Bowerfield House

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People told us staff were good at supporting them. We noted that people’s weight was generally stable and appropriate referrals to external services were made when needed. There was evidence that the staff team worked well together and worked effectively with external agencies where this was required. Further work in relation to the application of the Mental Capacity Act and best interest decisions and the management of the needs and conditions for people who were subject to restrictions for their own safety was needed.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Families told us their relative had their needs assessed prior to moving in the home. People’s assessed needs had been used to develop plans of care and generally people felt their needs were being met.

Staff told us information about new admissions was communicated to them prior to the person’s admission and they were therefore aware of the person’s needs and the action they needed to take. The management team and staff told us how they had learnt lessons about how they assess and ensure they can meet people’s needs prior to admission.

The home used an electronic care planning system and information about people’s initial and current assessments was available, alongside risk assessments about people’s specific needs including their nutritional assessments, skin integrity assessments and choking and falls risk. These assessments appeared to be reflective of people’s current needs. However, some shortfalls were noted in how staff completed dynamic assessments of people’s needs. For example, staff continued to move a person who needed to weight bear for this to be done safely, even though they were not able to do this at that time. This was observed by the inspector and a member of the providers quality support team and this person was supported to have their moving and handling needs reassessed.

People told us they were supported to access services and support as needed. Families told us they were kept up to date of any changes. People felt aspects of the food served could be improved. People were supported well with their skin integrity and where people had wounds, these were healing. However, some aspects of care were not delivered in line with the assessments in relation to repositioning and mattress settings and people did not consistently have access to fluids, especially when in bed. This was immediately addressed by the management team after we had identified the concerns.

Staff understood people’s needs and generally recognised where additional support might be needed, for example encouragement to eat and drink. The new manager had plans to review the menus for people to ensure they met people’s dietary needs and preferences.

People were supported to access care and treatment which was in line with best practice. For example, people at risk were supported to eat well, provided with meals with extra calories and we saw additional snacks were offered throughout the day. Dietetic advice was sought and the use of additional supplements to support nutrition were provided where this was needed. Drinks were provided by staff throughout the day but not everyone had access to fluids when in their bedroom or at nighttime. This was quickly addressed by the management team for the people where this was appropriate.

People told us that staff worked together to meet their needs.

Staff gave positive feedback about how they worked together with each other and with other professionals. Staff told us they understood the importance of taking action following advice from healthcare professionals.

Partner agencies fed back they had no concerns about how the staff and manager at Bowerfield House worked with them to meet people’s needs.

There was evidence that suitable systems were in place to access advice and support from other services where needed. The provider has learnt lessons from incidents to ensure specialist advice was sought where needed.

People told us they were supported to access medical advice and support where needed. They spoke positively about how they were supported to eat and drink, although some felt the food provided could be improved. It was not always evident people had access to regular fluids and a varied diet in line with their preferences.

Staff generally showed us they understood people’s needs and recognised where additional support and input might be needed to help people live health lives.

People’s needs were regularly reassessed and reviewed and action taken to ensure people’s health needs were met, for example, to reduce risks associated with weight loss. There were processes for oversight of needs which ensured that referrals were made where needed. People’s skin integrity needs were generally being met, although further improvements to ensure repositioning needs were consistently met was needed. Where people had skin damage, these wounds were being well monitored and improving. Like other care services there were challenges in supporting people to access dental input but it was not always evident that people were receiving the regular oral care needed or that there was sufficient oversight of this.

People were happy with how they were supported and had no concerns about the care they received. People felt that they were provided with care which met their needs and supported them to be independent and make choices.

Staff understood the importance of monitoring people and completing regular checks.

Systems were in place to ensure people’s needs were monitored and action taken where risks or needs were identified. People’s needs were reviewed frequently and, overall, records reflected that people’s needs were being met. Further development in how the electronic care recording system was used by staff to maintain accurate and contemporaneous records was needed to ensure care and checks completed were reflective of the action staff had taken. For example, where mattresses pressure setting checks were completed that these had been done and ensured that the setting of the air flow mattress was correct for the persons weight. On the first day of the site vist we noted people did not have ready access to fluids overnight and were not meeting the fluid targets they were assessed as needing. Whilst this had been discussed with staff it was not clear that action to address this shortfall had been effective or embedded.

People told us staff asked consent before providing support and this was generally how we observed care being delivered. Families felt that appropriate care was provided and that people’s needs and risks were met.

Staff showed they understood the importance of asking consent before providing support and this was generally reflected in their practice.

The service completed assessments and best interest decisions in line with the requirements of the Mental Capacity Act. However, this did not always demonstrate that a least restrictive approach had been taken or that the appropriate people had consistently been involved in making the decisions. Applications for legal authorisation where people were subject to restrictions were in place through the Deprivation of Liberties Safeguards (DoLS) and although conditions to these restrictions were noted, it was not always clearly evidenced that conditions to the DOLS were being complied with. Consent to care records was not always accurately maintained within the electronic system.