Bowerswood House Residential Home Limited

Bowerswood House Residential Home Limited is a care home providing personal and nursing care for up to 24 people. The home is set on two levels. There is a lounge and dining room located on the ground floor. Bedrooms are located on both floors and there is a lift to the second floor.

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

Governance systems were implemented to drive improvements at the home and further audits were being introduced to identify shortfalls.

People were supported by staff who had undergone sufficient recruitment checks to help ensure they could support people who may be vulnerable. Staffing was arranged so people had their needs met quickly and staff undertook training and supervision to maintain their skills.

Medicines were managed safely and staff had been assessed as competent to administer medicines. There was a safeguarding policy to ensure staff could raise concerns if they believed people were at risk of harm. The environment was clean, and refurbishment was taking place at the home. Equipment was serviced to check it was safe to use.

Risks to people were assessed and documented. If people needed medical advice this was arranged for them and changes made to their care to support their well-being. People were provided with a choice of meals and snacks and were supported by staff to eat and drink if this was needed. Staff knew the help people needed to remain safe and people spoke highly of the staff.

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 able to take part in activities they enjoyed and there was an organised programme of activities for people to take part in. People told us they were happy at the home and were confident any comments or complaints would be resolved.

People were consulted and asked their views on the service provided. Surveys were available to enable people to share their views. Audits and checks were carried out to see if improvements were required. There was a documented action plan to enable management to check required actions were being completed.

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 30 July 2020). We found the improvements were required and the provider was in breach of regulations. Medicines were not managed safely, and audit systems had not identified the shortfalls we found on inspection. 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 announced focused inspection of this service on 15 July 2020. A breach 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 care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We also checked recommendations we had made to improve the service. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements and recommendations.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions 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 Bowerswood House Residential Home 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.

Bowerswood House Residential Home Limited is situated near the village of Nateby. There is a lounge and a separate dining room for people to enjoy. Parking is available outside the home.

We found the following examples of good practice.

¿ The provider had ensured staff could access comprehensive and informative training in various aspects of infection control. Staff confirmed they felt confident in the training and this helped them deliver care based on best practice.

¿ The environment had been arranged to minimise the risk of infection and was clean and clutter free.

¿ Information was gathered from visitors to help minimise the risk and spread of infection.

¿ Processes to minimise the risk of infection were carried out by staff. For example, temperature checks and increased cleaning of the home took place.

¿ Covid 19 policies and risk assessments were available.

¿ Checks and audits were carried out on the cleanliness of the home and action taken if this was needed.

¿ Adequate handwashing facilities, infection control gel and personal protective equipment (PPE) was available to support best practice.

¿ Staff supported people to use electronic tablets and a designated telephone was provided to help people maintain contact with loved ones.

¿ People were supported to access health professional advice and care records were updated to reflect the advice.

¿ The service was taking part in the whole home testing process. People at the home were supported to decide if they wanted to participate. If people were unable to make this decision for themselves, best interest discussions were held with relatives and documented.

¿ Appropriate signage was displayed throughout the home to promote best practice.

Further information is in the detailed findings below.

About the service

Bowerswood House Residential Home Limited is a residential care home providing personal care to 17 older people at the time of the inspection. The service can support up to 24 people.

Bowerswood House Residential Home Limited is situated near the village of Nateby. There is a lounge and a separate dining room for people to enjoy. Parking is available outside the home.

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

There is a history of not meeting legal requirements and people were at risk of avoidable harm. Medicines were not always managed safely which placed people at risk of harm.

The service was not being well-led. Auditing systems did not always identify the concerns found during the inspection and documentation was not always completed accurately.

Notifications were being made to the commission as required, however there was no policy to guide staff. We have made a recommendation about providing written information for staff.

The last fire risk assessment was completed in 2018. We have made a recommendation about the formal review of fire risk assessments.

People said they were happy at the home and they liked the staff. People were cared for in a clean and homely environment by staff who were caring, competent and keen to improve the service provided.

Recruitment procedures were followed to ensure staff were suitable to work with people who may be vulnerable. People were supported by staff who had time to spend with them and risk assessments were completed to help ensure risks to people were identified and managed.

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 inadequate (published 5 May 2020) and there were three breaches of regulation. At this inspection enough improvement had not been made and sustained and the provider was still in breach of regulations.

This service has been in Special Measures since 3 February 2020.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 30 October and 5 November 2019. Breaches of legal requirements were found. The provider sent us written assurances and documentary evidence of the action they had taken to improve the service in relation to safe care and treatment, good governance and the notification of incidents.

We carried out this focused inspection to check made improvements 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.

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 inadequate to requires improvement. 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 Bowerswood House Residential Home Limited on our website at www.cqc.org.uk.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

The provider responded quickly to our concerns and has taken action to mitigate risk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to the safe management of medicines, record keeping and audit systems.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. In addition, we will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘requires improvement.’ The service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Bowerswood House Residential Home Limited is situated near the village of Nateby. There is a lounge and a separate dining room for people to enjoy. Parking is available outside the home.

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

There is a history of not meeting legal requirements and people were at risk of avoidable harm. Medicines were not always managed safely which placed people at risk of harm.

The service was not being well-led. Auditing systems did not always identify the concerns found during the inspection and risk assessments to support people’s safety were not always completed. Statutory notifications were not always sent to the Care Quality Commission as required by regulation and the rating displayed at the service did not relate to the previous inspection. Care records did not always contain person centred information to support staff to give person centred care.

Oral health assessments were carried out. There were no specific care records to instruct staff on how oral health was to be promoted. We have made a recommendation about the documentation of people’s oral health care needs.

People were treated with dignity and respect and staff we spoke with told us how they respected people and ensured their privacy and dignity was maintained. People could express their end of life wishes.

People were consulted and asked their views on the service provided. The registered provider reviewed surveys completed by people and relatives to assess their satisfaction with the service. Any comments were actioned whenever possible. People told us they were happy at the home and were confident any comments or complaints would be resolved.

People were cared for in a clean and homely environment by staff who were caring, competent and knowledgeable about people's needs. Training and supervision was arranged to ensure staff had the skills to carry out their role. People described staff as, "very patient” and told us they enjoyed the activities provided and were supported to take part.

People spoke highly of the meals and snacks they received at the home. Alternatives were provided if people wanted these. People also told us they were supported to see other health professionals if this was required and documentation recorded this.

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.

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 31 October 2018) 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 they would improve. This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found not enough improvement had been made and sustained. Please see the safe, effective, responsive and well-led sections of this full report. You can see the action we have told the provider to take at the end of this report.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Bowerswood House Residential Home Limited is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home is a large country house set in its own grounds and offers residential support to older people. Bowerswood House Residential Home Limited can support up to 24 people in mostly single en suite bedrooms. Rooms are on ground or first floor levels with lift access. There are large communal areas including two lounges and a dining room. There are gardens with raised beds for people to access if they wish. The home is a short drive from the town of Garstang.

At our last inspection in June 2016 the service was rated as ‘Requires improvement’. We identified a breach of Regulation 12 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014. We found people could not be assured that medicines were managed safely. We took regulatory action and served a warning notice for this breach in regulation.

At this inspection in September 2018 we found medicines management had improved but further improvements were required to ensure that medicines were managed safely. For example, records did not always inform staff of the support people required in relation to their creams and records were not consistently completed accurately. This was a breach of Regulation 12 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014.

We looked at the arrangements in place for the prevention of infection. We saw a bathroom required attention as it was not visibly clean, clean laundry was stored in open baskets where soiled laundry was washed, and hand washing facilities did not minimise the risk and spread of infection. This was a breach of the Regulation 12 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection in September 2018 we found records in relation to the management of the home and a staff recruitment record, were not complete. We also found audits had not identified the concerns we had identified in relation to the safe management of medicines and the prevention of infection. This was a breach of Regulation 17 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014.

You can see the action we told the provider to take in the full version of the report.

Care records contained information regarding risks and guidance for staff on how risks were to be managed. We found two care records required updating as further information was required regarding the needs of the people they related to. We also viewed food charts relating to two individuals in the home and saw these did not specify the amount of food people had eaten. We have made a recommendation about the recording of care and nutritional information.

Staff told us they were recruited safety, received regular training activities and they felt supported by the registered manager. Staff told us they had supervision and meetings to discuss their training needs and any concerns they had. We noted some meetings with staff were recorded informally. We have made a recommendation regarding the recording of staff meetings.

We found some information was recorded regarding people’s end of life wishes and the deputy manager and registered manager told us they were planning to seek further guidance regarding the documentation of people’s end of life wishes. We have made a recommendation regarding end of life care planning.

At the time of the inspection visit there was a manager in place who was registered with the Care Quality Commission. 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.

People told us they had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was appropriate. People and relatives told us they were happy with the care at support provided at Bowerswood House Residential Home Limited.

People told us they could raise their views with staff and these were listened to. We saw minutes of meetings where people at the home were informed of changes and were asked their opinion on the service provided.

People told us they had a choice of meals to choose from and they enjoyed the meals provided. We observed the lunchtime meal. We saw people were given the meal of their choice and were offered more if they requested it. Staff were available to help people if they needed support.

Staff we spoke with knew the needs and wishes of people who lived at the home. Staff spoke fondly of the people they supported and said they cared about them and their wellbeing. Staff were gentle and patient with people who lived at the home and people told us they felt respected and valued.

Relatives told us they were consulted and involved in their family members care. People we spoke with confirmed they were involved in their care planning if they wished to be and staff treated them kindly and with respect.

Staff we spoke with were able to describe the help and support people required to maintain their safety and people who lived at the home told us they felt safe.

Staff told us they were committed to protecting people at the home from abuse and would raise any concerns with the registered provider or the Lancashire Safeguarding Authorities so people were protected.

There was a complaints procedure available at the home. People we spoke with told us they had no complaints, but they if they did these would be raised to the registered manager or staff.

People and relatives we spoke with told us they were happy with the staffing arrangements at the home. We observed staff spending time with people and the atmosphere was relaxed and unhurried. Staff we spoke with told us they had the time to support people in a calm and unrushed way.

People told us there were a range of activities provided to take part in if they wished to do so. People told us they were asked if they wanted to take part in activities and if they declined, their wishes were respected. Staff told us they reminded people of the activities available.

The registered manager demonstrated their understanding of the Mental Capacity Act 2005. People told us they were enabled to make decisions and staff told us they would help people with decision making if this was required. People are supported to have maximum choice and control in their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Relatives we spoke with told us they were could speak with the registered manager if they wished to do so and they found the registered manager approachable.

This is the third time the service has been rated Requires Improvement.

Further information is in the detailed findings below.

Bowerswood House is a large country house set in its own grounds. The home offers residential support to older people. The home can support up to 24 people in mostly single en suite bedrooms. Rooms are on ground or first floor levels with lift access. There are large communal areas including two lounges and a dining room. The home is a short drive from the town of Garstang.

At the time of the inspection visit there was a manager in place who was registered with the Care Quality Commission. 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.

We last inspected Bowerswood House in October 2015. The registered provider did not meet the requirements of the regulations during that inspection as multiple breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. Breaches were identified in good governance, consent to care and treatment, staffing and safe care and treatment.

Following the inspection the registered provider sent us an action plan detailing how they would achieve compliance with the regulations. At this inspection visit we checked to see if they had followed their plan and found some improvements had been made.

During this inspection visit carried out in June 2017 we found good practice guidelines were not consistently followed to ensure people received their medicines safely. We found medicines were not always stored safely and medicine records were not always accurate. In addition we found one person was managing their own medicine but we found the records and care planning about this were not accurate. We saw medicines were sometimes administered without consideration for people’s dignity and checks in place had not identified the improvements required in the safe management of medicines. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Safe care and treatment.)

At this inspection we found some improvements had been made. We found staff had access to a range of refresher training to enable them to update their skills. This included training in moving and handling, safeguarding, the Mental Capacity Act and Deprivation of Liberty training. Staff told us they received supervision and they could approach the registered manager or the deputy manager if they wanted clarity or had any concerns.

We found improvements had been made to the environment. We saw window restrictors had been fitted to windows, PEEPS were in place and fire doors were closed.

The registered manager carried out checks to ensure improvements could be identified. These included checks on care records, attendance at training and accidents and incidents. There was a quality survey in place, which was provided to people who lived at the home. This enabled people to give feedback on the service provided.

We reviewed documentation which described the care and support people required. The documentation we viewed contained the social histories and interests of people who lived at the home. We saw if people required advice from other health professionals, referrals were made appropriately.

We observed care and support being provided in a safe way and people told us they felt safe. One person told us, “I feel very safe here.”

Staff were able to explain the actions they would take if they were concerned someone was at risk of harm or abuse. They told us they would report concerns to the registered manager, the Care Quality Commission or the Lancashire Safeguarding Authorities so further investigations could take place. One staff member was unclear on the processes in place to report concerns externally. We discussed this with the registered manager to enable further action to take place.

We checked to see if people without mental capacity were lawfully deprived of their liberty if this was necessary. We found appropriate applications to deprive people of their liberty were made to the local authorities as required.

We reviewed staff files and found there were processes that ensured staff were suitably recruited. Staff we spoke with confirmed checks had been carried out prior to starting work at the home.

We discussed staffing with people who lived at the home. People and their relatives told us, “I don’t have to wait for help.” And, “There’s no concerns with staffing.” During the inspection we saw staff were patient and kind with people who lived at the home. We saw people were supported at a pace appropriate to their individual needs.

People who lived at Bowerswood House Residential Home Limited told us they considered staff were caring. One person told us, “The staff are simply superb.” We observed people being supported with kindness and compassion.

People who lived at the home told us activities were available for them to participate in if they wished to do so. One person said, “People very often come in.” And, ““I go to the musicals and I like the film afternoons.”

There was a complaints policy available at the home. People told us they would talk to staff if they had any concerns.

People told us they enjoyed the meals provided. We observed the lunchtime meal and saw this was a positive experience for people who lived at the home. Staff gently encouraged people to eat and we saw people enjoyed their meal.

People who lived at the home told us they could speak with the registered manager if they wished to do so. We saw meetings were held for people to express their opinions and people who lived at the home and their relatives told us the manager was approachable.

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

We visited the home on 5th November 2013 and found that the provider had made the necessary improvements to achieve compliance.

People told us they were able to consent to their care and treatment and we saw the home had assessed people when they had concerns about their capacity. One person told us, 'I like to be left in peace and this is our agreement and understanding. They are very nice people (staff) who respect my wishes'.

We saw that the home had revised the menu in consultation with people living at the home and had made suitable arrangements for the storage of food products.

We saw that monitoring quality had improved and the provider had recognised that they could still improve the quality assurance process.

Relatives and people living in the home we spoke with said they felt safe and had confidence in the staff. One relative said, 'My mother has been here for four years and I wouldn't leave her here if I wasn't happy with how she is treated.'

We spoke with people living at the home about the food provided and its nutritional standards. People seemed generally happy with the standard of the food but were unsure about the choices they were offered. One person said, 'I get asked if I want what is offered, if I decline I can always have an egg.'

We spoke to people living in the home about the suitability of staff. Everyone we spoke with said the staff were very nice. One person said, 'The staff do very well taking good care of us all.'

The home did not have a standard quality monitoring system. We were not given any evidence to support the home had undertaken appropriate assessment of health and safety including risks associated with the kitchen.