21 May 2023
During an inspection looking at part of 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.