This inspection took place on 14 and 15 June 2017 and was unannounced. This meant the staff and provider did not know we would be visiting.

Bowburn Care Centre provides care and accommodation for up to 80 people with nursing or personal care needs. On the two days of our inspection there were 53 people using 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 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.

Bowburn Care Centre was last inspected by CQC on 14 March 2016 and was rated Requires Improvement overall. At the inspection in March 2016 we identified the following breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

Regulation 9 (Person-centred care)

Regulation 10 (Dignity and respect)

Regulation 12 (Safe care and treatment)

Regulation 15 (Premises and equipment)

Regulation 17 (Good governance)

Regulation 18 (Staffing)

Regulation 19 (Fit and proper persons employed)

At this inspection we checked to see whether improvements had been made and we found improvements had been made in all the areas identified at the previous inspection.

Accidents and incidents were appropriately recorded, and risk assessments were in place for people who used the service. These described potential risks and the safeguards in place to mitigate these risks.

The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

At the previous inspection it was identified that people were not always protected against the risks associated with the unsafe use and management of medicines. At this inspection we found medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. Staff were suitably trained and training was arranged for any due or overdue refresher training. Staff received regular supervisions and appraisals.

At the previous inspection we found some checks of staff employment history had not been appropriately carried out. At this inspection we found the provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

At the previous inspection it was identified that some people had to wait a long time for support at meal times. At this inspection we found people were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

At the previous inspection it was identified that the environment of the home did not reflect best practice in dementia care. At this inspection we found the service incorporated environmental aspects that were dementia friendly.

People who used the service and family members were complimentary about the standard of care at Bowburn Care Centre. Care plans were in place that recorded people’s plans and wishes for their end of life care.

At the previous inspection it was identified that people were not always treated with dignity and respect. At this inspection we found staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

This inspection took place on 14 and 15 March 2016 and was unannounced. This meant the staff and the provider did not know we would be visiting.

Bowburn Care Centre provides accommodation and personal care for up to 80 older people. The home is set in its own grounds in a residential area near to public transport routes, shops and local facilities.

On the day of our inspection there were 60 people using the service. Accommodation is provided across two floors within four separate areas. Facilities included several lounges, dining rooms and kitchenettes, a hair salon and an enclosed garden area.

We saw that entry to the premises was controlled by key-pad entry. All visitors were required to sign in. This meant the provider had appropriate security measures in place to ensure the safety of the people who used the service.

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. At the time of the inspection there was a registered manager who had been in their present post at this home for over two years.

The registered provider had in place a safeguarding policy. However we found one person to be at risk of harm because details in their care plan had not been followed in practice. We made a referral to the local safeguarding authority to ensure this person was protected from the risk of harm.

People living at the home were at risk of inappropriate use of sedation medicines because there was incomplete information in their care plan about the reasons and thresholds where they should or should not be given. The provider could not demonstrate if pain relief patches were actually removed or not, potentially placing the people at risk of overdose.

The registered manager carried out a monthly analysis of accidents and incidents to check for patterns and trends and see if there were any ways of preventing future accidents. But we found instances where people were put at increased risk of accidental injury from insecure bedroom furniture, fire protection doors being held open and broken or disengaged window restrictors.

There were odour control issues in some parts of the home and steps to ensure that the home is kept clean and the people living and working there were protected from risk of infection were not effective.

There was a staff training plan in place. However staff had been required to carry out physical restraint without any training having taken place to ensure this was safe. This meant that staff had not been provided with the necessary skills to safely meet the needs of the people in their care.

People were not always treated with dignity and respect. Not all staff spoke with the people they were supporting in a respectful manner and one person’s property checklist had been written on a piece of hand towel paper.

We saw that people’s nutritional needs were assessed and plans of care drawn up if they were at risk of malnutrition or choking. The cook demonstrated that she had an extensive knowledge of people’s likes and dislikes and prepared a wide selection of wholesome and popular meals to cater for people’s tastes.

Arrangements for the assessment planning and review of peoples’ needs were not consistently in place. Staff and vulnerable people living at the home were at risk where the needs of people with complex mental health requirements were not known, understood or well planned.

There was member of staff employed by the provider whose role it was to prepare activities for people living in the home and staff had found out about some peoples’ past histories and provided activities to meet their needs.

The provider did not take steps to promote a calm relaxed therapeutic atmosphere at mealtimes nor ensure sufficient staff wer

We undertook this unannounced focused inspection on the 15 January 2016 in response to a statutory notification submitted by the registered manager informing us about the temporary disruption to the provision of heating and hot water to the service dated 30 December 2015. This report only covers our findings in relation to the notification. You can read the report from our last inspection, by selecting the 'all reports' link for Bowburn Care Centre on our website at www.cqc.org.uk

Bowburn Care Centre provides accommodation and personal care for up to 80 older people. The home is set in its own grounds in a residential area near to public transport routes, shops and local facilities. On the day of our inspection there were 57 people using the service. Accommodation is provided across two levels within four units. Facilities included several lounges, dining rooms and kitchenettes, a hair salon and an enclosed garden area.

The home had a registered manager in place. A registered manager is a person who has registered with 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 saw the registered provider had taken measures to ensure people were provided with safe care and treatment during the temporary loss of heating and hot water to the premises.

People who used the service and their relatives were complimentary about the standard of care at Bowburn Care Centre.

There were sufficient numbers of staff on duty in order to meet the needs of people using the service.

Risk assessments were in place for people and staff.

The registered provider had a Business Continuity Plan in place and all the people who used the service had a Personal Emergency Evacuation Plan.

The registered provider had a quality assurance system in place.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

During our visit we found people's privacy, dignity and independence were respected. People we spoke with said staff respected their choices, privacy and dignity. One person told us, “I would definitely say I was treated respectfully by staff.”

We found personal care was planned and delivered in a way which ensured people's safety and welfare. One person said, “The staff are well organised, I would give them eleven out of ten.”

Before this inspection we were given information that suggested peoples’ dietary needs were not catered for. During our visit we found the acting manager had taken successful steps to make sure anyone who was likely to be at risk from a poor diet, had a plan in place to support them. There was evidence this had been carried out and monitored by the acting manager, provider, nurses and doctors where necessary.

The provider had taken steps to make sure people at the home were protected from staff who were unsuitable to work with vulnerable people. This was because they had carried out thorough background checks.

People who used the service and their representatives were asked for their views about how the service was performing and their views were acknowledged and acted on.

At our last inspection in October 2012 we found the provider was not protecting people against the risks of unsafe use and management of medicines. This was because the manager was unable to tell if the medication stock present was correct or that people had been given their medication appropriately.

At this inspection we found improvements had been made. We found people were now protected against the risks of unsafe use or management of medicines because the provider had appropriate arrangements in place.

We also checked the provider’s arrangements to protect vulnerable people following alerts made to the local authority safeguarding adults team. We found the provider had made suitable arrangements to protect vulnerable people and had responded appropriately to allegations of abuse.

This was a follow up inspection where we did not collect the views of people at the home or visitors.

During our visit we spoke with several people who used the service and with their relatives. They said staff respected their privacy and dignity. They told us staff knocked on their bedroom doors before entering and were polite with them.

One person said, “They do the very best for me.”

People at the home said they felt involved in decisions about their care.

One person told us, “I’m OK here they (staff) know what they’re doing.”

One person’s relative said, “Overall everything they do for my (relative) is fine. There aren’t any of his care needs that are not met here.”

People told us they were happy with the support they received from staff.

One person told us, “No matter how busy they are, they will put things to one side to help.”

One persons’ relative said, “The staff are very good. My (relative) has got to know staffs’ names because they’re so friendly. It’s really important because he can’t see them.”

People said their care was monitored by the provider and the manager to make sure it was meeting their needs. One person said, “I don’t have any complaints at all.”

One persons’ relative said, “We’ve been having relatives meetings with the manager and the things we raised have been taken up.”

During our visit we spoke with people who used the service. We sat with people from 6am and during breakfast to see what sort of an experience this was for them.

We asked people about drinks, meals and snacks at the home, they said,

“I enjoy my breakfast.”

“I like a nice cup of tea in the morning.”

Many of the people who lived at this home found it difficult to give us their views because of their dementia care needs.

"I’ve been waiting ages;”

“I don’t want to go back to my room.”

"I can’t get the staff to get me a cup of tea;"

"I'm still waiting here to go for breakfast but the staff say they’re busy;"

“They lock the door but I don’t know the code.”