We carried out this inspection on 19 July 2018. The inspection was unannounced. This meant no-one at the service knew we would be visiting.

Lower Bowshaw View Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 40 people in one building. The home is located in a residential area of Sheffield with access to public services and amenities. At the time of the inspection, there were 31 people living at the home.

The service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Our last inspection at Lower Bowshaw View took place on 31 October 2017. The service was rated Inadequate overall. We found the service was in breach of six of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. Regulation 15, Premises and Equipment, Regulation 14, Meeting Nutritional and Hydration Needs and Regulation 17, Governance, Regulation 18, Staffing, Regulation 10, Dignity and respect and Regulation 9, Person centred care.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions asking if the service was safe, effective, responsive and well led, to at least good. The registered provider sent us an action plan detailing how they were going to make improvements. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of the Regulations.

There was a recently appointed manager at the service. The previously registered manager had left Lower Bowshaw View the month before this inspection. The provider and manager said they intended to apply for the current manager to be registered with the CQC. 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.

People living at Lower Bowshaw View told us they felt safe and they liked the staff. Relatives we spoke with felt their family member was in a safe place and did not have any concerns about their family member’s safety.

The numbers and deployment of staff were appropriate to safely meet the needs of people who used the service.

The home was generally clean, improvements had been made to the environment. There were still some malodours in the ground floor corridors and two bedrooms. The service could not evidence they had completed all recommendations and requirements from the Infection control and prevention audit completed by the Infection Prevention and Control Nurse, NHS Sheffield Clinical Commissioning Group.

We found systems were in place to make sure people received their medicines safely.

Staff were provided with relevant training and supervision to make sure they had the right skills and knowledge to support people.

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 enjoyed the food provided and were supported to receive adequate food and drink to remain healthy.

Some areas of the home still required redec

Lower Bowshaw View is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates 40 people in one building. The home is located in a residential area of Sheffield with access to public services and amenities.

The home was last inspected on 3 January 2017 at which time it was rated overall as requires improvement. There were no breaches of the regulations identified during the inspection, but some improvements were required. Some infection prevention and control practices did not always promote people's safety, staff did not always support people to eat effectively and some quality assurance and audit processes were ineffective.

At this inspection we found that sufficient improvements had not been made to these areas and we found there was now a breach in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 15,Premises and Equipment, Regulation 14, Meeting Nutritional and Hydration Needs and Regulation 17,Governance. We also found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014,Regulation 18,Staffing,Regulation 10,Dignity and respect and Regulation 9, Person centred care.

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.

This inspection took place on 31 October 2017 and was unannounced. This meant the people who lived at Lower Bowshaw View and the staff who worked there did not know we were coming.

There was a manager at the service who was registered with the CQC. 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.

The numbers and deployment of staff were not appropriate to safely meet the needs of people who used the service.

People were not consistently cared for in a safe and clean environment.

Some people’s nutritional needs were not being met. Meal times were not appropriately spaced and some people were not eating for long periods of time.

Although some people and their relatives told us that staff treated people with kindness and were caring, we saw a number of examples where this was not the case and some people’s privacy and dignity were not upheld.

We found people did not always receive care in a person centred way. This was because the deployment of staff meant staff's approach was mainly task and routine focused, which did not take into account people’s own preferences.

Staff were aware of safeguarding procedures and knew what to do if an allegation was made or if they suspected abuse. People told us they felt safe.

We found systems were in place to make sure people received their medicines safely so their health was looked after.

Staff had regular updates to their training and were provided with relevant supervision and appraisal so they had the skills and support they needed to undertake their role.

Staff recruitment procedures ensured people’s safety was promoted.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) code of practice and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice.

People had access to a range of health care professionals to help maintain their health.

People and their relatives were confident in reporting concerns to the

Lower Bowshaw View is registered to provide accommodation, nursing and personal care for up to 40 older people. The home is located in a residential area of Sheffield with access to public services and amenities.

There was a manager at the service who was registered with the Care Quality Commission (CQC). 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.

Our last inspection at Lower Bowshaw View took place on 15 and 19 October 2015. The home was rated as Requires Improvement. We found four breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in regulations 11: Need for consent, 12: Safe care and treatment, 17: Good governance and 19: Fit and proper persons employed. Requirement notices were given for these breaches in regulation and the registered provider was told to make improvements. On this inspection we checked improvements the registered provider had made. We found some improvements had been made to meet the requirements of these regulations. However, some quality audits had not identified concerns reported to us which meant they were not always effective.

This inspection took place on 3 January 2017 and was unannounced. This meant the people who lived at Lower Bowshaw View and the staff who worked there did not know we were coming. On the day of our inspection there were 35 people living at Lower Bowshaw View.

People spoken with were positive about their experience of living at Lower Bowshaw View. They told us they felt safe and they liked the staff.

We found systems were in place to make sure people received their medicines safely so that their health was looked after.

Staff recruitment procedures ensured people’s safety was promoted.

Whilst we found the home generally clean, information shared by the Clinical Commissioning Group (CCG) showed that infection prevention and control practices did not always promote people’s safety.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role. Staff were provided with supervision and appraisal at appropriate frequencies for their development and support.

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.

A maintenance plan was in operation but parts of the environment and some furnishings were worn and tired which meant people did not always have a well maintained environment in which to spend their time.

People had access to a range of health care professionals to help maintain their health. A varied diet was provided, which took into account dietary needs and preferences so people’s health was promoted and choices could be respected. Whilst staff were available to support people to eat, this was not always effectively managed.

A range of activities were available to provide people with leisure opportunities.

People living at the home, and their relatives said they could speak with staff if they had any worries or concerns and they would be listened to.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. People living at the home and their relatives had been asked their opinion via questionnaires. The results of these had been audited to identify any areas for improvement.

During our inspection we spoke with three people using the service, two relatives and six members of staff. We looked at five sets of care planning documentation and three staff files.

All of the people using the service and their relatives that we spoke with were positive about the home. One comment from a person living at the home included “They’re good lasses [care workers]. They look after us the best they can. It’s not easy looking after us all.”

People using the service and their relatives told us that care and treatment was planned and delivered in a way that ensured safety and welfare. A comment from a relative included, “They look after her needs here well.”

We found that staff received appropriate professional development and support. People who used the service and their relatives were positive about the staff and their skills in providing care. One comment from a relative included "Staff seem fine and happy. They are polite to us and offer cups of tea. They’ve been good. Very good.”

We found that that there was an effective quality monitoring system to analyse, identify and reduce risk through audit and incident reporting.

We found that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We spoke with eight people who told us that they were treated with respect and they were happy with the quality of support they had received. Their comments included, "the staff are very friendly, helpful and nice."

People told us that the staff looked after them well, they received good care and their health and personal care needs were met. One person said, "I like it here. The carers come and talk to you. They are friendly.”

All the people we spoke with told us that they felt ‘safe’ and if they had any concerns they would speak to a member of staff. Staff were clear about what their roles and responsibilities were and what action they would take if they saw or suspected any abuse.

We found that people who used the service benefited from sufficient staff to meet their needs.

We found that a complaints policy and procedure was in place. People had been provided with information on how to make a complaint. All of the people spoken with said they had no complaints or concerns about the home.

We identified issues relating to some care records at Lower Bowshaw View nursing home. We found people were not protected from the risks of unsafe or inappropriate care because accurate and appropriate records were not maintained. The service was non compliant with this outcome area.

People using the service told us they were happy with the care provided and were involved in decisions about their care and welfare needs. One person told us they were able to choose if they wanted to attend the day centre and they were given choice about the food they ate. One person told us they had not read their care plan but the staff had told them information contained in the care plan and were able to make changes to their care needs if required. Two relative’s told us they were involved in the development of their relatives care plan. They also told us their relative’s dignity was respected and confidentiality was always maintained.

People using the service told us they were happy living at the home and they were well looked after. One person told us “it’s a nice home nothing is wrong,’ and another person told us “I like it very much and would come back again”. Staff were described as kind, nice and approachable. We observed staff assisting people with their care; staff were caring and spoke to people in an appropriate manner.

One relative we spoke to told us care was good and they had no concerns. Another relative we spoke to told us they were “happy with the care provided and had no concerns at all”. Both relatives we spoke to told us they were contacted by the home straight away if their family member required any treatment.

We spoke to two relatives who confirmed they would talk to the manager if they had any concerns. People told us that they felt safe at the home and they would tell staff or the manager if they were worried about anything.

The inspection took place on 15 and 19 October 2015 and was unannounced which meant no one at the service knew we would be attending.

The service was last inspected in November 2013 and was found to be meeting the requirements of the regulations we inspected at that time.

Lower Bowshaw View Nursing Home accommodates up to 40 older people that require nursing or personal care. At the time of our inspection there were 36 people living at the service.

There was a registered manager in post at the service. 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.

We found that some people had no risk assessments and care plans in place that detailed what support they needed . We saw that some people’s individual risks had not been appropriately managed to maximise their safety.

There were current vacancies for nurses which meant the service had to use agency staff at times. Staff said they felt the staffing levels in place were satisfactory. We saw that deployment of staff required improvement at times as we saw examples of when there was a lack of trained staff to support people.

People were administered their medicines in accordance with safe administration however information in records did not always show why people did not have medicines if these were not administered. There was no guidance in place to direct staff when people needed medicines to be taken ‘as and when required’.

Staff were aware of the need to report abuse and what procedures to follow and there were policies in place for staff to follow. Staff had regular supervisions and appraisals and said they felt supported by management. Training was provided for staff so they had the skills for their roles and staff were encouraged to pursue further development. Team meetings took place regularly.

There was guidance and training in place for the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). No one at the service had a current DoLS authorisation in place. We saw an example of where the MCA was followed for one person however we saw examples of where consent was not appropriately obtained for people.

People spoke positively about the food and we saw people had access to, and input from, a number of health professionals where required. Staff were able to describe people’s personalised needs and we did see evidence of person centred detailed care plans in place for some people. However a lack of information in the majority of records we looked at did not always show what care people needed and what care they had received in accordance with any needs.

People and relatives spoke positively about the staff and the care they received. We saw positive interactions and communication from staff towards people when providing support. People told us, and observations showed, that people’s privacy and dignity was maintained.

There was a varied activities schedule in place and we saw differing activities take place which people enjoyed. Meetings took place so that people had opportunities to feedback their views of the service and suggest improvements. There was a complaints procedure in place and people said they would feel comfortable in raising any issues.

The registered manager had an internal audit system in place to identify areas for improvement. Although incidents were monitored, the system was not robust enough to effectively identify patterns and trends with a view to reduce risk.

Feedback from people, relatives and staff was positive about the registered manager. Quality assurance surveys were completed with a view to improve the service and there was evidence of actions taken.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.