About the service:

Bowes House is a residential care home that provides personal and nursing care for up to 90 people. At the time of inspection, 76 people were living at the service. People were aged 65 and over and lived with disabilities including dementia, Parkinson’s disease and diabetes.

The building is divided into four units, each providing specialist support. There are two units for older persons on the ground floor. On the first floor there is a unit providing nursing care and another for people living with dementia.

People’s experience of using this service:

People received their medicines on time. Although some medicine records were not always maintained accurately, this had not impacted on people.

People and their relatives spoke positively about the staff and about the service they received. They told us that they felt safe and that there were enough staff to meet their needs. Staff received training in safeguarding and knew how to keep people safe.

People’s dietary needs were met and there was enough to eat and drink. One person told us, “There is so much food, we are spoiled for choice”. People with specific dietary requirements had their needs and preferences met.

Staff supported people with timely access to healthcare and encouraged people to maintain a healthy wellbeing. There was a range of activities within the service and there was plenty of choice available every day.

People said that staff were very respectful. One person said, “Staff are very good and always treat me with dignity and respect, nothing is too much trouble for them”. We were told that people felt supported by staff who knew them well and understood their wishes.

Care was provided by knowledgeable staff who were trained to carry out their roles. Training and observations of staff practice as well as supervision, ensured that staff were competent in their roles.

People and their families were involved in the planning of their care and their individual needs and preferences were known and understood by staff. There was an up to date strategy for providing dementia care and staff received bespoke training to ensure they had the skills needed to provide a tailored and person centred model of care. Staff demonstrated compassion for people’s wellbeing and a shared commitment to enhancing the quality of life for people. They had worked with people living with dementia to redesign the care provided and the ethos of a person centred model of care was clearly imbedded by the way every member of staff interacted with people.

The environment was purpose built and described by one person as, “Bright, spacious, clean and just right for me”. People had their own bedrooms and bathrooms and said that they liked the fact that visitors and family pets were welcome at any time.

Staff knew how to address concerns. People felt listened to and said that they had the opportunity to raise concerns, ideas and share their experiences.

The service was well led by a management team who were skilled and knowledgeable. They demonstrated compassion and commitment to the needs of people who used the service.

The management team worked professionally with agencies outside of the service and ensured a transparent and open approach.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems supported this practice.

Rating at last comprehensive inspection:

Good. (Published 7 September 2016).

Why we inspected:

We inspected the service as part of our inspection methodology for ‘Good’ rated services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected Bowes House on the 11 and 13 June 2017 and the inspection was unannounced. Bowes House provides accommodation and nursing care for up to 90 people who have nursing needs, including poor mobility or diabetes, as well as those living with various stages of dementia. The home also had a contract with the CCG (Clinical Commissioning Group) to provide rehabilitation for people, for up to 6 weeks. This aimed to either provide people with an alternative to a hospital admission. There were 81 people living at the home on the first day of the inspection and 84 people on the second day of our inspection.

Bowes House is owned by the organisation Care UK Community Partnerships Limited. The service is purpose built and provides accommodation and facilities over two floors. Split into four units, the units include; Aylesham (Elderly Residential), Weald (Nursing care), Barley (Rehabilitation) and Meadow (Dementia). Local school children were involved in the naming of each unit.

The service had a registered 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.

We last inspected Bowes House in August 2016 when the service was rated 'Good'. After that inspection we received concerns in relation to poor staffing levels at night. This was a focussed inspection in response to these concerns. We looked at these concerns under the key question 'Is the service safe?’ You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bowes House on our website at www.cqc.org.uk.

Systems were in place to calculate staffing levels and the provider used an electronic dependency tool known as CAPE. Staffing levels were reviewed monthly or sooner. Not all staff vacancies had been recruited to and the provider was using agency staff to maintain staffing levels. Staff recognised the need for agency staff but felt it had an impact. One staff member told us, “We are using agency staff whilst recruiting. We try and get the same agency staff but it isn’t always possible. It then means we have to explain to them what to do, induct them and that takes time away from what we need to do.” Staff rotas confirmed that staffing levels were being maintained with input from agency staff. The management team told us that staff turnover and use of agency staff may compound people’s feelings that there isn’t enough staff.

People told us they felt safe but felt staffing levels could be improved. People confirmed that although staff answered their call bell promptly, they were then advised that staff would return but often that would take a long time. One person told us, “I hear, I’ll be a back a lot.” We have identified this as an area of practice that needs improvement and have made a recommendation about responding to call bells.

People were protected by a safe recruitment system. Each personnel file had a completed application form listing their work history as wells as their skills and qualifications. Nurses employed by Bowes House had registration with the Nursing and Midwifery Council (NMC) that was up to date.

Safeguarding adult's procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to. People's medicines were managed appropriately and people received their medicines as prescribed by health care professionals.

Risks to people's wellbeing were assessed and staff knew what action they needed to take to keep people safe. People had individual evacuation plans outlining the support and equipment they would need to safely evacuate the building.

We inspected Bowes House on the 1 and 2 August 2016. Bowes House provides accommodation and nursing care for up to 90 people who have nursing needs, including poor mobility or diabetes, as well as those living with various stages of dementia. The home also had a contract with the CCG (Clinical Commissioning Group) to provide rehabilitation for people, for up to 6 weeks. This aimed to either provide people with an alternative to a hospital admission. There were 78 people living at the home on the days of our inspection.

Bowes House is owned by the organisation Care UK Community Partnerships Limited. The service is purpose built and provides accommodation and facilities over two floors. Split into four units, the units include; Aylesham (Elderly Residential), Weald (Nursing care), Barley (Rehabilitation) and Meadow (Dementia). Local school children were involved in the naming of each unit.

The service had a registered 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.

At the last inspection undertaken on the 15 and 16 March 2015, we asked the provider to make improvements in relation to care plans and risk assessments to ensure sufficient guidance was provided to staff to provide safe care. This included the care for people who had lost weight. In addition, we asked the provider to make improvements to the opportunities available for meaningful activities, encouraging those receiving rehabilitation to self-administer their medicines and for care plans to be personalised to the individual. The provider sent us an action plan stating they would have addressed all of these concerns by October 2015. At this inspection we found the provider was meeting these regulations and had acted upon the recommendations made.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLs) which applies to care homes. Applications to restrict people’s freedom had been submitted to the appropriate DoLS office and people had individual DoLS care plans. However, staff were not consistently aware of who was subject to a DoLS authorisation and what it meant for the individual. We have made a recommendation for improvement.

The principles of the Mental Capacity Act (MCA) were not consistently embedded into practice. Further work was required to clearly demonstrate whether people had consented to their care plan, photograph being taken or sharing of information. We have made a recommendation for improvement.

Staff had completed training to enable them to carry out their roles. There was an ongoing programme of training and development for staff. Upon commencing employment with the provider, staff were subject to an induction. However, documentation was not consistently completed to evidence when staff had finished their induction and were deemed competent to work alone. Where concerns had been raised regarding the competency of staff, we could see that individual action had been taken, however, documentation failed to evidence how the management team had oversight of staff's progress and how they continually assessed staff’s competency. We have made recommendations for improvement.

People’s nutrition and hydration needs were met. The kitchen team were dedicated and passionate about providing good quality food which in return promoted people’s quality of life. People were provided with a wide range of food options and individual dietary requirements were catered for. Where people had not met their daily fluid intake target, further work was required to ensure this was effectively shared with staff to ensure all staff encouraged people to drink more that day.

There were appropriate arrangements in place for monito

There were 32 people living at Bowes House at the time of our visit.

We spoke with six people who used the service, three relatives, two health care professionals, the lead nurse, four care staff, the manager and regional manager. We spent time with people living in the home and observed interaction they had with each other and the staff.

Staff said they asked people for their consent before they provided support. We found evidence that people were encouraged to make choices and observed staff treated people with respect and dignity.

We examined four care plans and found that they were based on people’s individual support needs. The care workers we spoke with demonstrated a good understanding of people's needs and how these were met.

Safeguarding procedures and policies were in place and the home used them as required to ensure people’s safety.

We reviewed the systems used to support staff, including supervision and training. We found that staff had attended appropriate training, and that they felt that this enabled them to provide the support that people wanted.

Systems were in place to assess and monitor the services provided by the home. Complaint policies and procedures were in place, and staff said people were encouraged to discuss the support they received.

We inspected Bowes House on the 16 and 17 March 2015. Bowes House provides accommodation and nursing care for up to 90 people, who have nursing needs, including poor mobility, diabetes, as well as those living in various stages of dementia. The home also had a contract with the CCG (Clinical Commissioning Group) to provide rehabilitation for people, for up to 12 weeks. Either to prevent a hospital admission or for people to receive rehabilitation before going home from hospital. There were 67 people living at the home on the days of our inspections.

The home was adapted to provide a safe environment for people living there. Bathrooms were specially designed and doors were wide enough so people who were in wheelchairs could move freely around the building. Accommodation was provided over two floors and split into four units. The units included Aylesham (Elderly Residential), Weald (Nursing care), Barley (Dementia care) and Meadow (Rehabilitation and End of Life care). Local school children were involved in the naming of each unit.

Bowes House belongs to the large corporate organisation called Care UK. Care UK provides nursing care all over England and has several nursing homes within the local area.

A manager was in post but they were not the registered manager. 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 and associated Regulations about how the service is run. The manager had been in post nearly six months but had not yet submitted an application to the CQC.

People’s needs had been assessed and individual care plans devised and developed. However care plans were often contradictory and did not provide clear guidance for staff. Care plans were not regularly reviewed when changes to people’s health and wellbeing had occurred. Documentation also failed to tell us what action had been taken when someone had suffered weight loss. Despite concerns with documentation, we saw that people received the care they required. However, we have identified recording as an area of practice that requires improvement.

Most people spoke highly of the activities and opportunity for social engagement. The provider employed dedicated activities coordinators and throughout the inspection, we observed regular group activities. However, some people commented they were not supported to pursue their individual hobbies and interests. One person told us, “The group activities are not for me.” We have identified this as an area of practice that requires improvement.

Medicines were stored safely and in line with legal requirements. People received their medicines on time; however, consideration had not been given as to whether people could be supported to regain their independence with their medicine regime. Pain assessments were not consistently completed. Therefore, there were no formal systems or mechanisms in place to recognise and acknowledge when people were in pain and required pain relief. We have identified this as an area of practice that requires improvement.

Incident and accidents were consistently recorded; however, they were not reviewed on a regular basis to monitor for any emerging trends or patterns. We have identified this as an area of practice that requires improvement.

People were treated with respect and dignity by staff. They were spoken with and supported in a sensitive, respectful and caring manner. People were seen laughing and smiling with staff. Staff understood the importance of monitoring people’s health and well-being on a daily basis.

Everyone we spoke with was happy with the food provided and people were supported to eat and drink enough to meet their nutrition and hydration needs.

Staff commented they felt well supported by the unit leaders, registered nurses and deputy manager. Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Training schedules were kept up to date. Plans were in place to promote good practice and develop the knowledge and skills of staff.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.