Archived: Bowlacre Home

Updated 24 August 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to investigation and 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 of falls from heights. This inspection examined those risks.

This inspection took place on 6 and 7 June 2018 and was unannounced on the first day. The first day of inspection was undertaken by two adult social care inspectors 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. This person had experience of this type of service. The second day was undertaken by one adult social care inspector.

Before the inspection we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make. We also reviewed information we held about the service and provider, including notifications the provider had sent us. A notification is information about important events which the provider is required to send us by law. We also asked the local authority and Health watch Stockport for their views on the service. No concerns were raised with us.

During our inspection we spoke with nine people who used the service, four visitors, the provider, the registered manager, a care team leader, two care staff, a domestic worker and the cook.

Some of the people living at Bowlacre Home were not able to clearly tell us about their experiences. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We looked at the environment and the standard of accommodation offered to people. We also reviewed four care files, medication administration records (MARs), four staff recruitment files and training and development records as well as information about the management and conduct of the service.

Updated 24 August 2018

This inspection was unannounced and took place on the 6 and 7 June 2018.

We last carried out a comprehensive inspection of this service on 28 September 2016. At that inspection we found five breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. The breaches related to the safe management and administration of medicines, capacity and consent, infection control, improvements to the environment and good governance. A recommendation was also made with regards to the development of an activity programme. The service was given an overall rating of ‘Requires Improvement’.

Following the inspection, we required the provider to complete an improvement action plan to show how they would improve the key questions; safe, effective, responsive and well led to at least good.

Prior to the inspection we had been made aware of two concerns about the safe care and treatment of people living at Bowlacre. These matters were currently subject to investigation by the local authority.

At this inspection we looked to see if the required improvements had been made. We found three repeated breaches in relation to management and administration of medication, capacity and consent and good governance. A further five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were also identified. These relate to recruitment procedures, fire safety, safe water temperatures, staff training and support and care records. We have also made three recommendations, advising the provider to refer to good practice guidance in relation to legionella, dementia friendly environment and activities and opportunities for people.

Bowlacre Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

The home is a large detached property set back from the main road in its own well-maintained grounds. The building has been adapted and extended over the years to provide accommodation for 37 people. The home is owned and managed by a voluntary housing association. At the time of our inspection there were 26 people living at the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 again found the provider did not have effective governance systems in place to continually monitor and review the service so that required improvements, as found during this inspection, could be identified and acted upon.

Whilst some improvements had been made to the management and administration of people’s prescribed medicines, some issues remained and did not demonstrate a safe and effective system was in place.

The provider did not carry out all necessary recruitment checks prior to new staff commencing employment to ensure that people were kept safe.

Suitable arrangements were not in place to help maintain the safety and protection of people using the service particularly in relation to fire safety and risk of scalding.

Following a recent accident, no action had been taken to minimise potential risks to other people living at the home. We recommend the provider refers to good practice guidance to help identify and mitigate risks so that people are kept safe.

Improvements were being made to enhance the appearance of the home. Whilst some consideration had been given to developing a ‘dementia friendly’ environment, we have recommended the provider should refer to good practice guidance so that facilities help encourage people to maintain their independence and movement around the home.

Suitable arrangements were in place to ensure people were protected against the risks of cross infection. We have recommended the provider refers to guidance on the management of legionella in hot and cold-water systems.

Relevant authorisations were in place where people were being deprived of their liberty. However, care records did not show that capacity and consent had been considered when planning people’s care and support.

Care plans were not always updated to reflect people’s current and changing needs as well as their individual needs, wishes and preferences.

Staff said there was good teamwork within the home and that sufficient numbers of staff were available to meet people’s needs. However, we found staff had not received all the necessary training and support essential to their role so that the current and changing needs of people could be met in a safe and consistent way.

Whilst some activities and opportunities were made available, further consideration was needed to help encourage and support those people less able or living with dementia. We have recommended the provider explores more meaningful activities so that people have a sense of purpose to their day and are actively engaged.

People told us they were happy and well cared for. Whilst some of our observations of staff interactions with people were positive, at times support was task focused and did not always demonstrate people were treated in a dignified manner.

Staff were aware of their responsibilities and knew what to do to protect people from abuse.

People were offered adequate food and drink throughout the day. People told us they were happy with the quality and variety of meals offered.

Staff worked in co-operation with healthcare professionals to ensure that people received appropriate care and treatment.

People and their visitors told us they could raise any issues or concerns with care staff and felt these would be dealt with.

You can see what action we told the provider to take at the back of the full version of the report. 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.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not, enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

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.