Bowerfield Court

Updated 17 February 2023

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 infection control and prevention measures in place. 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 1 inspector, a medicines inspector, a nurse specialist advisor and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Bowerfield Court 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 Court is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a manager in post who had begun the process of registering with CQC to be the registered manager. At the time of the inspection this process had not yet been completed.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. This included any information of concern and notifications the service is required to submit regarding any significant events happening at the service. We sought feedback from the local authority, professionals who work with the service and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. 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 reviewed staffing levels and walked around the building to ensure it was clean and a safe place for people to live. We observed how staff supported people and provided care.

We spoke with 11 people who use the service, 2 relatives and 16 members of staff, including the manager, nurses, senior care workers, care workers, and auxiliary staff including the activity worker.

We reviewed a range of records including 8 people's care records. We looked at 4 staff files in relation to recruitment, training and support. A variety of records relating to the management of the service, including policies and procedures were examined.

During the inspection we looked at people’s electronic medicine records and other medicine related documents. We observed medicines administration on both floors of the home and spoke to 4 members of staff about the management of medicines.

We continued to review evidence and seek further clarification during and following the inspection.

Updated 17 February 2023

About the service

Bowerfield Court is a nursing home providing accommodation for people who require nursing or personal care and treatment of disease, disorder or injury for up to 40 people. At the time of the inspection 35 people were using the service. The nursing home accommodates people across two floors in one building, with shared communal living and dining areas and outside space, and single person bedrooms with ensuite facilities.

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

People felt there was not always enough staff to support them when they needed assistance, although they told us generally staff were kind and caring and worked hard. Records did not easily allow oversight to ensure safe recruitment processes had been completed, or that staff had received all the relevant training needed for their role.

The new management team were working hard to address any shortfalls identified within the home. There were suitable audits which were identifying issues and required actions. However, this had not yet been embedded and there were still areas of shortfall regarding care plans and record keeping. People and staff spoke very positively about the new management team and felt that improvements were being made.

Medicines were mostly managed safely. However, some records necessary for the safe and responsive administration of medicines were not in place and we have made a recommendation about this.

The care home was clean and tidy and there were appropriate checks of equipment and throughout the building. There were systems in place to ensure staff knew people’s current needs and the new manager had oversight that these were being appropriately managed such as wound management.

People were mostly supported to have 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. However, records did not always reflect how people were involved in developing and reviewing aspects of their care, or that information about a person’s capacity and any restrictions was accurate and up to date.

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 05 May 2022). The service remains rated requires improvement. This service has been rated requires improvement for 2 consecutive inspections.

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 in some areas and the provider was no longer in breach of regulation 12. However, at this inspection we found the provider remained in breach of regulations 17 and regulation 18.

At our last inspection we recommended that the provider review their process for recruitment and regulatory requirements to ensure they are following suitably robust processes. At this inspection we found the processes in place did not allow for easy oversight and further work was needed in this area.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 08 March 2022. Breaches 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 safe care and treatment, good governance and staffing at 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 Safe, Responsive and Well-led which contain those requirements.

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 remained 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 Bowerfield Court on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified ongoing breaches in relation to staffing and the overall governance of the service. We have made a recommendation in relation to medicine administration records.

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