About the service: Bowerfield Court is a nursing home in High Lane, Disley, Stockport. The home is a purpose built facility registered to provide accommodation and nursing care for up to 40 people including younger adults with high level physical needs. The home also supports respite placements and provides end of life care. At the time of the inspection there were 37 people living at the home.

People’s experience of using this service:

• Improvements had been made to the service since our last inspection. Issues relating to night staffing levels and poor record keeping had been addressed

• People living in the home and staff told us they had noticed an improvement since our last inspection and were happier.

• People told us there were always staff to help them and they did not have to wait too long to receive support.

• Staff told us they felt they had more time to spend with people and felt less rushed.

• People told us they felt safe and well looked after

• Staff worked as a team and understood the importance of the contribution made by different staff members to ensure that people were well looked after.

• Improvements had been made to the management of the home with a service manager being appointed to support the registered manager who would have more time to talk to people living in the home and resolve issues.

• The home employed a mobility therapist who helped people maintain what mobility they had.

• People received support that was personal to them and staff communicated with people in formal or less formal ways according to the person’s preference.

• The registered manager had appropriate support to enable them to meet their responsibilities.

• The service met the characteristics for a rating of “good” in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was “good”.

• More information is in the full report

Rating at last inspection: At the last inspection the service was rated Requires Improvement (25 May 2018)

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

Follow up: We will continue to monitor the service through information we receive and future inspections.

This inspection took place on 21, 22 November and 12 December 2017. The inspection was unannounced on the first day and on the 12 December when the inspection was carried out at night.

The service was last inspected by the Care Quality Commission (CQC) on 15 and 16 August 2016 where we rated the service as requires improvement overall. Following the last inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve the key question; is the service safe, effective, responsive and well-led to at least good.

At this inspection we found that action had been taken to address some of the findings in the requirements made at the last inspection. However, we identified a continuing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance, in relation to the recording of topical medicines.

We also found that the provider had not fully considered a recommendation we made at the last inspection in relation to staffing levels. We found the home was still not sufficiently staffed to meet the high physical needs of some people.

We identified three further breaches of the Regulations. These were in relation to records in respect of service users, staffing levels and staff supervision.

Although we saw records that showed day staff were provided with up to date supervision and support, night staff told us they had not received supervision following the reduction of night staffing levels.

Bowerfield Court is a nursing home in High Lane, Disley, Stockport. The home is a purpose built facility registered to provide accommodation and nursing care for up to 40 people including younger adults with high level physical needs. The home also supports respite placements and provides end of life care. At the time of the inspection there were 31 people living at the home.

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

Two people and a person’s relative told us they did not always feel safe living at Bowerfield Court particularly at night time. Systems in place to consult people about whether they felt safe and protected whilst living at Bowerfield Court were not fully utilised.

Call bells were not always responded to in a timely way. Staffing levels were not sufficient at the time of the inspection to meet the needs of people who were cared for and supported by the service.

Any specific requirements or risks in relation to people taking particular medicines were clearly documented in people’s care records. However governance systems to help ensure topical medicines were administered and recorded were not used effectively.

Systems were in place and used to assess, monitor and mitigate risks relating to people’s health, safety and welfare. Risk assessments were in place to minimise the potential risk of harm to people during delivery of their care.

Care records were reviewed frequently and showed people’s dietary requirements indicated the type of food people had eaten and what they had drank. However we found some care records were not consistently maintained and accurate in relation to fluid and food intake/output amounts. Also some care record entries had not been initialled to verify the entry was accurate when changes were made to some records.

A robust recruitment and selection system was in place to minimise the risk of unsuitable people being employed to work in the service. Staff confirmed that the training they received was appropriate and supported them to carry out their job roles effectively.

The registered manager understood the requirements of the Mental C

This inspection took place on 15 and 16 August 2016 and was unannounced. The provider had changed legal entity in 2015 and this was the first inspection under this new provider registration.

Bowerfield Court is a nursing home in High Lane, Cheshire. The home is a purpose built facility registered to provide accommodation and nursing care for up to forty people including younger people with high level physical needs and older people, some of whom were living with dementia. The home also supports respite placements and provides end of life care. At the time of the inspection there were 38 people living at the home.

The manager told us she had recently been subject to a fit person interview by a CQC registration inspector and was awaiting final confirmation of her registration. We noted subsequently that her registration with the CQC had been approved. A registered manager is a person who has registered with the 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.

People said they felt safe living at the home and said the staff treated them well. Staff had received training with regards to safeguarding and demonstrated an understanding of potential abuse. We initially found that stairwells and fire exits were used for the storage of equipment and wheelchairs, including an electric wheelchair with it’s battery charging. By the second day of the inspection exits and stair wells had been cleared to allow safe evacuation of the building in an emergency. Windows on the upper floor did not have restrictors or devices that met with current Health and Safety Executive guidance for care homes and no risk assessments were in place. The manager told us she would immediately address this. Other checks and risk assessments on fire equipment, water systems and electrical and gas installations had been undertaken.

The home was generally clean and tidy throughout the inspections, although dining areas were not always well cleaned after meal times. The home used an electronic system to help manage medicines safely, although there were no clear systems in place to ensure people received topical medicines (creams and lotions). Topical medicines were not always dated when opened to ensure they remained in date to use and were always effective. Clinical rooms where medicines were stored were often at a temperature in excess of 25 degrees Celsius, meaning some medicines may cease to be safe or effective.

Suitable recruitment procedures and checks were in place, to ensure staff had the right skills to support people at the home. People told us there had been frequent use of agency staff in recent months and felt that staffing was not always sufficient to meet their needs. The manager and regional manager told us dependency assessments showed the home was properly staffed, although we noted the dependency tool did not specifically highlight the high physical needs of some people. We have made a recommendation to the provider regarding staffing at the home.

Most people told us they were happy with the standard and range of food and drink provided and could request alternative dishes, if they wished. Kitchen staff had knowledge of specialist dietary requirements. Soft or pureed diets were presented in a manner that supported people’s dignity.

People and relatives told us permanent staff had the right skills to look after them, although were less sure about agency staff. Staff confirmed they had access to a range of training and told us, regular supervision took place. The manager told us annual appraisals were due to be undertaken.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropr