident the improvements would continue to be made.

Some concerns were raised by community healthcare staff who regularly work in the home relating to the quality of personal care and pressure area care for people by some staff. The community team were positive about the improvement work being carried out at the home by the managers but felt not all staff were engaged with this, all the time. We discussed this with the provider and manager who were taking steps to ensure all staff were aware of their responsibility to provide high quality care for people.

There were enough staff on duty to keep people safe, although the home were still utilising agency staff whilst they recruit. We noted that the home's layout meant at times staff deployment wasn't clear but the manager told us they would ensure people would have access to staff support quickly. We found agency staff had not always been properly inducted and the provider took steps to address this immediately.

We found the audit and analysis documents had improved following our January 2021 inspection. Additional support such as a senior support manager who worked at the home full-time ensuring improvement had been made. They completed quality checks, out of hours visits and staff support had been carried out.

Staff recruitment procedures had been strengthened to ensure staff were employed safely. Staff training and supervision had been delivered which ensured all staff had received mandatory training and received one to one supervision sessions.

Medicines were now managed and administered safely by trained and competent staff. Medicines records had significantly improved.

Care records had significantly improved and were more person centred and had been reviewed. Some care records we viewed still needed further work but the provider had a clear action plan in place to address this.

We saw significant improvements had been made to the environment and it was safe and clean. Staff were clear on the use of personal protective equipment and had been trained in infection control procedures. Measures to reduce the risk of COVID-19 were now in place.

The manager closely analysed information about accidents and incidents to determine if all reasonable steps were being taken to minimise the risk of falls and people sustaining injuries. They could outline how changes to practice had reduced the number of falls people experienced.

The home had undergone a major refurbishment programme, which had enhanced the environment, and further work was planned.

The provider and manager had engaged positively with the local authority and other healthcare partners to address the issues found following our inspection in January 2021. Their willingness to work with others to make improvements was commended.

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

Rating at last inspection

The last rating for this service was inadequate (published 18 February 2021).

This service has been in Special Measures since January 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service in January 2021 and found multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve the delivery of person-centred care. They also outlined how they would address the breaches around delivering safe care and treatment, safeguarding people from abuse, employing suitable and experienced staff and governance systems. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this 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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bowburn Care Centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bowburn Care Centre is a residential care home providing accommodation with personal care to older people, some of whom were living with dementia. The service can support up to 80 people in one building over two floors. At the time of this inspection, 65 people lived at the service.

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

We arrived at the home at 6am and found a large number of people were already up and dressed by night staff. We raised with the interim manager that people were dozing and why were so many people up and dressed at this time.

Staffing levels were not always safe. Records relating to peoples' health and wellbeing such as weight and fluid charts were not always documented. This meant that people were at risk of not receiving safe care. Accidents and incidents had not been thoroughly recorded and action to follow up on them had not always been taken.

Medicines had not been managed safely. Staff had not received appropriate training and competency assessments. Guidance from other professionals had not always been put in place promptly. Medicines ordering was poor with large overstocks and records relating to medicines management were poor or not in place.

The service did not have sufficient infection prevention and control measures in place. Government guidance in relation to COVID-19 was not always followed. Staff were not all wearing appropriate Personal Protective Equipment (PPE). Cleaning programmes were not recorded so it could not be evidenced if these had taken place. Safety equipment such as sensor checks and mattress checks had not been carried out.

Quality assurance processes to monitor the quality and safety of the service had not been carried out. There was a lack of provider oversight and they had not ensured effective and competent management was in place.

All staff members we spoke with raised concerns about the management of the service. Staff we spoke with said they felt unsupported by the registered manager and at times unsafe. Staff told us they were happy about the interim manager and felt they were now listened to.

We did observe people appeared comfortable and happy with staff interaction with them. Since our inspection the new interim manager and provider had carried out robust audits, brought in additional staff and were providing regular updates on an action plan to address the issues we found.

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

Rating at last inspection

The last rating for this service was good (report published 22 October 2020)

Why we inspected

Serious whistleblowing concerns were received by the local authority safeguarding team in relation to management of the service and the quality of care and support that was being provided. There had been a number of safeguarding concerns raised by other professionals. As a result, we carried out a focused inspection to review the key questions of safe, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make substantial improvements. Please see the safe, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bowburn Care Centre on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the safety of people and the risk of harm. We also identified breaches in relation to the management and monitoring of the service, person-centred care and staffing at this inspection.

Follow up

We will continue to monitor information we receive about the service and we will continue to work with partner agencies. We will also request a specific action plan to understand what the provider will do immediately to ensure the service is safe. We will work alongside the provider and the local authority to closely monitor the service. We will return to visit in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘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 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

Bowburn Care Centre accommodates up to 80 people with residential care needs in a purpose-built building. 51 people were using the service at the time of the inspection.

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

People were protected from risks. There were enough staff on duty to meet people’s needs. Appropriate arrangements were in place for the safe administration and recording of medicines. Infection prevention and control procedures were in place to reduce the risk of infection and to keep people safe.

Complaints were appropriately recorded and acted on in a timely manner. Care records were regularly reviewed and up to date. People were protected from social isolation.

The provider and registered manager monitored the quality of the service to make sure they delivered a high standard of care. People and family members spoke positively about the registered manager and staff. Staff said they were comfortable raising any concerns and the management team were very approachable.

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 requires improvement (published 17 June 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We carried out an unannounced focused inspection of this service on 10 and 23 May 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and responding to complaints.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bowburn Care Centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: During our inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to ensuring the safe care of people and dealing with complaints.

Staff were not adhering to people’s percutaneous endoscopic gastrostomy (PEG) feed prescription. PEG feeding involves have a tube passed into a person's stomach through the abdominal wall to provide a means of feeding when oral intake is not adequate. staff were not following the prescriber’s instructions in relation to PEG feeds.

Work was being completed to improve the care records and staff were producing more detailed assessments. However, the existing care records contained minimal information.

For some people risks were not clearly described or addressed, for instance one person was drinking very limited amounts of fluid and was at risk of severe dehydration. No risk assessment was in place. No action had been taken to explore with the GP alternative means to support them to remain hydrated.

Nutritional assessment tools were in place, and staff ensured people were encouraged to eat a balanced diet. However, we could not determine what action had been taken when people had lost weight or had very low Body Mass Index (BMIs) and therefore underweight.

People were not happy with the way complaints had been managed. The complaint records were incomplete. We were unable to track whether complaints had been responded to, investigated or resolved. The regional manager had identified this issue and was acting to resolve the matter.

Staffing levels met people's needs but until recently this had been problematic. There was regular use of agency nurses. We found that more consideration needed to be given to how agency staff were made aware of processes and practice at the service such as how to navigate the computerised care records, where to record fluids and where equipment such as suction machines were kept.

Medicine management had been improved over recent weeks and were much more robust. The clinical lead and staff had worked closely with the local Clinical commissioning Group (CCG) pharmacist to make positive changes to their practice.

We observed a lot of person-centred practice where staff worked with people in a very sensitive and empathetic manner.

Staff were able to alter the temperature of rooms but during changeable weather staff needed to have a system in place for checking heating so that room temperatures did not become excessively hot or cold.

Staff were aware of safeguarding procedures and we found these were acted upon. The clinical lead was very thorough and used incidents to determine lessons that could be learnt.

The activity coordinator was extremely proactive, and people were positive about the range of activities. A wide range of stimulating and innovative activities were provided. Their link work with other organisations was exceptionally good.

The regional manager, registered manager, deputy manager and clinical lead were critically reviewing the service and had identified improvements that needed to be made. Positive changes were being made but it was too early to see if these would be effective and if so sustained.

Staff told us the registered manager and deputy were approachable and closely listened to their views. They felt positive about how the service was now being operated.

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

Rating at last inspection: Good (report published 2 August 2017).

Why we inspected: We completed the inspection on the back of concerns, complaints and safeguarding raised from multiple sources, including members of the public, whistle-blowers and local commissioners.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Bowburn Care Centre provides care and accommodation for up to 80 people with nursing or personal care needs. On the two days of our inspection there were 53 people using 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 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.

Bowburn Care Centre was last inspected by CQC on 14 March 2016 and was rated Requires Improvement overall. At the inspection in March 2016 we identified the following breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

Regulation 9 (Person-centred care)

Regulation 10 (Dignity and respect)

Regulation 12 (Safe care and treatment)

Regulation 15 (Premises and equipment)

Regulation 17 (Good governance)

Regulation 18 (Staffing)

Regulation 19 (Fit and proper persons employed)

At this inspection we checked to see whether improvements had been made and we found improvements had been made in all the areas identified at the previous inspection.

Accidents and incidents were appropriately recorded, and risk assessments were in place for people who used the service. These described potential risks and the safeguards in place to mitigate these risks.

The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

At the previous inspection it was identified that people were not always protected against the risks associated with the unsafe use and management of medicines. At this inspection we found medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. Staff were suitably trained and training was arranged for any due or overdue refresher training. Staff received regular supervisions and appraisals.

At the previous inspection we found some checks of staff employment history had not been appropriately carried out. At this inspection we found the provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

At the previous inspection it was identified that some people had to wait a long time for support at meal times. At this inspection we found people were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

At the previous inspection it was identified that the environment of the home did not reflect best practice in dementia care. At this inspection we found the service incorporated environmental aspects that were dementia friendly.

People who used the service and family members were complimentary about the standard of care at Bowburn Care Centre. Care plans were in place that recorded people’s plans and wishes for their end of life care.

At the previous inspection it was identified that people were not always treated with dignity and respect. At this inspection we found staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

At the previous inspection it was identified that some care records were incomplete and missing important information. At this inspection we found records were up to date, and regularly reviewed and evaluated.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs. The service had good links with the local community.

People who used the service and family members were aware of how to make a complaint but had no complaints about the service.

At the previous inspection it was identified that governance systems had failed to ensure that risks to the health and safety of people living at the home were minimised. At this inspection we found these risks had been minimised and an appropriate quality assurance process was in place.

Staff said they felt supported by the registered manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys.

Bowburn Care Centre provides accommodation and personal care for up to 80 older people. The home is set in its own grounds in a residential area near to public transport routes, shops and local facilities.

On the day of our inspection there were 60 people using the service. Accommodation is provided across two floors within four separate areas. Facilities included several lounges, dining rooms and kitchenettes, a hair salon and an enclosed garden area.

We saw that entry to the premises was controlled by key-pad entry. All visitors were required to sign in. This meant the provider had appropriate security measures in place to ensure the safety of the people who used the service.

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. At the time of the inspection there was a registered manager who had been in their present post at this home for over two years.

The registered provider had in place a safeguarding policy. However we found one person to be at risk of harm because details in their care plan had not been followed in practice. We made a referral to the local safeguarding authority to ensure this person was protected from the risk of harm.

People living at the home were at risk of inappropriate use of sedation medicines because there was incomplete information in their care plan about the reasons and thresholds where they should or should not be given. The provider could not demonstrate if pain relief patches were actually removed or not, potentially placing the people at risk of overdose.

The registered manager carried out a monthly analysis of accidents and incidents to check for patterns and trends and see if there were any ways of preventing future accidents. But we found instances where people were put at increased risk of accidental injury from insecure bedroom furniture, fire protection doors being held open and broken or disengaged window restrictors.

There were odour control issues in some parts of the home and steps to ensure that the home is kept clean and the people living and working there were protected from risk of infection were not effective.

There was a staff training plan in place. However staff had been required to carry out physical restraint without any training having taken place to ensure this was safe. This meant that staff had not been provided with the necessary skills to safely meet the needs of the people in their care.

People were not always treated with dignity and respect. Not all staff spoke with the people they were supporting in a respectful manner and one person’s property checklist had been written on a piece of hand towel paper.

We saw that people’s nutritional needs were assessed and plans of care drawn up if they were at risk of malnutrition or choking. The cook demonstrated that she had an extensive knowledge of people’s likes and dislikes and prepared a wide selection of wholesome and popular meals to cater for people’s tastes.

Arrangements for the assessment planning and review of peoples’ needs were not consistently in place. Staff and vulnerable people living at the home were at risk where the needs of people with complex mental health requirements were not known, understood or well planned.

There was member of staff employed by the provider whose role it was to prepare activities for people living in the home and staff had found out about some peoples’ past histories and provided activities to meet their needs.

The provider did not take steps to promote a calm relaxed therapeutic atmosphere at mealtimes nor ensure sufficient staff were deployed in a timely manner to make sure people were not at risk: Checks to make sure the continued use of antipsychotic medication was appropriate for some people, had not taken place: Measures to reduce the risk of skin pressure damage were not implemented in a safe way for some people. The provider’s systems to assess monitor and improve the quality and safety of the home had not been successful in these areas.

CQC monitors the operation of the Deprivation of Liberty Safeguards [DoLS] which applies to care homes. The Deprivation of Liberty Safeguards are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We found the provider was following legal requirements in the DoLS.

We found the provider had recruitment procedures in place to make sure only those suitable to work with vulnerable people are employed. However the provider had failed to fully explore some staffs previous work history so their suitability could not be assured.

The service had a complaints policy which provided people who used the service and their representatives with information about how to raise any concerns and how they would be managed.

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.

During our visit we found people's privacy, dignity and independence were respected. People we spoke with said staff respected their choices, privacy and dignity. One person told us, 'I would definitely say I was treated respectfully by staff.'

We found personal care was planned and delivered in a way which ensured people's safety and welfare. One person said, 'The staff are well organised, I would give them eleven out of ten.'

Before this inspection we were given information that suggested peoples' dietary needs were not catered for. During our visit we found the acting manager had taken successful steps to make sure anyone who was likely to be at risk from a poor diet, had a plan in place to support them. There was evidence this had been carried out and monitored by the acting manager, provider, nurses and doctors where necessary.

The provider had taken steps to make sure people at the home were protected from staff who were unsuitable to work with vulnerable people. This was because they had carried out thorough background checks.

People who used the service and their representatives were asked for their views about how the service was performing and their views were acknowledged and acted on.

At this inspection we found improvements had been made. We found people were now protected against the risks of unsafe use or management of medicines because the provider had appropriate arrangements in place.

We also checked the provider's arrangements to protect vulnerable people following alerts made to the local authority safeguarding adults team. We found the provider had made suitable arrangements to protect vulnerable people and had responded appropriately to allegations of abuse.

This was a follow up inspection where we did not collect the views of people at the home or visitors.