Archived: Bows

Updated 8 December 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by 2 inspectors, 1 medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Bows is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Bows is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. The provider had appointed a manager, but they had not submitted an application to become registered. We refer to them as ‘the manager’ in the report.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We communicated informally with 5 people who used the service about their experience of the care provided. People who were unable to talk with us used different ways of communicating including using Makaton, objects and their body language. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with 4 members of staff, the manager and the operations director.

We reviewed care and support records for 5 people, this included risk management plans, care plans, medicines records, menu plans, health monitoring information and records. We also reviewed incidents and accidents records, health and safety records and information, handover records, communication book, staff rotas, agency profiles, training data, 2 staff files for recruitment, service improvement plan and quality assurance records.

Following our site visit we also spoke with a further 4 members of staff and 5 relatives on the telephone about people’s experiences of care received.

Updated 8 December 2023

About the service

Bows is a residential care home providing accommodation for up to 5 people who require nursing or personal care. The service provides support to adults under 65 years and people who have a learning disability and/or Autism. At the time of our inspection there were 5 people using the service.

People had their own rooms and the use of communal rooms, such as a lounge, kitchen, sensory room and dining area. There was a large garden to the rear of the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance the Care Quality Commission (CQC) follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

Risks to people’s safety were not always managed safely and we observed staff not always following risk management plans. This placed people at risk of harm. People were not supported to engage in their social interests and there was limited opportunity for people to access their local community and services. Staff were not encouraging or supporting people to achieve their goals.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not support this practice.

People’s medicines were not managed safely.

Staff had been recruited safely and recruitment at the service was ongoing.

Right Care

People’s care was not person-centred and there was no evidence people had been involved in making decisions about their care. People’s known communication methods were not always used by staff to communicate with people.

People’s activity plans were not being used by staff to make sure people were occupied or engaged. People were not encouraged to carry out activities of daily living to maintain and develop skills.

There were not always enough staff available to support people in line with their funded care hours. This meant people were not able to go out at times as there were not enough staff on duty.

Right Culture

Changes in management had impacted on service delivery. There had been no leadership to guide and mentor staff to provide person-centred care. The service was easily identified as a care home from the road. There was a big banner on the fence advertising to the public the service was hiring staff. There were large industrial bins by the front gates and the front of the building had a sign with the providers name visible. This was not in line with the guidance Right Support, Right Care, Right Culture.

Safeguarding incidents had not always been reported to the local authority which placed people at risk of harm. Incidents and accidents had not been managed to make sure actions were taken to prevent reoccurrence. CQC had not been notified of significant incidents and events as required by law. Quality monitoring systems were not effective in identifying and driving improvement at this service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 12 August 2022) and there were 3 breaches of Regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted in part due to concerns received about low staffing numbers which was preventing people from going out into the community, 1 person’s seizure not being managed safely and poor maintenance in bathrooms. We found evidence to substantiate some of the concerns received.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, medicines management, person-centred care, safeguarding and good governance at this inspection.

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.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.