We inspected Bowes House on the 1 and 2 August 2016. Bowes House provides accommodation and nursing care for up to 90 people who have nursing needs, including poor mobility or diabetes, as well as those living with various stages of dementia. The home also had a contract with the CCG (Clinical Commissioning Group) to provide rehabilitation for people, for up to 6 weeks. This aimed to either provide people with an alternative to a hospital admission. There were 78 people living at the home on the days of our inspection.Bowes House is owned by the organisation Care UK Community Partnerships Limited. The service is purpose built and provides accommodation and facilities over two floors. Split into four units, the units include; Aylesham (Elderly Residential), Weald (Nursing care), Barley (Rehabilitation) and Meadow (Dementia). Local school children were involved in the naming of each unit.
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.
At the last inspection undertaken on the 15 and 16 March 2015, we asked the provider to make improvements in relation to care plans and risk assessments to ensure sufficient guidance was provided to staff to provide safe care. This included the care for people who had lost weight. In addition, we asked the provider to make improvements to the opportunities available for meaningful activities, encouraging those receiving rehabilitation to self-administer their medicines and for care plans to be personalised to the individual. The provider sent us an action plan stating they would have addressed all of these concerns by October 2015. At this inspection we found the provider was meeting these regulations and had acted upon the recommendations made.
The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLs) which applies to care homes. Applications to restrict people’s freedom had been submitted to the appropriate DoLS office and people had individual DoLS care plans. However, staff were not consistently aware of who was subject to a DoLS authorisation and what it meant for the individual. We have made a recommendation for improvement.
The principles of the Mental Capacity Act (MCA) were not consistently embedded into practice. Further work was required to clearly demonstrate whether people had consented to their care plan, photograph being taken or sharing of information. We have made a recommendation for improvement.
Staff had completed training to enable them to carry out their roles. There was an ongoing programme of training and development for staff. Upon commencing employment with the provider, staff were subject to an induction. However, documentation was not consistently completed to evidence when staff had finished their induction and were deemed competent to work alone. Where concerns had been raised regarding the competency of staff, we could see that individual action had been taken, however, documentation failed to evidence how the management team had oversight of staff's progress and how they continually assessed staff’s competency. We have made recommendations for improvement.
People’s nutrition and hydration needs were met. The kitchen team were dedicated and passionate about providing good quality food which in return promoted people’s quality of life. People were provided with a wide range of food options and individual dietary requirements were catered for. Where people had not met their daily fluid intake target, further work was required to ensure this was effectively shared with staff to ensure all staff encouraged people to drink more that day.
There were appropriate arrangements in place for monitoring the quality of the service that people received. The provider took into account the views of people, relatives and staff through surveys. The results were analysed and action was taken to make improvements for people living at the home. The registered manager carried out unannounced visits to the home to make sure people were receiving appropriate care and support. Staff said they enjoyed working at the home and they received good support from the management team.
People said they felt safe and staff treated them well. One person told us, “I feel extremely safe living here. Although it was hard moving in I knew I wasn’t safe living by myself. Living here, there are staff available at all times and I know I’m safe.” Appropriate recruitment checks took place before staff started work. There were enough staff on duty and deployed throughout the home to meet people's care and support needs.
Safeguarding adult's procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to. People's medicines were managed appropriately and people received their medicines as prescribed by health care professionals.
People had access to relevant healthcare professionals to maintain good health. Records confirmed that external healthcare professionals had been consulted to ensure that people were being provided with safe and effective care. People's clinical needs were assessed and met. People received good health care to maintain their health and well-being.
Dedicated activities coordinators were in post who provided a wide range of interaction, engagement and stimulation. One person told us, “The activity coordinator who takes us out on the bus is fantastic, they design trips to see places we have not been before and the trips are very interesting and informative, I really enjoy their outings.” A visiting relative told us, “Staff are quite responsive and try to encourage mum to do activities.” Further work was underway to ensure that those who did not enjoy group activities, were not at risk of social isolation.
People’s privacy and dignity was respected and staff had a caring attitude towards people. We saw staff smiling and laughing with people and offering support. There was a good rapport between people and staff.
Feedback from people and their relatives was positive about the care, the atmosphere in the service and the approach and openness of the staff and registered manager. Comments included, “I am very happy here and would not have any difficulty recommending Bowes House to my friends, I have been made to feel very welcome. I cannot fault it.”