We inspected Bowbridge Court on 23 and 24 July 2018. The inspection was unannounced. Bowbridge Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Bowbridge Court accommodates up to 54 people in one purpose built building, which is split across three floors. On the day of our inspection 41 people were living at the home.

Bowbridge Court was rated as requires improvement at our last inspection in April 2018. During this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, safeguarding and governance. 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 the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was a registered manager in post at the time of our inspection. 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.

During this inspection we found ongoing concerns about the safety of people living at the home. Sufficient action had not been taken to protect people from the behaviour of others living at the home, this placed people at risk of harm. Systems to review and learn from accidents and incidents were not fully effective. Action was not always taken to protect people from improper treatment or abuse, and referrals were not consistently made to the local authority safeguarding adults team. People were not always protected from risks associated with their care and support, such as falls.

Medicines were stored and managed safely and people received their medicines as required. Improvements were underway to ensure the home was clean and hygienic and effective infection control procedures were in place.

Improvements had been made to ensure people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported by staff who had training and supervision. Overall, staff were skilled and knowledgeable. People had enough to eat and drink, mealtimes were positive sociable experiences and people were offered choices. Where people had risks associated with eating and drinking these were managed safely. People had access to healthcare and their health needs were monitored and responded to. Improvements were underway to ensure people’s health needs were fully reflected in their care plans. There were systems to share information between services to ensure care was person centred. The environment was adapted to meet people’s needs and people had been involved in the decoration of the home.

Staff were kind and caring in their approach and treated people with dignity and respect. Support was person centred and based upon those things that mattered most to people. People were involved in day to day decisions about their care and support. There were links with local advocacy services to enable people to express their views if needed. People’s right to privacy was respected and independence was promoted and encouraged.

People received the support they required from staff who had a good knowledge of their needs, wishes and preferences. Overall, care plans were detailed and reflected people’s needs. People were given the opportunity to discuss their end of life wishes and were given compassionate support at t

We inspected the service on 17 and 19 April 2018. The inspection was unannounced. Bowbridge Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Bowbridge Court accommodates up to 54 people in one purpose built building, which is split across three floors. On the day of our inspection 41 people were living at the home.

Bowbridge Court was rated as inadequate at our last two inspections which were in April and December 2017. During this inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, staffing, consent and governance. 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 the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was a registered manager in post at the time of our inspection. 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.

During this inspection we found people were not always protected from risks associated with their care and support. Risks were not always identified, assessed or managed and this placed people at risk of harm. There were not always enough staff to ensure people’s safety and meet their needs. Adequate steps had not always been taken to ensure people were protected from staff that may not be fit and safe to support them.

People told us they felt safe and improvements had been made to protect people from abuse and improper treatment. Medicines were stored and managed safely and this meant people received their medicines as required. The home was clean and hygienic and effective infection control procedures were in place.

People’s rights under the Mental Capacity Act (2005) were not respected. People were subject to restrictions upon their freedom but their capacity to consent had not been assessed.

People could not be assured they would receive effective support in relation to their health. Health professionals were not always contacted quickly when people required specialist support and the advice of health professionals was not always followed. People had enough to eat and drink. However, improvements were required to ensure people’s needs and preferences were met.

The physical environment had been adapted to meet people’s needs and people had been involved in the decoration of the home. Improvements were planned to ensure the design and decoration of the home met the needs of people living with dementia. People were supported by staff who had training and supervision.

Staff were kind and caring in their approach and treated people with dignity and respect. People were involved in and consulted on day to day decisions about their care and support. There were links with local advocacy services to enable people to express their views if needed. People told us most staff understood what was important to them. This was not always reflected in care plans, but work was underway to make improvements. People’s right to privacy was respected and they were encouraged to maintain their independence.

Care plans did not always reflect people’s needs and preferences, improvements were underway to address this. People were given opportunities to get involved in meaningful activity and further improvements were planned to ensure people’s individual interests were taken into account. People were supported to raise issues and c

We inspected the service on 18 December 2017. The inspection was unannounced. Bowbridge Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Bowbridge Court accommodates up to 54 people in one purpose built building, which is split across three floors. On the day of our inspection 50 people were using the service.

At the last inspection in April 2017, we asked the provider to take action to make improvements to the safety of the service, consent, staffing, leadership and quality assurance. During this inspection we found the required improvements had not been made.

There was no registered manager in place at the time of our inspection. The previous registered manager had left Bowbridge Court at the start of December 2017. 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. There was a new manager in post at the time of our inspection who had been in post for a period of approximately two weeks at the time of our inspection visit. They informed us they would be submitting an application to register with CQC. We will monitor this.

During this inspection we found ongoing concerns about the safety of people living at the home. Action had not been taken to protect people from the behaviour of others living at the home, this placed people at risk of serious harm. Systems to review and learn from accidents and incidents were not consistently effective. Action was not always taken to protect people from improper treatment or abuse, and referrals were not consistently made to the local authority safeguarding adults team. People were not always protected from risks associated with their care and support, such as pressure ulcers. Medicines were not always managed safely. Equipment was not clean and hygienic.

There were not enough, adequately trained staff available to provide care and support to people at all times. Staff did not always have the necessary training to enable them to provide safe and effective support. Staff were not provided with regular supervision, this meant opportunities to monitor and improve staff practice may have been missed. Safe recruitment practices were followed.

Where people lacked capacity to make choices and decisions their rights under the Mental Capacity Act (2005) were not always respected. Some people had restrictions imposed upon their rights but we could not be assured this was in their best interests. People who had the capacity to make decisions were supported to have choice and control of their lives.

Systems to ensure people had enough to eat and drink were not consistently effective and this placed people at risk of insufficient food and fluid intake. People’s day to day health needs were met and they were supported to access healthcare as required. The physical environment had been adapted to meet people’s needs, further work was required to ensure people’s cognitive needs were met by the design and decoration of the home.

People’s right to privacy was not always respected. People told us the quality of care varied between staff members, this meant they could not be assured they would be provided with consistently kind and caring support. People felt involved in day to day decisions about their care and support and families were offered opportunities to be involved in developing their loved one’s care plans. People told us most staff understood what was important to them. However, this was not always reflected in care plans. People were encouraged to maintain their independence.

People were at risk of receiv

We inspected Bowbridge Court on 25 and 27 April 2017. The inspection was unannounced. Bowbridge Court is a situated in Newark in North Nottinghamshire and is operated by Ideal Care Homes (Number One) Limited. The service is registered to provide accommodation for 54 older people who require personal care. There were 49 people living at the service on the day of our inspection. The service is split across three floors, each with communal living spaces.

We inspected this service on 30 August 2016 and the service was rated as requires improvement with multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection we found that the required improvements had not been made and found ongoing concerns in relation to the quality and safety of the service. This resulted in us finding new and ongoing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safeguarding service users from abuse and improper treatment, consent, safe care and treatment, staffing and good governance. We also found an ongoing breach of regulation 18 of the Care Quality Commission (Registration) Regulations) 2009. You can see what action we told the provider to take at the back of the full version of the report.

There was no registered manager in post at the time of our inspection, our records showed that the previous registered manager had left the service in October 2016. 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. There was a service manager in place during our inspection who had taken over responsibility for the day to day running of the service in November 2016. They informed us that they would be submitting an application to register as manager for the service. We will monitor this.

During this inspection we found that the systems in place to reduce risks associated with people’s care and support were not always effective and this exposed people to the risk of harm. Risks in relation to people's care were still not planned for appropriately to ensure people received safe care and people's care records did not contain sufficient guidance for staff to minimise risks to people.

Although people felt safe in the service, they were still not always protected from the risk of abuse and information of concern was not always acted upon or shared with the local authority. People did not always receive their medicines as prescribed and medicines were not always managed safely. Equipment used to support people was not always clean.

There were enough staff to provide care and support to people. However safe recruitment practices were not always followed. Staff did not always receive suitable training or support to enable them carry out their duties effectively and meet people’s individual needs and were not provided with regular supervision and support.

People’s rights under the Mental Capacity Act (2005) were not respected. People could not be assured that restrictions imposed upon their freedom were appropriate or in their best interests. However, people told us they felt involved in day to day decisions about their care and support.

People’s day to day health needs were met, however, there was a risk that people may not receive appropriate support with specific health conditions due to a lack of information in care plans. Most people were supported to have enough to eat and drink. However a small number of people were placed at risk of malnutrition as action was not taken to monitor their weight.

People were not provided with consistently kind and caring support and they could not always be assured that they would receive support that was bas

This inspection took place on 30 August 2016, it was an unannounced inspection. Bowbridge Court is run by Ideal Care Homes (Number One) Ltd. It is situated in the town of Newark in Nottinghamshire. The service is registered to provide accommodation for 54 older people who require personal care. There were 51 people living at the service on the day of our inspection. The service is split across three floors, each with communal living spaces.

We carried out an unannounced comprehensive inspection of this service on 25 and 27 November 2014. Breaches of legal requirements were found in relation to the care, treatment and safety of people, consent, nutrition and hydration and governance. We conducted this inspection to follow up on breaches identified in our November 2014 inspection and to look at the overall quality of the service.

There was no registered manager for the service at the time of our visit and there had not been one in place since June 2016. A new manager had recently been appointed however they had not yet started in post, on the day of our visit there was a new acting 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.

During this inspection we found that although people felt safe in the service, people were not always protected from the risk of abuse and information of concern was not always acted upon or shared with the local authority swiftly. Risks in relation to people's care were not always planned for appropriately to ensure people received safe care and support. Safe recruitment practices were not always followed.

Medicines were not always stored or managed safely. There were not always enough staff to provide care and support. People were supported by staff who had not received adequate levels of training.

People could not be assured that they would be provided with effective support in relation to their nutrition and hydration. People had their day to day healthcare needs met but where people had health conditions they could not always be assured that they would receive effective support.

People were supported to make day to day decisions but where people lacked capacity their rights under the Mental Capacity Act 2015 were not respected.

People were not always treated with dignity and their right to privacy was not always respected. Staff were caring and had positive relationships with people using the service. People were supported to make choices about how they spent their day. People had the opportunity to get involved in activities in the home but these were not always based upon people’s interests and hobbies.

People’s care plans did not provide a detailed description of people’s individual needs and preferences and did not contain all the relevant information to enable staff to provide effective support. People and their families were involved in the development of their care plans but were not involved in care plan reviews.

There was a lack of effective governance from the provider which put people at risk of receiving poor care. Quality assurance systems were not effective in identifying areas for development and action plans were not consistently developed or implemented. People and staff were not involved the development and running of the service.

The management team, led by the new acting manager, were approachable and open. People using the service felt able to share any concerns with the management knew how to raise concerns. Complaints and concerns were responded to appropriately. Staff were given feedback on their practice in supervision and they felt comfortable discussing issues, concerns and ideas with the management team.

We found multiple breaches of the Health and S

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with 11 people who used the service and three relatives and asked them for their views. We also spoke with seven care workers, a housekeeper, a deputy manager, the registered manager and the area manager. We also looked at some of the records held in the service including the care files for nine people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

The inspection team who carried out this inspection consisted of one inspector and a pharmacy inspector to answer five key questions; is the service safe, effective, caring, responsive and well-led.”

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found people’s care and support was planned and delivered in a way that ensured their safety and welfare, although we found that the service was not safe because people were not protected against the risks associated with the use and management of medicines. People did not always receive their medicines and nutritional supplements they needed. Some ‘creams’ were not kept in a safe way. Some medicines were not disposed of appropriately after their use by date. A person who used the service told us their support with medicines was, “Ideal, but I’m taking a lot of tablets and I have asked staff several times (about their medicines and pain control) and nothing’s happened for my pain”.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We found the provider did not have effective systems to involve people in planning their care, and obtaining people’s consent for this to be provided. A person who used the service told us, “I haven’t had anyone talk to me about my care plan. I would like someone to talk to me about it.”

We found staff were effective at meeting the care and welfare needs of people who used the service. A person who used the service told us, “I feel absolutely safe in here. Staff are here to help you do the best you can.”

Is the service caring?

We saw staff respond to people in a sensitive and caring manner. A person who used the service told us, “They do everything I want, I wish I could help them a bit. They are very good to me.”

Is the service responsive?

We found care workers responded appropriately when people had the capacity to make decisions about their care and welfare. A person who used the service told us, “I do exactly what I would do if I was in my own flat, I feel confident in here.”

We found staff responded appropriately to the care and welfare needs of people who used the service. We saw the correct procedures had been followed when a person had fallen the previous evening.

There were sufficient care workers to respond to people’s health and welfare needs. A person who spent a lot of time in their room told us, “There is always someone here if I press the buzzer, they will be here in five minutes.”

Is the service well-led

Staff told us the manager provided good leadership, although they commented they seemed to have a lot they had to do. The area manager described the manager as, “A good manager, but needs to delegate more.” A person who used the service told us, “I think this is very well run.”

We undertook this inspection to check what improvements the provider had made since our last inspection on 7 August 2013. We checked care plans, staffing rotas and spoke with the area manager, registered manager and three staff members.

A member of staff told us, “It is a lovely home to work in. (Name) is a really good manager. It is a pleasure to come to work. There is a lot of teamwork here.”

Due to the complex needs of some of the people living at Bowbridge Court we used a number of different methods to help us understand the quality of service provision. We spoke with twelve people who used the service, the registered manager, four members of staff, two visitors and one health care professional.

People we spoke with told us they were happy at the care home. Comments included, “I like it, I have everything I need here and everybody is nice to me.” A visitor told us, “My relative is definitely safe.” A member of staff told us, “It is well led here and the manager is approachable, supportive and is always checking that staff are alright.”

The care plans examined showed that reviews of care and associated risks were not completed and reviewed in a timely manner.

We asked people who used the service if they felt that their safety and wellbeing was promoted. They told us they did, comments included, “Yes, I have my call bell if I need anyone, everybody and the building make me feel safe.”

Some staff and visitors we spoke with thought that there were not enough staff employed by the home to deliver an appropriate standard of care. Comments included, “The home is always understaffed and struggles to get gaps in the rota filled by carers who were on their days off.”

We saw that regular health and safety audits were undertaken. These included regular testing of fire alarms and that information from these was used to ensure that the environment was safe.

This inspection took place on 25 and 27 November 2014. The inspection was unannounced. Bowbridge Court provides residential care for up to 54 older people, including people with dementia, over three self-contained floors. On the day of our inspection 41 people were using the service.

The service did not have a registered manager in place at the time of our inspection. A new manager had been recruited and the area manager told us they would apply for registration shortly. 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 and associated Regulations about how the service is run.

When we last inspected Bowbridge Court in May 2014 we found there were improvements needed in relation to how people gave consent to their care and treatment, and the management of their medicines. The provider sent us an action plan telling us they would make these improvements by September 2014. We found at this latest inspection that the provider had made the improvements in line with the action plan they provided us with for the management of people’s medicines. However we found the improvements stated in the action plan for how people gave consent to their care and treatment had not been made.

People received their medication when they were meant to and they were given this sensitively.

People told us they felt safe at the service. Staff understood signs that may indicate if someone had been abused and they knew how to pass any concerns about people’s safety to the local authority.

A number of staff had left the service, but new staff had been recruited to replace them. There were sufficient staff on duty but sometimes they did not work as effectively as people expected. The acting manager had identified ways to make staff more effective in the way they worked.

Staff received regular training to provide them with the knowledge they needed to care for people. However staff did not have opportunities to discuss how they were doing or if they had any difficulties they needed to discuss. This was because staff had not been having supervision or appraisals.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS is part of the MCA, which is in place to protect people who lack capacity to make certain decisions because of illness or disability. DoLS protects the rights of such people by ensuring that if there are restrictions on their freedom these are assessed by professionals who are trained to decide if the restriction is needed. We found this legislation was not used correctly to protect people who were not able to make their own decisions about the care they received.

We saw some people were not eating as well as they could, because they were not provided with the support they needed to eat their meals. This put their nutritional intake at risk. Where people were at risk of not eating properly the systems used to monitor this were not used effectively.

People were supported to access healthcare services when they needed medical attention. However plans of treatment were not always followed, so people did not get the maximum benefit from these.

Whilst we saw some examples of people being treated with compassion and respect we also saw occasions where people did not receive their care and support in a compassionate way. Some people described experiences where staff had not treated them with the care and kindness they expected.

There were times when people did not receive the care they needed or make the choices they wanted. We found examples where people’s care plans were not accurate and these did not provide staff with the direction about people’s care they should.

Concerns were raised that sometimes information was not communicated between staff. Staff did not feel any suggestions they made were listened to. Systems to monitor the quality of the service were not used to identify any improvements needed.

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