Bowood Court & Mews

Bowood Court & Mews is a residential care home providing care and support for up to 93 people. The service is split across 2 buildings on the same site, providing support to younger and older adults, some of whom may have a physical and/or sensory impairment. The larger of the buildings is referred to as Bowood Court and the smaller is Bowood Mews, which specialises in providing care to people with dementia. At the time of our inspection everyone had been supported to move into Bowood Court and the Mews was not in use. There were 59 people using the service.

People’s experience of the service and what we found:

Care plans were comprehensive, personalised and detailed people's current care needs and included how to safely manage any identified risks. The management of medicines was not always safe, however the provider took immediate action following the inspection to address our concerns. Medicines administration was safe, and staff were trained and had their competency checked. There was a safeguarding policy in place and staff knew how to identify and report any concerns. The home was very clean and followed appropriate infection control practices.

There was a training program in place for all staff. Feedback we received about food and drink was mixed. However, kitchen staff were aware of people's preferences and individual risks around food and drink. People were supported to access healthcare and the service facilitated appropriate and timely referrals to other agencies and professionals.

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. Staff we spoke with talked about people in a kind and compassionate manner and were passionate about providing good care. Care plans provided guidance on how to support people, in accordance with their preferences, choices and communication needs. Activities were in the process of improvement and enrichment, and we observed people enjoying the new activities.

Staff were recruited safely as relevant background checks had been completed. Management systems, such as audits and quality assurance, were robust and were now actively used to monitor and improve the service. During this inspection the registered manager resigned, and new manager was employed. People and relatives provided mixed feedback about Bowood Court & Mews. The provider and management team were eager to make the necessary improvements in the service and were working with the local authority as well as external agencies to ensure people received safe and effective care.

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 16 January 2023).

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

When we last inspected Bowood Court & Mews in October 2023, breaches of legal requirements were found. This inspection was undertaken to check whether they were now meeting the legal requirements.

The inspection was also prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk and people’s safety. This inspection examined those risks.

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 comprehensive inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘All inspection reports and timeline’ link for Bowood Court & Mews on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Bowood Court & Mews is a residential care home providing care and support for up to 93 people. The service is split across 2 buildings on the same site, providing support to younger and older adults, some of whom may have a physical and/or sensory impairment. The larger of the buildings is referred to as Bowood Court and the smaller is Bowood Mews, which specialises in providing care to people with dementia. At the time of our inspection there were 51 people were living at Bowood Court and 29 living at Bowood Mews.

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

People were not always protected from avoidable harm and abuse. The provider had an inconsistent approach that sometimes put people’s safety, health or wellbeing at risk. The provider had policies and procedures about upholding people’s rights and making sure diverse needs were respected and met, however, these were not fully understood or consistently followed by staff. Risk management did not always consider the least restrictive option, and this limited some people’s control over their lives and their independence.

Deprivation of Liberty Safeguards and the key requirements of the Mental Capacity Act 2005 were not fully understood. People and their family and friends were not always included in decision making. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There was a lack of consistency in the effectiveness of the care and support that people received.

The provider did not have a consistent approach to supporting staff to maintain their knowledge of best practice. The provider monitored people’s health, care and support needs, but did not consistently act on issues identified.

The leadership and governance of the service did not always support the delivery of high-quality, person-centred care. Support for staff from management was inconsistent. Quality assurance arrangements were not always applied consistently across the service.

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 good (published 09 August 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the management of medicines and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

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.

Enforcement

We have identified breaches in relation to people's safety and the leadership of the service at this inspection.

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

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.

Bowood Court and Mews is a residential care home providing personal and nursing care for up to 93 people aged 65 and over at the time of the inspection.

Bowood Court and Mew is a care home for adults set across two buildings. One larger building is called Bowood Court. Bowood Mews is a smaller building that caters for people with greater support needs in living with dementia.

People felt safe around staff they knew and who were familiar to them. Staff understood how to support people safely and minimise any risks to their health. Staff also understood how to raise any concerns they may have to the management team. People had access to support from staff when needed and from staff who had undergone background checks to review their suitability to work at the home. Staff understood how to minimise the spread of infection.

People were supported by staff whose training was regularly reviewed and updated. People were confident if they required additional medical support and guidance this would be provided. Bowood Court and Mews had recently been redeveloped to improve people's experience of care and day to day living.

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; systems supported this practice.

People were involved in their care planning on a day to day basis as well as a longer term. People were shown kindness by staff who respected their individuality and understood how to demonstrate caring with dignity.

People’s care was reviewed and updated regularly. People understood they could complain if needed.

People’s experience of care was reviewed and where improvements needed, changes made. People were positive about the management of the home and systems were in place to continually check and review the quality of care people received.

Why we inspected

This was a planned inspection based on the previous rating.

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

Rating at last inspection

The service was rated as Requires Improvement (published in November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on 11 September 2019 and was unannounced.

The inspection was partly prompted by an incident which had a serious impact on a person using the service. This indicated potential concerns about the management of risk in the service. While we did not look at the circumstances of the specific incident, we did look at associated risks.

We focused on two of the five key questions we ask of services. Is the service ‘safe,’ and is the service ‘well-led.’ This report only covers our findings in relation to these topics.

The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Bowood Court and Mews 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.

Bowood Court and Mews accommodates 90 people across two units, each of which have separate adapted facilities in a separate building. One of the units is called Bowood Court and the other is called Bowood Mews.

At the time of our inspection, there were 83 people living at the home, a number of whom were living with dementia.

Shortly before the inspection the registered manager resigned from their post. At the time of the inspection an interim manager was in charge at the home. We refer to this person as the manager throughout the report. 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.

Since our last there had been a number of changes in the overall management of the service. This had impacted the effectiveness of the governance and working practices. Experienced and long-standing staff members no longer worked at the home and this posed challenges to the management team.

People’s experience of care at the home was not always reviewed and updated in a systematic manner. Where people had accidents and incidents, these were recorded by staff however were not always reviewed and analysed promptly so that action could be taken to reduce the risk of further occurrences.

Care planning and recording did not reflect people’s experience of care. Accurate fluid and food charts were not maintained. Opportunities to engage with families were not always promoted. Whilst meetings with families had been planned, they did not always take place. Although the registered provider was able to evidence how reviews of care delivered at the home occurred, we saw people’s care was not always reviewed and updated accurately and promptly. Action was being taken to improve people’s experience of care at the home.

People felt safe around staff that understand how to protect people from abuse. People were relaxed and comfortable around the staff supporting them. Staff knew how to report concerns both within the home and to external organisations like the CQC if needed. Training had been provided to staff about keeping people safe and the manager understood their obligations in reporting concerns reported to them.

Staff understood people’s identified risks of harm or injury and overall supported people in line with actions described to mitigate those risks. Risks were recorded in care plans for staff to refer to. People were able to access support from staff when needed. Staff recruited to work at the home had undergone background checks to check they were suitable to work at the home. Staff understood the importance of reducing the risk of infection spreading and had access to protective clothing such as gloves and aprons.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

personal care. The home was split across two building called Bowood Court and Bowood Mews. At the time of the inspection, Bowood Court offered Nursing and personal care and there were 53 people living at the home. Bowood Mews offered specialist Dementia Care and there were 33 people living at that building when we visited. A registered manager was not in post when we inspected the service as they had recently left. However, a new manager had been appointed and was due to commence employment at the home. 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 home is run across two buildings with one registered manager overseeing both sites.

People felt safe around the staff supporting them and relatives felt assured that they could leave their family members there safely. Staff had received training and guidance on protecting people from harm. Staff recognised the signs of abuse and understood how their concerns needed to be escalated to management in order to protect the person from harm. Risks to people’s health had been identified for staff to refer to in order to support people appropriately. People had access to support from staff when they needed and staff underwent background checks to assure the registered provider of their suitability to work at the home. People received help to take their medicines and regular checks were made to ensure people received their medicines correctly.

People felt confident that staff had the training needed to support them. Staff had access to training which was reviewed and updated regularly. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People were offered choices in the meals and drinks they were offered and alternatives were suggested where people did not like any of the meals on offer. Where special diets were needed, people were catered for. Staff worked with other health care professionals to ensure people had access to services that met their healthcare needs. Advice suggested by professionals was incorporated into people’s care.

People liked the staff caring for them and enjoyed their company. People explained to staff how they needed help and staff supported accordingly. Relatives were kept informed about their family member’s health and were involved in making decisions about their care, where appropriate. People were treated with dignity and respected and staff understood how to enable people to maintain their independence.

People’s care needs were assessed and care provided in response to their needs. As people’s needs changed, care was adjusted to ensure people had access to the support they needed. People had access to a variety of activities that they enjoyed taking part in. Friends and relatives were encouraged to visit whenever they chose to. People and their families were offered opportunities to feedback what they thought about the service they received at the home. A number of different methods were used by the management to gather views about the service.

There had been a number of changes within the home in terms of staffing, management and in the ownership of the home. The registered provider had recognised some areas of care at the home needed improvement and was putting into place measures to address these areas. Plans were in place to improve the overall appearance of the home as well as people’s experiences of care.