Lower Bowshaw View Nursing Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

During our assessment of this key question, we found concerns around medicines management, risk, and staffing, which resulted in a breach of Regulation 12 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured people’s needs were met safely. Information was not always shared effectively with health care professionals and partners. The service was aware of the need to and had submitted applications for people to assess and authorise any restrictions in place and to ensure they were in the best interests of the person. The provider had systems in place to record and analyse accidents and incidents. People were protected as much as possible from the risk of infection. However, we identified some areas that required attention. This was addressed by the management team. Environmental checks were in place and equipment checks were undertaken to support the delivery of safe care.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Some areas of analysis were good, incidents and accidents were monitored, review and lessons learnt completed. However, not all areas were followed through, falls were not always effectively managed, and people did not always feel concerns about safety were listened to.

The provider is implementing a new management structure which they told us will implement new practices to improve the service ensuring new systems are embedded into practice.

We identified processes were not always followed. However, the new manager was aware improvements were required and had commenced implementing more robust processes. These included new audit systems, supervisions, and staff competencies. Action was being taken to mitigate future risks. For example, improve communication with professionals to manage risks and improve outcomes for people.

Staff worked with partners. People and relatives told us health care professionals regularly visited the service. We saw evidence in care plans of visits and referrals however, partners felt communication could improve to provide more continuity of care and achieve better outcomes for people.

The new manager explained how they were implementing new procedures to ensure information was shared, reviewed, and monitored to ensure lessons were learnt to embed good practice.

The local authority had received concerns about the quality of care and safety of people using the service. We received concerns from visiting professionals, they said, communication was poor, staff had lack of knowledge, and this was impacting on people’s safety. However, following the changes in management, we received feedback that this was improving.

The processes were being improved to ensure a robust system was in palace to record, monitor and review care needs so appropriate information was shared between staff and other professionals.

People told the staff made them feel safe. However, at times they did not feel safe, they said they felt vulnerable as some people who lived at the service required support and when no staff were around, they felt at risk. One person said, “I have been slapped [by another resident].” Relatives told us, “There are long periods when there are no staff in the sitting room providing supervision and/or support.”

The new manager shared information of the action they were intending to take to ensure people were appropriately supported and safeguarded from abuse and possible harm. There was a commitment from the manager to provide staff with the skills and knowledge to keep people safe from abuse and neglect

Staff had received training in safeguarding people, but did not always identify concerns to ensure peoples safety.

There were ineffective systems, processes, and practices to make sure people were protected from abuse and neglect. We found safeguarding concerns during our assessment that had not been identified by the staff and not all safeguarding had been notified to CQC. The service had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The service was aware of the need to and had submitted applications for people to assess and authorise that any restrictions in place were in the best interests of the person.

Risks were identified and detailed in peoples plans of care. However, they were not always managed safely. For example, falls were recorded but the 24hr monitoring post fall was not always followed and lack of follow up to reduce risk of future falls. The care plans detailed actions to be taken, however, staff were not documenting effectively, therefore it was not possible to determine if the care plans were being followed. There was no monitoring, review, or oversight of the risks.

The new manager was aware of the need to improve practices for assessed risk to ensure people were appropriately supported. They told us improvements in documentation were required and were working with staff through supervision to embed good practice.

Staff knew people well; we saw staff supporting people safely. However, documentation following an incident was not always in place, so it was not possible to monitor or learn lessons to minimise future risk.

People had individual risk assessments in place and the care plans detailed actions to be taken. However, staff were not assessing changing needs or documenting effectively, therefore it was not possible to determine if the care plans were being followed. There was no monitoring, review, or oversight of the risks.

People were cared for in an environment that was designed to meet their needs. People had a range of equipment available to use. However, we found furniture stored in stairwells causing a fire hazard and various floor coverings causing tripping hazards.

All maintenance checks were completed to ensure safety. Staff said there was enough equipment available to meet people’s needs.

We saw evidence that environmental and equipment checks had been completed. Equipment was available in different areas of the service for staff to access easily. Maintenance of the environment was ongoing at the time of our site visit to ensure it was well maintained and safe. However, we found several areas required improvement. For example, floor coverings were damaged and causing a tripping hazard.

There were ineffective systems, processes, and practices to make sure people were protected from abuse and neglect. We found safeguarding concerns during our assessment that had not been identified by the staff and not all safeguarding had been notified to CQC. The service had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The service was aware of the need to and had submitted applications for people to assess and authorise that any restrictions in place were in the best interests of the person.

There was a staffing dependency tool used; at the time of the visit the staffing levels did not meet the required hours identified by the tool. All people told us there was not enough staff. People said staff were not always available in communal areas and did not always give support in a timely way. One person said, “There aren’t really enough staff especially at nighttime we could do with more.”

The new manager explained that the existing dependency tool was not suitable and they were in the process of implementing a new one. This would ensure the correct staffing hours were allocated to ensure safety and meet people’s needs. Staff told us there was not enough staff in the mornings to meet people’s needs safely. We observed lack of staff in communal areas and lack of social stimulation.

There were not always sufficient staff available to support peoples care needs in a timely way. We observed communal areas were left unattended for extended periods of time, putting people at risk. Staff did not receive leadership, direction, or supervision to support them in their roles.

Staff received training to ensure they had the skills to meet people's needs. However, it was not clear if it was always effective. Staff supervision and support was not up to date, this has been identified by the new manager and has been scheduled. Safe recruitment practices had not always been followed. This did not ensure robust, safe recruitment of staff who were suitable to work with vulnerable people.

People and relatives felt the service was clean. People said, “My room is always kept clean.” However, we found some areas were not well maintained so could not be effectively cleaned.

The new manager was aware of the need to improve quality monitoring. The infection control audit tool had been improved and they assured us they would be following best practice guidance.

We carried out a tour of the service and found the service to be predominantly clean, however, there were areas that were not well maintained. For example, floor coverings were damaged, plaster damaged in storerooms, untreated wooden shelves and many lounge chairs were damaged and unable to be effectively cleaned. The audit tool used did not identify some areas that required attention.

There were systems in place to monitor infection, prevention, and control. However, the audit tool used did not identify some areas that required attention.

Medicines management was not safe. We found many errors and lack of effective quality monitoring. People did not receive their medicines as prescribed. Errors identified, included, inconsistencies and confusion whether a medicine was a regular dose or to be given as and when required. Protocols in place for as, and when required medicines lacked detail to guide staff. It was, therefore, not clear if people received these when they needed them. There was no audit of medicines in stock, so at times medicines were recorded out of stock but were available.

There were measures in place to monitor medicines management. However, these were ineffective. Management conducted a full audit following our site visit and identified concerns, no actions were completed or followed up, as the same errors were still occurring when the local authority completed a medicines audit 2 weeks later. Lessons were not learnt.

The processes were not robust or safe.