Bowerfield House

Updated 5 April 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the IPC measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Bowerfield House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Bowerfield House is a care home with nursing care. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with CQC. This meant the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced. Inspection activity started on 02 February 2022 and ended on 17 February 2022. We visited the service on 02 February 2022 and 09 February 2022, we remotely reviewed documents on 16 February 2022 and provided feedback on 17 February 2022.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with two people who used the service and three relatives about their experience of the care provided. We spoke with 11 members of staff including the manager, regional director, service support practitioner, nurses and care workers. We reviewed a range of records. This included three people's care records and various medication records. We looked at three staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the manager and regional director to validate evidence found.

Updated 5 April 2022

About the service

Bowerfield House is a nursing home providing accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for up to 26 people. At the time of the inspection 23 people were using the service. The nursing home accommodates people across two floors in one building.

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

Medicines were not managed safely, stock levels did not always match with records, medicines administration was not always being recorded and opened bottles of medicines and tubes of creams were not always dated when opened. The home was clean and tidy, though various infection prevention and control (IPC) practices and procedures were either not in place or not being followed. The manager implemented some of these processes during the inspection. Staff were safely recruited, and staffing levels were adequate, though the home did use a high level of agency staff. People were safeguarded from abuse and there were a variety of necessary risk assessments in place. The home was working towards improving their compliance rate for some training in areas including IPC and fire training.

There were some governance concerns in the home in relation to audits and gaps in paperwork. The service did not have a registered manager in post and there were only limited recent lessons learned documents in place. Staff spoke positively about the new manager and told us they enjoyed their roles. The manager told us they were working to improve and increase the number of meetings for people and their relatives. The service had recently sent surveys out to families and were awaiting their responses.

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 25 June 2021). At our last inspection we recommended the provider continues to review staffing levels. At this inspection we found the home had managed to keep a consistent level of staffing, though this was topped up by high use of agency staff.

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about IPC. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with governance, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led. We looked at IPC 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 the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

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 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 report. The provider has taken some immediate action to mitigate risk, however some improvements/actions will take time to embed.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bowerfield House on our website at www.cqc.org.uk.

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 and will take further action if needed.

We have identified breaches in relation to IPC, medicines management and governance at this inspection. Please see the action we have told the provider to take at the end of this report. 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.