Bowe's Court Care Home

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

People and relatives were complimentary about the care provided by staff. They trusted the staff who supported them. They said staff were kind, caring and supportive of people and their families. One relative said, “The staff are brilliant. It takes a special kind of person to do the job.”

Staff had received safeguarding training and were clear on how and when to raise their concerns. Where appropriate, actions were taken to keep people safe.

Records provided guidance to ensure people received safe, person-centred care and support from all staff members. Systems were in place for people to receive their medicines in a safe way.

Staffing capacity was sufficient and staff deployment was effective to ensure people's needs were met in a safe, timely way.

There was a cheerful atmosphere at the service. Staff spoke positively about working at the home and the people they cared for. Staff said the manager was approachable and they were supported in their role.

People received a variety of food and drink to meet their needs and any specialist diets were catered for.

There were opportunities for staff to receive training, to give them insight into people’s support needs.

People's diversity as unique individuals with their own needs was respected by staff. The staff team knew people well and provided support discreetly and with compassion. People’s privacy was respected, and people were supported to maintain contact with relatives.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of all the key questions the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Systems were in place to ensure the right culture was being promoted. People’s human rights were respected and their opinions were listened to and valued. People were supported to make choices and achieve their aspirations. Staff adopted the ethos to provide person-centred care.

The service was following safe infection prevention and control procedures to keep people safe.

An effective quality assurance system was in place to assess the standards of care in 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 good (published 29 May 2021).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and people’s care. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the relevant key questions sections of this full report.

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, which will help inform when we next inspect.

Bowe's Court provides personal and nursing care for up to 23 younger adults living with a range of conditions such as Huntingdon's Disease and physical and learning disabilities. At the time of inspection 23 people were using the service.

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

People and their relatives were very positive about the service and the care provided. One relative told us, "My relation could not be in a better place."

Incidents and accidents were investigated, and actions were taken to prevent reoccurrence.

Staff understood their responsibilities for keeping people safe. There was a proactive approach to assessing and managing risk which supported people to be as independent as possible. Safe recruitment practices were in place to help ensure that only suitable people were employed at the service.

Medicines were managed safely. Reviews were regularly undertaken which involved the person, health and social care professionals to ensure people's physical and mental health needs were met and changes responded to quickly.

The home was clean and tidy. Staff wore appropriate PPE and we observed good infection control practice.

People were treated in a respectful manner by all staff. People felt listened to and were actively involved in the running of the home and were being supported to access rehabilitation opportunities.

People, their relatives and staff said the management team were supportive. Systems were in place to monitor the quality of care provided and continuously improve the service. The management team and staff worked with a wide range of health professionals both internally and externally to the service, to achieve positive outcomes for people’s health and well-being.

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 10 October 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

We carried out an unannounced comprehensive inspection of this service on 6 August 2019. Two 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 the safe recruitment of suitable staff and good governance.

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 safe and well-led which contain those requirements.

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.

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 Bowes Court 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.

Bowe’s Court Care Home provides accommodation for up to 23 people who require personal or nursing care. The service provides care to people with learning disabilities, mental health problems and physical disabilities. At the time of this inspection there were 20 people in receipt of care from the service.

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

In general staff delivered consistent and timely care to people. The electronic care system prompted staff to record generic risks but did not support staff to consider other risks, such as physical conditions, which increase the risk of sepsis.

The service had one hot-lock to cover all three units’ meals and staff staggered meal times. However, we noted some hot meals were left to stand on kitchen benches for extended periods. This was not in line with Food Standards Agency guidance. Staff did not appear to appreciate the risks associated with this practice. Not all staff who prepared meals had completed level 2 food safety and hygiene training. It is a legal requirement for staff handling and cooking food have received appropriate training. The provider could not demonstrate these staff had received the appropriate supervision and training in food hygiene.

Staff deployment led to times when there was only one member of staff to support three people who all needed additional assistance.

Medicines were not always managed safely. Issues had been identified regarding the recording and application of both pain relief patches and people’s topical medicines.

We have made two recommendations regarding pain relief patches and topical creams.

The registered manager was clearly invested in providing people with a good service at the home. However. the quality assurance systems, recruitment procedures, computer generated care records and IT equipment were not supporting them to achieve the goal of delivering an effective service.

Issues had been identified with the electronic systems staff used to record and review people’s care. The care record system did not support staff to develop fully person-centred care records, meet accessible communication standards, allow staff to produce communication records and could not be translated in to easy read. People who used the service could be inadvertently excluded from contributing to their care plan.

People we spoke with were very complimentary about the service, staff and registered manager. A relative told us, "The care is outstanding. They treat my relative as I would and are so good. We have never had any complaints."

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 8 November 2017).

Why we inspected

We undertook this focused inspection because concerns had been raised about the provider’s overall operation of their services.

This report only covers our findings in relation to the Key Questions Safe and Well-led. The ratings from the previous comprehensive inspection for those Key Questions were not looked at on this occasion but were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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

You can see what action we have asked the provider to take at the end of this full report.

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

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.

We last inspected the service on 15 November 2016 in response to a safeguarding investigation into anonymous alerts raised about the service in relation to safety. The investigation found that the concerns were unsubstantiated. We inspected the service in October 2015 and rated the service as Good. At this inspection we found the service retained its overall rating of ‘Good’.

Bowe’s Court Care Home provides accommodation for up to 23 people who require personal or nursing care. The service provides care to people with learning disabilities, mental health problems and physical disabilities. At the time of this inspection there were 18 people in receipt of care from the service.

The service had a registered manager in place. 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.

Staff were exceptional in their caring approach to people using the service and in their support to people’s families and wider social networks. Relatives spoke of how they felt part of the home and we observed family members making cakes in the communal kitchen and enjoying this activity with people and staff as part of daily life in the home.

We were told by the manager and staff members of how the service had supported a person, their family and other people living at the home in an extremely caring, way when someone had passed away this year. The manager drove to the person’s family home to break the news in person, as they did not wish to relay this news over the phone and they supported the person’s family at the home in their own time. Over 20 staff members attended the person’s funeral and Bowe’s Court also held a big celebration event with everyone at the service and the person’s family, which we were told helped everyone come to terms with the loss and remember the person in a fun and positive light.

Staff promoted people’s privacy and dignity through the use of discrete signs which showed others not to disturb a room when personal care was being carried out. Staff took great pride in ensuring people’s personal care was carried out to the highest standards.

Staff and the management team understood their responsibilities with regard to safeguarding and had been trained in safeguarding vulnerable adults. People we spoke with and their families told us they felt safe at the home.

Where potential risks had been identified an assessment had been completed to keep people as safe as possible. Accidents and incidents were logged and investigated with appropriate action taken to help keep people safe. Health and safety checks were completed and procedures were in place to deal with emergency situations.

Medicines were managed safely and administered to people in a safe and caring way. We saw that people received their medicines at the correct times.

We found there were sufficient care staff deployed to provide people’s care in a timely manner. Recruitment checks were carried out to ensure that staff were suitable to work with vulnerable people.

Staff received the support and training they required. Records confirmed training, supervisions and appraisals were up to date and forward planned. Staff told us they felt supported by the management team at the service.

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

People gave positive feedback about the meals they were served at the home. People received the support they needed with eating and drinking and those people who had specialist dietary needs were closely monitored and supported by the nursing and care staff team.

People’s needs were assessed before they came to live at the service by a specialist transition co-ordinator. Personalised care plans were then developed and regularly reviewed to support staff in caring for people the way they preferred.

An activity co-ordinator provided a wide range of activities and support for people to access the community. The service had created activities such as horse-riding, a tuck shop within the home and baking sessions where people made cakes and then had a coffee morning.

The service had good links with the local community and local organisations.

People and staff were very positive about the management of the home. The registered manager had a daily presence at the service. The manager had taken action to address improvements around staff support and quality audits since our previous visit. They had also increased people’s choices and family involvement at the service.

The provider had an effective complaints procedure in place. People who used the service and family members were aware of how to make a complaint. Feedback systems were used to obtain people’s views about the quality of the service.

Further information is in the detailed findings below.

Bowe's Court is registered to provide nursing care and accommodation for up to 23 people. The service was providing care to people with learning disabilities, mental health problems and physical disabilities during our inspection.

The service did not currently have a registered manager but the manager we met with stated they were in the process of applying for their registration 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.

The service was last inspected on 8 October 2015 and it was compliant with CQC regulations at that time.

Safeguarding alerts were appropriately recorded and showed that staff had taken the action needed. Staff we spoke with were able to provide good examples about things that would could present as abuse and the action they would need to take. Safeguarding training was up to date and CQC had been notified of all safeguarding alerts. Risk assessments for the day to day running of the service and more specific risk assessments individual to people were in place and regularly reviewed.

We saw that staffing was usually provided at levels whereby people's needs were fully met including support for people to access the community. We saw on a couple of occasions that staffing levels had dropped below this level, due to staff sickness. The service did have an active recruitment process in place.

Fire drills had not been carried out regularly with staff and the response times when they had been carried out were not recorded so their effectiveness could not be determined.

We looked at the guidance information kept about medicines to be administered 'when required'. We saw that MAR sheets correctly recorded all medicines prescribed by the G.P and care plans detailed peoples prescribed medicines.

Care staff had received up to date training and regularly participated in supervision however nurses had not received professional supervision to ensure their practice was safe and up to date. When we spoke to nursing staff they told us they did feel supported by the home manager in relation to their day to day practice. Staff meetings had also not occurred consistently over the last few months but we saw they were planned in for the rest of the year and information about these dates were on display.

People were supported at mealtimes and were encouraged to have drinks and snacks throughout the day. For people supported by percutaneous endoscopic gastronomy (PEG), trained staff were available to safely provide assistance. A PEG is a procedure in which a flexible feeding tube is placed through the abdominal wall and into the stomach. A PEG allows nutrition, fluids and/or medications to be put directly into the stomach, bypassing the mouth and oesophagus. Staff responded quickly when people lost weight and acted appropriately to ensure appropriate health professionals were involved in their care.

People spoke positively about the care and support they received from staff. We saw staff interacting positively with people and observed staff respecting people’s privacy and dignity.

Care plans were in place and showed that people were getting the care they required to meet their needs in relation to care and nursing support.

Staff spoke positively about the leadership in the service and about themselves as a team. Staff told us they were happy working at the service.

We found some audits were not up to date. The manager explained that they had been addressing other investigations required by the local authority and would address the outstanding audits straight away.

Below is a summary of what we found. The summary is based on our observations during the inspection, seeking experience and views from people who used the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Due to people's complex needs they were unable to tell us their experiences so we took an expert Clinical Psychologist who specialised in Learning Disabilities with us to assess the quality of care people received.

The service had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application for Deprivation of Liberty should be made, and how to submit one. There were systems in place where people did not have capacity and best interest decisions were made through a multi-agency approach. However we did find that people the service had not reviewed people's care appropriately and where people had complex conditions they were not always cared for safely and effectively.

Is the service effective?

People's health and welfare was not always protected and promoted although we do recognise the service had sought expertise and support from other health and social care services that people required, in order to meet their needs effectively.

People did not always receive appropriate care and support because there were not effective systems in place to assess, plan, implement, monitor and evaluate people's needs. We also found that national guidance and best practices had not been embedded into the service to ensure people received effective care.

Is the service caring?

we found staff were very compassionate people and demonstrated a willingness to learn but we did find Staff did not have a good awareness of individuals' needs and staff were not always able to manage behaviours that were complex or challenging.

Is the service responsive?

Systems were in place to ensure where people required healthcare support they received it. However we found staff often lacked the skills to understand when it was necessary to obtain advice and guidance from health professionals which meant people did not always receive the care they required.

Is the service well-led?

The manager had been in post for 6 months when we inspected. We found they had made improvements to the service, for example implemented a robust quality assurance system for auditing medication and a system for ensuring each staff member had regular supervision.

It was evident the manger was committed to ensuring people received care which was safe and effective but we did find shortfalls in auditing, care planning and staff attitude skills which meant people's needs were not always met in a safe and effective way. We told the manager and provider improvements were necessary.

We issued a warning notice telling the provider they had to make immediate improvements by 9 December 2013. We carried out our recent review to ensure standards had improved.

We did not speak with people who used the service during our visit regarding this outcome area but we did speak with nursing staff and senior managers to evaluate the improvements made.

We found the service had made improvements and had systems in place for the safe handling and administration of medicines.

Overall, we found that medicines were not managed safely because records did not clearly confirm that medicines had been given correctly.

Most of the people we spoke with were happy with the care provided. Comments included 'I like living here, the staff are good', 'I think they are good, they look after me' and 'My key worker is great.' However, one person said 'I don't want to live here.' We spoke with this person's relative who told us they were happy with the staff and the care provided, although they said it could sometimes be a noisy environment.

We checked medication records and found some stock levels and records were inaccurate. We found three items where there were more medicines left than there should have been, according to the records.

When we visited there were 21 people accommodated in the home. We arrived during the morning and looked at the number of staff supporting people at the home. We found there was one nurse, one senior support worker and eight care staff on duty. In the evening, we saw there was one nurse and four care staff on duty. The manager showed us the staff rotas for the past two months and they showed similar staffing levels.

People said that they knew they could speak to a member of staff if they had a complaint. One person said "I would just say.' Another said 'I would tell the staff if I wasn't happy, they would sort it out for me.'

People we spoke with said they were happy with the staff, one person said 'yes, they give me privacy', another said 'they always knock on my door, they don't just come into my room'.

When we spoke with people they were all very positive about the care they received. Comments included 'The care is really good and staff are very supportive', 'My carer looks after me' and 'I like it here'.

We spoke with five staff who worked in the home; they were all familiar with safeguarding procedures and aware of what constituted abuse. People said they felt safe living there; 'Yes, I feel safe, they look after me', and a relative said "I'm comfortable (my relative) is safe here".

We looked at training records and found staff attended regular courses throughout the year. This meant staff were well supported in gaining the knowledge required to meet people's needs safely and effectively. However, we also saw formal supervisory arrangements were not in place for all staff involved in delivering care, treatment and support.

We saw people who used the service, relatives and staff were asked for their views about their care and treatment through regular meetings. One person said 'I occasionally go the meetings', another said 'I just tell the staff if I have any problems'.