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Bowe's Court Care Home Requires improvement

Reports


Inspection carried out on 6 August 2019

During an inspection to make sure that the improvements required had been made

About the service

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.

Inspection carried out on 4 October 2017

During a routine inspection

This inspection took place on 4 October 2017 and was unannounced. This meant staff did not know we were visiting.

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 we

Inspection carried out on 15 November 2016

During an inspection to make sure that the improvements required had been made

This inspection took place on 15 November and was unannounced. We visited the service in response to a safeguarding investigation into anonymous alerts raised about the service. The investigation found that the concerns were unsubstantiated.

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 investig

Inspection carried out on 1 and 2 September 2015

During a routine inspection

This inspection took place on 1 and 2 September 2015 and was unannounced. This meant the staff and the provider did not know we would be visiting. The home had a registered manager in place. A registered manager is a person who has registered with 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 registered manager was not present during our visit however the deputy manager was present and was the acting manager at the time of the inspection.

On 23 May 2014 we completed an inspection and informed the provider they were in breach of a number of regulations including the care and welfare of people using the service, staffing and assessing and monitoring the quality of the service. Whilst completing the visit we reviewed the action the provider had taken to address the above breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that the provider had ensured improvements were made in these areas and these had led the home to meeting the above regulations.

Bowes Court Care Home is situated in the village of Evenwood, close to Bishop Auckland. The service provides accommodation with personal care and nursing for up to 23 people. The service provides care to people with learning disabilities, mental health conditions and physical disabilities. On the days of our inspection there were 23 people using the service.

People who used the service and their relatives were complimentary about the standard of care at Bowes Court Care Home. We saw staff supporting and helping to maintain people’s independence. People were encouraged to care for themselves where possible. Staff treated people with dignity and respect.

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Training records were up to date and staff received supervisions and appraisals, which meant that staff were properly supported to provide care to people who used the service.

The layout of the building provided adequate space for people with walking aids or wheelchairs to mobilise safely around the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) is 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 discussed DoLS with the acting manager and looked at records. The registered manager was fully aware of the recent changes in legislation and we found the provider was following the requirements of DoLS.

We found evidence of mental capacity assessments or best interest decision making in the care records. Staff were following the Mental Capacity Act 2005 for people who lacked capacity to make particular decisions and the provider had made applications under the Mental Capacity Act Deprivation of Liberty Safeguards for people being restricted of their liberty.

People were protected against the risks associated with the unsafe use and management of medicines.

People had access to food and drink throughout the day and we saw staff supporting people at meal times when required.

People who used the service had access to a range of activities in the home and within the local community.

All the care records we looked at showed people’s needs were assessed. Care plans and risk assessments were in place when required and daily records were up to date. Care plans were written in a person centred way and were reviewed regularly.

We saw staff used a range of assessment tools and kept clear records about how care was to be delivered and people who used the service had access to healthcare services and received ongoing healthcare support.

Inspection carried out on 23, 30 May and 13 June 2014

During a routine inspection

The purpose of this inspection was to find out five key questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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.

Inspection carried out on 21 February 2014

During an inspection to make sure that the improvements required had been made

We inspected the service on 29 October 2013 and found that the service had not carried out competency assessments of nursing staff in the home to ensure they were handling and administering medicines in accordance with the providers policy. We also found that medicines were not being handled safely and stored safely.

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.

Inspection carried out on 29 October 2013

During an inspection to make sure that the improvements required had been made

We did not discuss medication with people who use the service because many of them were unable to communicate with us about their care. We therefore looked at their medication records and medicines supplies in detail and talked with staff.

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

Inspection carried out on 17 June 2013

During a routine inspection

We asked staff how they ensured they obtained consent from people. Staff were all able to give examples of how they obtained verbal consent. Comments included �I always ask if I can go into someone�s room. If they don�t want me to I�ll ask if it�s OK to come back later�, �I ask people first before I give any support� and �I explain everything so people can choose what they want.�

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.�

Inspection carried out on 6 November 2012

During a routine inspection

We spent time observing how staff supported people living at the home. We found staff were very respectful in their approach, treating people with dignity and courtesy.

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�.

Reports under our old system of regulation (including those from before CQC was created)