Lower Bowshaw View Nursing Home

Lower Bowshaw View Nursing Home is a care home providing personal and nursing care for to up to 40 people in one adapted building over two floors. At the time of our inspection there were 36 people using the service.

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

Building maintenance was not always completed within a timely manner, putting people’s health and safety at risk. Staff were recruited safely, however there were issues the number of staff deployed to deliver safe and timely care, especially at busy times. During the inspection we were informed that additional staff were to be deployed at busy times. Some furnishings within the home required updating and the provider was in the process of addressing this.

Not all staff training was up to date or robust, and there were insufficient processes in place to monitor staff capabilities. The registered manager was undertaking work to improve staff induction, training, and quality assurance at the time of the inspection, this work will take time to embed.

The registered manager had undertaken work to improve people's care plans, however during the inspection we found that some records had not been reviewed regularly and that some monitoring information was missing, this meant that we could not check if people had received the right care.

The majority of people and their relatives told us that they were happy with the care they received, and that staff were kind and caring. Staff told us they felt supported and that improvements in training were taking place in the service. The management team within the service expressed a strong desire to work towards improvements and had started work in this area.

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.

Rating at last inspection and update

The last rating for this service was good (published 18 June 2021).

Why we inspected

The inspection was prompted in part due to concerns received about the provider making sufficient timely improvements to the environment of the home and staff training. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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.

Since the inspection the provider has taken some steps to improve the service, for example some outstanding health and safety actions have now been completed and additional staff training has been booked.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lower Bowshaw View Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to governance, staffing and equipment and premises.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

Lower Bowshaw View Nursing Home is a residential care home which provides personal and nursing care to older adults. The home can support up to 40 people in one adapted building over two floors. There were 20 people using the service at the time of this inspection.

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

Significant improvements had been made to the way the service assessed and managed risks and to the planning and review of people’s care. This supported staff to deliver person-centred care to people which met their needs. People were happy with the care they received. A range of activities were provided to keep people occupied and entertained. People’s relatives were being supported to visit the home in a safe way, in line with governance guidance during the COVID-19 pandemic.

We have made a recommendation about staffing levels. We identified staff could be deployed more effectively during busy periods in the day, such as during the morning medicines round. Some improvements were needed to the provider’s recruitment practices. People received their medicines, as prescribed, though records for the support people received with some creams required improvement to ensure they were consistently completed. People were protected from the risk of infection. Staff wore personal protective equipment and the home was regularly cleaned.

People were supported by staff who knew how to meet their needs effectively. Staff felt well supported in their roles. 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. People were provided with good quality food options, in line with their individual needs and preferences.

The registered manager had ensured necessary improvements were made to the service since the last inspection. A range of checks and audits were completed to identify issues and continuously improve the service. A new system had been introduced to support the provider to have increased oversight of the management of the home and the quality and safety of the service. People, relatives and staff all provided positive feedback about the way the home was being managed.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 8 August 2020) and the provider was in breach of regulations relating to safe care and treatment and good governance.

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 29 January 2020. Breaches of legal requirements were found. The provider completed an action plan after that inspection to show what they would do and by when to improve the governance systems and the safety of the service.

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 ‘is the service safe?’, ‘is the service effective?’, ‘is the service responsive?’ and ‘is the service well-led?’ as these are the key questions in which we previously identified concerns.

The rating from the previous comprehensive inspection for the key question of ‘is the service caring?’, which was not looked at on this occasion, was 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 Lower Bowshaw View Nursing Home on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the key question of ‘is the service safe?’. 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 re-inspection programme. If we receive any concerning information we may inspect sooner.

Lower Bowshaw View Nursing Home is a care home, providing nursing and personal care and accommodation for up to 40 people some of whom live with dementia. At the time of the inspection, 36 people were living at the service. The service is in one adapted building. There are large communal lounge and dining areas.

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

Not all risks to people's safety and wellbeing were assessed or recorded and improvements were required relating to safe medication practices and procedures. Satisfactory arrangements were not in place to ensure there were enough staff to meet people's needs as the tool used to determine the number of staff required was reliant on up to date needs assessments, which were not evident. Findings from this inspection showed lessons were not always learned and improvements were not made when things went wrong. Staff knew what to do to safeguard people. Safe recruitment practices were in place to make sure the appropriate staff were recruited. People were protected by the prevention and control of infection.

Not all staff training and supervision was timely although the interim manager had a programme to address this. People were supported to access healthcare services and receive ongoing healthcare support. The dining experience for people was positive and people were complimentary about the meals provided. The service worked with other organisations. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, best interest assessments were not completed where bedrails were in place.

Not all people using the service had an up to date care plan in place detailing their current care and support needs. Improvements were required to ensure information clearly recorded people's care and support needs and the delivery of care to be provided. People were able to engage people in activities and supported to participate in social activities within the local community. The service was compliant with the Accessible Information Standard to ensure people's communication needs were met. People and those acting on their behalf were confident to raise issues and concerns.

The provider's quality assurance systems were not frequent or robust enough and did not demonstrate they had systems to assess, monitor and improve the quality of the service effectively. Their audits had not identified the shortfalls in care planning, medicines and risk. The provider and interim manager expressed a strong desire to improve the service.

People's comments about the quality of care and support they received was positive. People told us they were treated with care, kindness, respect and dignity.

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 17 August 2018). There was also an inspection on 29 July 2019 however, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.

Why we inspected

This is a planned re-inspection because of the issue highlighted above.

Enforcement

We have identified breaches in relation to safe care and treatment and governance arrangements at this inspection. Please see the action we have told the provider to take at the end of this report.

Lower Bowshaw View Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 40 people in one building. The home is located in a residential area of Sheffield with access to public services and amenities. At the time of the inspection, there were 31 people living at the home.

The service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Our last inspection at Lower Bowshaw View took place on 31 October 2017. The service was rated Inadequate overall. We found the service was in breach of six of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. Regulation 15, Premises and Equipment, Regulation 14, Meeting Nutritional and Hydration Needs and Regulation 17, Governance, Regulation 18, Staffing, Regulation 10, Dignity and respect and Regulation 9, Person centred care.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions asking if the service was safe, effective, responsive and well led, to at least good. The registered provider sent us an action plan detailing how they were going to make improvements. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of the Regulations.

There was a recently appointed manager at the service. The previously registered manager had left Lower Bowshaw View the month before this inspection. The provider and manager said they intended to apply for the current manager to be registered with the CQC. 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.

People living at Lower Bowshaw View told us they felt safe and they liked the staff. Relatives we spoke with felt their family member was in a safe place and did not have any concerns about their family member’s safety.

The numbers and deployment of staff were appropriate to safely meet the needs of people who used the service.

The home was generally clean, improvements had been made to the environment. There were still some malodours in the ground floor corridors and two bedrooms. The service could not evidence they had completed all recommendations and requirements from the Infection control and prevention audit completed by the Infection Prevention and Control Nurse, NHS Sheffield Clinical Commissioning Group.

We found systems were in place to make sure people received their medicines safely.

Staff were provided with relevant training and supervision to make sure they had the right skills and knowledge to support people.

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 enjoyed the food provided and were supported to receive adequate food and drink to remain healthy.

Some areas of the home still required redecoration and refurbishment of carpets and furniture.

People were treated with dignity and respect and their privacy was protected. People and their relatives made positive comments about the care provided by staff.

A range of activities were available to provide people with leisure opportunities.

People living at the home and their relatives said they could speak with staff if they had any worries or concerns and they would be listened to.

People, relatives, health professionals and staff told us they thought the service was well-led and shared the view there had been significant improvements recently at Lower Bowshaw View.

Lower Bowshaw View is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates 40 people in one building. The home is located in a residential area of Sheffield with access to public services and amenities.

The home was last inspected on 3 January 2017 at which time it was rated overall as requires improvement. There were no breaches of the regulations identified during the inspection, but some improvements were required. Some infection prevention and control practices did not always promote people's safety, staff did not always support people to eat effectively and some quality assurance and audit processes were ineffective.

At this inspection we found that sufficient improvements had not been made to these areas and we found there was now a breach in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 15,Premises and Equipment, Regulation 14, Meeting Nutritional and Hydration Needs and Regulation 17,Governance. We also found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014,Regulation 18,Staffing,Regulation 10,Dignity and respect and Regulation 9, Person centred care.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

This inspection took place on 31 October 2017 and was unannounced. This meant the people who lived at Lower Bowshaw View and the staff who worked there did not know we were coming.

There was a manager at the service who was registered with the CQC. 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 and associated Regulations about how the service is run.

The numbers and deployment of staff were not appropriate to safely meet the needs of people who used the service.

People were not consistently cared for in a safe and clean environment.

Some people’s nutritional needs were not being met. Meal times were not appropriately spaced and some people were not eating for long periods of time.

Although some people and their relatives told us that staff treated people with kindness and were caring, we saw a number of examples where this was not the case and some people’s privacy and dignity were not upheld.

We found people did not always receive care in a person centred way. This was because the deployment of staff meant staff's approach was mainly task and routine focused, which did not take into account people’s own preferences.

Staff were aware of safeguarding procedures and knew what to do if an allegation was made or if they suspected abuse. People told us they felt safe.

We found systems were in place to make sure people received their medicines safely so their health was looked after.

Staff had regular updates to their training and were provided with relevant supervision and appraisal so they had the skills and support they needed to undertake their role.

Staff recruitment procedures ensured people’s safety was promoted.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) code of practice and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice.

People had access to a range of health care professionals to help maintain their health.

People and their relatives were confident in reporting concerns to the registered manager and felt they would be listened to.

Staff told us the registered manager was supportive and communication was good within the home.

There were quality assurance and audit processes in place to make sure the home was running safely. However these were not effective or acted upon to ensure care provided was adequately monitored, risks were managed safely and the service achieved compliance with the regulations.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

You can see what action we told the provider to take at the back of the full version of the report.

There was a manager at the service who was registered with the Care Quality Commission (CQC). 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 and associated Regulations about how the service is run.

Our last inspection at Lower Bowshaw View took place on 15 and 19 October 2015. The home was rated as Requires Improvement. We found four breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in regulations 11: Need for consent, 12: Safe care and treatment, 17: Good governance and 19: Fit and proper persons employed. Requirement notices were given for these breaches in regulation and the registered provider was told to make improvements. On this inspection we checked improvements the registered provider had made. We found some improvements had been made to meet the requirements of these regulations. However, some quality audits had not identified concerns reported to us which meant they were not always effective.

This inspection took place on 3 January 2017 and was unannounced. This meant the people who lived at Lower Bowshaw View and the staff who worked there did not know we were coming. On the day of our inspection there were 35 people living at Lower Bowshaw View.

People spoken with were positive about their experience of living at Lower Bowshaw View. They told us they felt safe and they liked the staff.

We found systems were in place to make sure people received their medicines safely so that their health was looked after.

Staff recruitment procedures ensured people’s safety was promoted.

Whilst we found the home generally clean, information shared by the Clinical Commissioning Group (CCG) showed that infection prevention and control practices did not always promote people’s safety.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role. Staff were provided with supervision and appraisal at appropriate frequencies for their development and support.

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.

A maintenance plan was in operation but parts of the environment and some furnishings were worn and tired which meant people did not always have a well maintained environment in which to spend their time.

People had access to a range of health care professionals to help maintain their health. A varied diet was provided, which took into account dietary needs and preferences so people’s health was promoted and choices could be respected. Whilst staff were available to support people to eat, this was not always effectively managed.

A range of activities were available to provide people with leisure opportunities.

People living at the home, and their relatives said they could speak with staff if they had any worries or concerns and they would be listened to.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. People living at the home and their relatives had been asked their opinion via questionnaires. The results of these had been audited to identify any areas for improvement.

All of the people using the service and their relatives that we spoke with were positive about the home. One comment from a person living at the home included 'They're good lasses [care workers]. They look after us the best they can. It's not easy looking after us all.'

People using the service and their relatives told us that care and treatment was planned and delivered in a way that ensured safety and welfare. A comment from a relative included, 'They look after her needs here well.'

We found that staff received appropriate professional development and support. People who used the service and their relatives were positive about the staff and their skills in providing care. One comment from a relative included "Staff seem fine and happy. They are polite to us and offer cups of tea. They've been good. Very good.'

We found that that there was an effective quality monitoring system to analyse, identify and reduce risk through audit and incident reporting.

We found that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

People told us that the staff looked after them well, they received good care and their health and personal care needs were met. One person said, "I like it here. The carers come and talk to you. They are friendly.'

All the people we spoke with told us that they felt 'safe' and if they had any concerns they would speak to a member of staff. Staff were clear about what their roles and responsibilities were and what action they would take if they saw or suspected any abuse.

We found that people who used the service benefited from sufficient staff to meet their needs.

We found that a complaints policy and procedure was in place. People had been provided with information on how to make a complaint. All of the people spoken with said they had no complaints or concerns about the home.

We identified issues relating to some care records at Lower Bowshaw View nursing home. We found people were not protected from the risks of unsafe or inappropriate care because accurate and appropriate records were not maintained. The service was non compliant with this outcome area.