Bowes House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

There had been a change in the management of the home which had led to changes being made in the systems used to report and track incidents and accidents for themes and trends.

This meant the provider had made improvements in the learning from safety incidents. There was a more positive culture towards safety, while processes to review and monitor incidents had become more robust.

The registered manager had previously identified an area of staff reporting that required improvement and had implemented learning and training to resolve this. Staff were now diligent in reporting both accidents that occurred, as well as incidents of potential and actual risk. This allowed leadership to review and analyse risk patterns and trends. The registered manager said, “It was about recognising it, reporting it and dealing with it." Discussions and scenarios implemented by the provider ensured that staff knowledge reflected these improvements.

A review of recorded incidents showed that actions taken were thorough. For example, staff had identified an emerging pressure sore for one person. There was a review of their repositioning process and the equipment used, while referrals to external professionals had been made in a timely manner, a review of the risks to the person had also been completed.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Once in the home, people had been moved when their needs changed, for example, if they developed a health need and lived on the residential unit, they were moved to the nursing unit. This had a detrimental effect on some people, for example, a relative told us their loved one had been moved three times. This person lived with dementia. The move had impacted negatively on their wellbeing as this meant an unfamiliar bedroom, and getting to know different staff. This was fully discussed with the management team. We were told this had been identified by the new registered manager, and two people who were unhappy with being told they were to move were now not being moved.

The management team worked with health and social care professionals to support people to move into the service smoothly. People confirmed they received support during transitions and moves. One person said, “I came here straight from hospital, very easy and no anxiety.” A visitor said, “We came to visit and everything went like clockwork, we chose a date and it all went smoothly.”

People moved out only when they chose to, sometimes to be closer to loved ones or because the service could no longer meet their needs.

The registered manager told us meetings were held with relevant health professionals and, where appropriate, the hospice team to discuss people’s changing support needs. Staff described meetings held when there were concerns about whether people’s needs were being met or when a person became unhappy or anxious. Relatives and all necessary professionals were involved to ensure the best outcomes for people.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People and their relatives told us they were happy and felt safe at the service. During the assessment we observed staff providing care in a safe and respectful manner. Safeguarding procedures were in place, and staff had a clear understanding of how to report concerns. Staff told us they felt confident the management team would respond to concerns promptly.

There was a system in place for recording safeguarding concerns which helped management have oversight. The management team had appropriately made safeguarding referrals to the local authority when required.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. Managers and staff understood MCA and had received relevant training. A DoLS tracker provided oversight and monitored the progress of applications and the manager had systems to ensure applications were made for DoLS to be renewed before they expired.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Care plans and risk assessments for each person were in place. Most were relevant and specific to the person, however, there were some areas that were not fully explored and reflective of the possible risk to their health and well-being. For example, some people had difficulties in managing their anxiety and this could impact on personal relationships with staff and other people. This was immediately acted on. Both the registered manager and deputy manager were new in post and they were still getting to know people and their complex needs.

We also found that people who were approaching their end of life did not have risk assessments and care plans to manage this effectively. For example, symptom relief. This was acknowledged by the management team and actioned immediately.

Other risk assessments contained detailed information about identified risks and the actions staff should take to keep people safe and minimise harm during day-to-day activities or when accessing the community. Assessments were reviewed regularly to ensure they remained current and relevant. This enabled staff to support and empower people to take positive risks, respecting their choices while helping them engage safely in activities that mattered to them.

Additional checks were in place for people at risk of falls. These included sensor mats, location checks, appropriate footwear checks, and ensuring people had the appropriate walking aids and were wearing their glasses if needed.

We spent time with people and staff both in communal areas and with permission in peoples' bedrooms. People who were at risk from pressure damage had air flow mattresses and these were set correctly as per manufacturers guidance against people’s weight. Staff checked these daily and recorded these checks on the persons’ care documentation, call bells were in peoples' rooms, and there were risk assessments in place for those who could not use a call bell, and we saw that staff checked them regularly. There were paper records kept in peoples’ bedrooms which recorded real time comfort and position checks, and food and drink records. This enabled staff to monitor people’s comfort and safety.

Care plans and risk assessments gave staff clear guidance on minimising risk. For people at risk of dehydration or malnutrition, records evidenced close monitoring and the actions taken, including fortifying food and providing supplements. People who lived with diabetes had detailed care plans and risk assessments that provided staff with guidance to manage their health safely.

We observed equipment being used appropriately to reduce people’s individual risks, such as walking aids and wheelchairs. People were supported with the correct equipment and assisted by staff in a safe way.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The home consisted of 4 units, each having communal spaces including lounges and dining rooms with kitchenettes. Additionally, the service offered a variety of communal facilities including a movie room, and a communal café area on the ground floor. All areas were open and allowed staff to assist people as needed.

The environment was safe, well decorated and well-maintained. There was a rolling redecorating and upgrading plan in place. Care equipment we saw was in good working order and documentation to support regular servicing was seen. There was no clutter, and the home was accessible for people with mobility needs and safe for those who enjoyed walking. Outside areas were safe for people to spend time in if they wished to.

Processes ensured the environment was safe and well maintained. Health and safety checks had been undertaken to ensure safe management of utilities, food hygiene, hazardous substances, moving and handling equipment, staff safety and welfare. There was a business continuity plan which instructed staff on what to do in the event of the service not being able to function normally, such as a loss of power or evacuation of the property. There were detailed fire risk assessments, which covered all areas in the home. Premises risk assessments and health and safety assessments were reviewed on an annual basis, which included gas, electrical safety, legionella and fire equipment.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staffing levels were based on people’s needs and reviewed regularly. Staff rotas showed consistent staffing levels, with relief staff covering vacancies, sickness and holidays. Staff numbers and deployment met people’s needs and preferences, supported by records showing that their care and social needs were met.

The provider ensured staff were skilled and experienced and received effective support, supervision and development. Staff said, “We get lots of training both online and face to face, also our clinical lead and nurses are always happy to show us things,” and “We get really good training and I have supervision regularly.” Training and supervision records were up to date and monitored. There were some gaps on both the training and supervision matrix. This was explained. Many of the staff team are currently in various stages of their induction and this was not clear on the matrix and the staff training matrix was not fully up to date. This was clarified during the inspection.

We saw that staff were visible and available to support people’s requests for support and company and could take the time to engage with people.

People received timely care, people we spoke with did not have any concerns regarding staff numbers. People told us, “I think staff numbers are good, never had a problem,” and “lots of staff around.”

Staff were recruited safely. The provider undertook checks on new staff before they started work. This included checking their identity, their eligibility to work in the UK, obtaining at least two references from previous employers and Disclosure and Barring Service (DBS) checks. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable people. Registered nurses have a unique registration code called a PIN. This tells the provider that they are fit to practice as nurses. Before employment, checks were made to ensure the PIN was current with no restrictions.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service was visibly clean and hygienic, and staff were observed wearing appropriate personal protective equipment (PPE). Records showed cleaning schedules were completed and monitored. Monthly IPC audits were carried out. Staff completed infection prevention and control (IPC) training.

The laundry was well managed and people’s clothes well cared for.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Staff supported and involved people in managing their medicines. Not everyone could share their experiences regarding medication, but one person said, “No worries at all, very organised, and staff are knowledgeable about the pills.” One family member we spoke with said, “Staff ring and inform us of any changes, we can ask any questions and they do get back to us, no concerns at all.”

People had a medication care plan, and where necessary an appropriate risk assessment for any specific need that needed regular review, for example, swallowing difficulties and the need for crushed medicines. Staff ensured people’s medication care plans accompanied people when moving between healthcare settings. Protocols for ‘as required’ (PRN) medicines such as pain relief medicines were in place, not all were informative and person specific, but this was already known by the registered manager and being addressed.

The management of medicines was very well organised, with minimal extra stock and all medicines no longer required were managed safely and returned as per their pharmacy’s procedures.

Staff who gave medicines had the relevant knowledge, training and competency that ensured medicines were handled safely. We observed staff giving medicines safely and that they were recorded accurately on the Electronic Medicines Administration Record (eMAR).

All discrepancies and medicine errors were recorded and investigated and action taken as required. Audits were carried out, and any shortfalls were addressed and used as ‘lessons learnt.’