Bowes House

Bowes House is a residential care home providing personal and nursing care to 81 people aged 65 and over at the time of the inspection. The service can support up to 90 people. The building is divided into four units, each providing specialist support. There are two units for older persons on the ground floor. On the first floor there is a unit providing nursing care and another for people living with dementia.

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

People and their relatives spoke highly of the care and support they received at Bowes House. One person said, “I am very happy with the care, I wouldn’t want to change anything.” A relative told us, “Staff have provided excellent care, promoting dignity and being responsive to people’s needs.”

People were receiving their medicines safely. There were effective systems in place for the management of medicines. Risks to people were assessed and care plans provided clear guidance for staff in how to care for people safely. Staff had received appropriate training and demonstrated an understanding of how to support people who were assessed as being at risk of choking.

There were enough staff to care for people and the process for recruiting new staff was safe. Appropriate infection control procedures for COVID-19 were in place to keep people safe. Staff had received additional training and used appropriate Personal Protective Equipment. Incidents and accidents were used as opportunities to learn and improve practice.

Systems for monitoring quality and managing risks had been improved and embedded. There were effective arrangements to support governance and to provide management oversight. Staff told us there had been improvements in the management of the home. One staff member said, “The new manager has been implementing policy which is good. We are going through good changes.”

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 22 March 2019).

Why we inspected

We received concerns in relation to the management of medicines and management of risks of choking. As a result, we undertook a focused inspection to review the key questions of Safe 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.

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 remained good. This is based on the findings at this inspection. We found no evidence during this inspection that people were at risk of harm from these concerns. The provider had identified shortfalls and taken action to mitigate the risks and this had been effective. Please see the Safe and Well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bowes House 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.

Bowes House is a residential care home that provides personal and nursing care for up to 90 people. At the time of inspection, 76 people were living at the service. People were aged 65 and over and lived with disabilities including dementia, Parkinson’s disease and diabetes.

The building is divided into four units, each providing specialist support. There are two units for older persons on the ground floor. On the first floor there is a unit providing nursing care and another for people living with dementia.

People’s experience of using this service:

People received their medicines on time. Although some medicine records were not always maintained accurately, this had not impacted on people.

People and their relatives spoke positively about the staff and about the service they received. They told us that they felt safe and that there were enough staff to meet their needs. Staff received training in safeguarding and knew how to keep people safe.

People’s dietary needs were met and there was enough to eat and drink. One person told us, “There is so much food, we are spoiled for choice”. People with specific dietary requirements had their needs and preferences met.

Staff supported people with timely access to healthcare and encouraged people to maintain a healthy wellbeing. There was a range of activities within the service and there was plenty of choice available every day.

People said that staff were very respectful. One person said, “Staff are very good and always treat me with dignity and respect, nothing is too much trouble for them”. We were told that people felt supported by staff who knew them well and understood their wishes.

Care was provided by knowledgeable staff who were trained to carry out their roles. Training and observations of staff practice as well as supervision, ensured that staff were competent in their roles.

People and their families were involved in the planning of their care and their individual needs and preferences were known and understood by staff. There was an up to date strategy for providing dementia care and staff received bespoke training to ensure they had the skills needed to provide a tailored and person centred model of care. Staff demonstrated compassion for people’s wellbeing and a shared commitment to enhancing the quality of life for people. They had worked with people living with dementia to redesign the care provided and the ethos of a person centred model of care was clearly imbedded by the way every member of staff interacted with people.

The environment was purpose built and described by one person as, “Bright, spacious, clean and just right for me”. People had their own bedrooms and bathrooms and said that they liked the fact that visitors and family pets were welcome at any time.

Staff knew how to address concerns. People felt listened to and said that they had the opportunity to raise concerns, ideas and share their experiences.

The service was well led by a management team who were skilled and knowledgeable. They demonstrated compassion and commitment to the needs of people who used the service.

The management team worked professionally with agencies outside of the service and ensured a transparent and open approach.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems supported this practice.

Rating at last comprehensive inspection:

Good. (Published 7 September 2016).

Why we inspected:

We inspected the service as part of our inspection methodology for ‘Good’ rated services.

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

Bowes House is owned by the organisation Care UK Community Partnerships Limited. The service is purpose built and provides accommodation and facilities over two floors. Split into four units, the units include; Aylesham (Elderly Residential), Weald (Nursing care), Barley (Rehabilitation) and Meadow (Dementia). Local school children were involved in the naming of each unit.

The service had a registered manager in place. 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 Bowes House in August 2016 when the service was rated 'Good'. After that inspection we received concerns in relation to poor staffing levels at night. This was a focussed inspection in response to these concerns. We looked at these concerns under the key question 'Is the service safe?’ You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bowes House on our website at www.cqc.org.uk.

Systems were in place to calculate staffing levels and the provider used an electronic dependency tool known as CAPE. Staffing levels were reviewed monthly or sooner. Not all staff vacancies had been recruited to and the provider was using agency staff to maintain staffing levels. Staff recognised the need for agency staff but felt it had an impact. One staff member told us, “We are using agency staff whilst recruiting. We try and get the same agency staff but it isn’t always possible. It then means we have to explain to them what to do, induct them and that takes time away from what we need to do.” Staff rotas confirmed that staffing levels were being maintained with input from agency staff. The management team told us that staff turnover and use of agency staff may compound people’s feelings that there isn’t enough staff.

People told us they felt safe but felt staffing levels could be improved. People confirmed that although staff answered their call bell promptly, they were then advised that staff would return but often that would take a long time. One person told us, “I hear, I’ll be a back a lot.” We have identified this as an area of practice that needs improvement and have made a recommendation about responding to call bells.

People were protected by a safe recruitment system. Each personnel file had a completed application form listing their work history as wells as their skills and qualifications. Nurses employed by Bowes House had registration with the Nursing and Midwifery Council (NMC) that was up to date.

Safeguarding adult's procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to. People's medicines were managed appropriately and people received their medicines as prescribed by health care professionals.

Risks to people's wellbeing were assessed and staff knew what action they needed to take to keep people safe. People had individual evacuation plans outlining the support and equipment they would need to safely evacuate the building.

Bowes House is owned by the organisation Care UK Community Partnerships Limited. The service is purpose built and provides accommodation and facilities over two floors. Split into four units, the units include; Aylesham (Elderly Residential), Weald (Nursing care), Barley (Rehabilitation) and Meadow (Dementia). Local school children were involved in the naming of each unit.

The service had a registered manager in place. 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.

At the last inspection undertaken on the 15 and 16 March 2015, we asked the provider to make improvements in relation to care plans and risk assessments to ensure sufficient guidance was provided to staff to provide safe care. This included the care for people who had lost weight. In addition, we asked the provider to make improvements to the opportunities available for meaningful activities, encouraging those receiving rehabilitation to self-administer their medicines and for care plans to be personalised to the individual. The provider sent us an action plan stating they would have addressed all of these concerns by October 2015. At this inspection we found the provider was meeting these regulations and had acted upon the recommendations made.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLs) which applies to care homes. Applications to restrict people’s freedom had been submitted to the appropriate DoLS office and people had individual DoLS care plans. However, staff were not consistently aware of who was subject to a DoLS authorisation and what it meant for the individual. We have made a recommendation for improvement.

The principles of the Mental Capacity Act (MCA) were not consistently embedded into practice. Further work was required to clearly demonstrate whether people had consented to their care plan, photograph being taken or sharing of information. We have made a recommendation for improvement.

Staff had completed training to enable them to carry out their roles. There was an ongoing programme of training and development for staff. Upon commencing employment with the provider, staff were subject to an induction. However, documentation was not consistently completed to evidence when staff had finished their induction and were deemed competent to work alone. Where concerns had been raised regarding the competency of staff, we could see that individual action had been taken, however, documentation failed to evidence how the management team had oversight of staff's progress and how they continually assessed staff’s competency. We have made recommendations for improvement.

People’s nutrition and hydration needs were met. The kitchen team were dedicated and passionate about providing good quality food which in return promoted people’s quality of life. People were provided with a wide range of food options and individual dietary requirements were catered for. Where people had not met their daily fluid intake target, further work was required to ensure this was effectively shared with staff to ensure all staff encouraged people to drink more that day.

There were appropriate arrangements in place for monitoring the quality of the service that people received. The provider took into account the views of people, relatives and staff through surveys. The results were analysed and action was taken to make improvements for people living at the home. The registered manager carried out unannounced visits to the home to make sure people were receiving appropriate care and support. Staff said they enjoyed working at the home and they received good support from the management team.

People said they felt safe and staff treated them well. One person told us, “I feel extremely safe living here. Although it was hard moving in I knew I wasn’t safe living by myself. Living here, there are staff available at all times and I know I’m safe.” Appropriate recruitment checks took place before staff started work. There were enough staff on duty and deployed throughout the home to meet people's care and support needs.

Safeguarding adult's procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to. People's medicines were managed appropriately and people received their medicines as prescribed by health care professionals.

People had access to relevant healthcare professionals to maintain good health. Records confirmed that external healthcare professionals had been consulted to ensure that people were being provided with safe and effective care. People's clinical needs were assessed and met. People received good health care to maintain their health and well-being.

Dedicated activities coordinators were in post who provided a wide range of interaction, engagement and stimulation. One person told us, “The activity coordinator who takes us out on the bus is fantastic, they design trips to see places we have not been before and the trips are very interesting and informative, I really enjoy their outings.” A visiting relative told us, “Staff are quite responsive and try to encourage mum to do activities.” Further work was underway to ensure that those who did not enjoy group activities, were not at risk of social isolation.

People’s privacy and dignity was respected and staff had a caring attitude towards people. We saw staff smiling and laughing with people and offering support. There was a good rapport between people and staff.

Feedback from people and their relatives was positive about the care, the atmosphere in the service and the approach and openness of the staff and registered manager. Comments included, “I am very happy here and would not have any difficulty recommending Bowes House to my friends, I have been made to feel very welcome. I cannot fault it.”

We spoke with six people who used the service, three relatives, two health care professionals, the lead nurse, four care staff, the manager and regional manager. We spent time with people living in the home and observed interaction they had with each other and the staff.

Staff said they asked people for their consent before they provided support. We found evidence that people were encouraged to make choices and observed staff treated people with respect and dignity.

We examined four care plans and found that they were based on people’s individual support needs. The care workers we spoke with demonstrated a good understanding of people's needs and how these were met.

Safeguarding procedures and policies were in place and the home used them as required to ensure people’s safety.

We reviewed the systems used to support staff, including supervision and training. We found that staff had attended appropriate training, and that they felt that this enabled them to provide the support that people wanted.

Systems were in place to assess and monitor the services provided by the home. Complaint policies and procedures were in place, and staff said people were encouraged to discuss the support they received.