Bowland Lodge

Bowland Lodge is a residential care home providing accommodation for up to 36 people who require personal care. The service provides support to people living with mental health conditions and dementia. At the time of our inspection there were 23 people using the service.

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

A system to ensure regulatory requirements were met was not in place. We identified shortfalls in areas of the service including the assessment of risk, safeguarding procedures, management of medicines, infection control, and the governance of the service.

We identified shortfalls with the assessment of risk. This included environmental risks and risks relating to the care and support of people. Some action had been taken to improve care planning since our last inspection. However, further improvements were required to ensure care plans and risk assessments reflected people's needs. No analysis of accidents and incidents had been carried out. This meant staff were unable to identify any trends or themes to help reduce the risk of any recurrence.

Medicines were not managed safely. Action had not always been taken to ensure incidents of a safeguarding nature were always reported to the correct authorities. Some people raised concerns with us regarding the attitude of some staff. The home was subject to ‘organisational safeguarding’ procedures. This meant the local authority were monitoring the whole home. Following our inspection, we made several safeguarding referrals to the local authority to ensure information we identified during our inspection was reported to them.

Some improvements had been made to improve the cleanliness of the environment. However, ongoing shortfalls were identified regarding the maintenance of the premises, including the outdoor space. A schedule of on-going maintenance for the service was not available.

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 inadequate (published 3 November 2023). At this inspection we found the provider remained in breach of regulations. The was the 8th consecutive inspection where the provider has been in breach of regulations since October 2015.

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about infection control, medicines management, safeguarding, the assessment of risk and the overall governance of the service. A decision was made for us to inspect and examine those risks. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding, premises and equipment 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

The overall rating for this service is ‘Inadequate’ and the service remains 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 the 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.

Bowland Lodge is a residential care home providing accommodation for up to 36 people who require personal care. The service provides support to people living with mental health conditions and dementia. At the time of our inspection there were 26 people using the service. The registered manager told us that 25 people received personal care. This meant that 25 people received the CQC regulated service of both accommodation and personal care.

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

A system to ensure regulatory requirements were met was not in place. The provider had not implemented robust governance procedures to improve the quality and safety of the service. The provider has been in breach of the regulations since 2015 and sustained improvements have not been made. Whilst action had been taken to improve in certain areas since our last inspection, additional shortfalls were identified which had been raised at previous inspections. There was a lack of evidence that lessons had been learned following each inspection to ensure a robust and effective system was in place to improve the management of risk.

We identified shortfalls with the assessment of risk relating to people’s care and support, the cleanliness and maintenance of the premises, including the outdoor space, fire safety and infection control including food hygiene. Risks relating to eating and drinking, including allergy information, had not always been fully assessed. The refurbishment plan discussed at our previous inspections was still ongoing.

Records did not always evidence that safe recruitment procedures were followed. An effective system to manage medicines was not fully in place.

Action had been taken to improve care planning. However, further improvements were required to ensure care plans and risk assessments reflected people’s needs.

We observed positive interactions between people and staff. However, due to the concerns identified during the inspection, we could not be assured people received a high quality, compassionate and caring service. In addition, the environment, furnishings and cleanliness did not promote people’s privacy, dignity and wellbeing.

There was a safeguarding system in place. However, we had not been notified of one safeguarding allegation in a timely manner. Following our last inspection, the local authority had placed the home into 'organisational safeguarding.’ This meant the local authority was monitoring the home and supporting them.

There were enough staff deployed to meet people’s needs. An activities coordinator had been recruited since our last inspection and an administrator was now in post.

A staff support and training system was in place. Additional training had been carried out since our previous inspection. Staff spoke positively about the support they were receiving from the registered manager.

Staff had been liaising with the local integrated care board with regards to training. They had also worked with health and social care professionals regarding people’s care and support.

Improvements had been made in relation to meeting people’s social needs. An activities programme was in place. People were supported to access the local community and take part in activities which interested them such as arts and crafts. An entertainer visited on our 2nd visit which people enjoyed.

The registered manager gave us examples of how being at the service, with the support of staff, had led to an improvement in people's independence and wellbeing. They also explained how several people had moved onto independent living.

Following our feedback, the registered manager wrote to us and explained that action had/was being taken to address the shortfalls identified and new systems/records had been implemented.

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 inadequate (published 21 March 2023). There were 5 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment; person-centred care, need for consent; good governance and duty of candour. We also identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009; notification of other incidents.

Whilst action had been taken to improve in certain areas, not enough action had been taken and the provider remained in breach of the regulations relating to safe care and treatment and good governance. We also identified a new breach in relation to the premises and equipment.

This is the 2nd consecutive time the service has been rated inadequate and the 3rd time it has been rated inadequate overall since 2018. The service has been rated requires improvement 3 times since 2017.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Enforcement and Recommendations

We identified 2 continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment and good governance. We also identified a new breach in relation to the premises and equipment.

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

The overall rating for this service remains ‘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 the 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.

Bowland Lodge is a residential care home providing accommodation for up to 36 people who require personal care. The service provides support to people living with mental health conditions and dementia. At the time of our inspection there were 30 people using the service.

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

There was a history of failing to provide good standards of safety during the previous five inspections dating back to December 2017. There was no evidence that lessons had been learned following each inspection to ensure a robust and effective system was in place to improve the management of risks.

There were ongoing risks relating to the environment, people’s care and support and infection control which had not been fully assessed to ensure the safety of people, staff and visitors. The refurbishment plan discussed at our previous inspections was still ongoing. Not all areas of the home were safe or person centred. In addition, records did not evidence that areas such as the communal kitchen were used to promote people’s independence. We have made a recommendation about this.

There was a safeguarding system in place. However, this was not always operated effectively. CQC had not been notified of all the safeguarding incidents at the home. This meant CQC were not fully aware of the level of risk to people at the home. Records did not always evidence that safe recruitment procedures were followed. There were enough staff to meet people’s needs; although staff were not always deployed effectively to meet people’s emotional and social needs. An effective system to manage medicines was not in place. There were gaps and inconsistencies in the recording of topical medicines and the storage of medicines was not always safe.

Systems to ensure people were provided with a suitable diet and their independence and involvement was promoted were not fully in place. Several people told us their goal was to move onto independent living. Care plans formulated by staff at the home, did not evidence how staff were going to support people to be independent with living skills such as meal preparation and cooking. The principles of the Mental Capacity Act had not been implemented or followed. Records did not promote staff to support people to have maximum choice and control of their lives and support people in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff had undertaken training in areas such as mental health conditions and alcohol use. However, this knowledge and understanding was not reflected in the care plans and risk assessments we reviewed. Some staff felt that more training was required to enable them to meet the needs of people. We have made a recommendation the provider keeps staff training under review to ensure staff are suitably skilled in supporting people’s needs and ensuring care and support is delivered in line with best practice guidance.

An effective system to ensure people were involved in their care and support was not fully in place. Records did not fully evidence people’s involvement. Care plans and risk assessments formulated by staff at the home, did not reflect people’s needs. People’s strengths and levels of independence had not been assessed to help ensure people achieved their full potential and positive outcomes. There were limited activities to occupy people’s attention. Staff explained that most people did not like to engage in planned activities but preferred to go out and about or spend time in their rooms. Staff told us however; that they would like to do more to encourage activities and social inclusion.

A system to ensure regulatory requirements were met was still not in place. The provider and registered manager had not implemented robust governance procedures to improve the quality and safety of the service. The provider’s duty of candour policy had not been followed. Records did not demonstrate how the provider was meeting their responsibilities under the duty of candour.

A new manager was in post. Staff spoke positively about her and the changes she was making. Following our inspection, the new manager submitted an action plan which stated the actions that had/were being taken. Whilst we acknowledged the content of the action plan; the provider had been in breach of the regulations since 2015 and action plans have been completed following each inspection. These, however, have not led to sustained improvements.

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 30 April 2022). There was a breach of the regulations relating to safe care and treatment and good governance. We issued a warning notice, telling the registered manager and provider, action must be taken to improve. The registered manager also completed an action plan 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

We undertook this inspection to check they had followed their action plan; achieved compliance with the warning notice and confirm they now met legal requirements.

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.

Enforcement and Recommendations

We identified 5 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment; person-centred care, need for consent; good governance and duty of candour. We also identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009; notification of other incidents.

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.

We have made recommendations in relation to staff training and facilities at the home. Please see the effective key question for further details.

Follow up

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 the 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.

Bowland Lodge is a residential care home proving accommodation for persons who require nursing or personal care to up to a maximum of 36 people. The service provides support to people living with mental health conditions and dementia. At the time of our inspection there were 19 people using the service.

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

Bowland Lodge has had a continuous breach in relation to good governance since February 2018. Concerns in relation to ensuring risks are assessed, managed and mitigated have been ongoing since that time. At this inspection some risks had not been assessed. The quality assurance system had not been effective in identifying the shortfalls we identified in relation to risk management, ensuring care records were complete, accurate and contemporaneous, failure to implement the Mental Capacity Act appropriately and concerns in relation to record keeping.

Staff and the management team were not following the current guidance in relation to PPE. Some risks had not been assessed. There were concerns in relation to fire drills and Portable Appliance Testing had not been completed since October 2019. Medicines were administered safely, however, there were some recording concerns related to ‘as required’ medicines. There were mixed views on staffing levels. Safe recruitment practices were followed and people told us they felt safe.

Staff were observed to offer people choice. Records did not promote staff to support people to have maximum choice and control of their lives and support people in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The principles of the Mental Capacity Act had not been implemented or followed. We have made a recommendation about this.

Pre-admission assessments were completed. However, people’s identified needs were not always care planned or risk assessed. Staff said they were well supported and had attended required training, although some commented that the majority of training was by eLearning. People were supported to access healthcare services and support. There was an ongoing refurbishment plan which had been delayed due to the COVID-19 pandemic.

People had no complaints about Bowland Lodge. A system was in place to record and investigate any concerns. Policies were in place in relation to the Accessible Information Standard and end of life care.

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 2 July 2019) and there was a breach of regulation relating to good governance. 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.

This service has been rated requires improvement or inadequate for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about Infection, Prevention and Control (IPC) and visiting concerns. We looked at IPC 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 provider can respond to COVID-19 and other infection outbreaks effectively.

We previously carried out an unannounced comprehensive inspection of this service on 5, 6 and 22 March 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bowland Lodge on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We identified a breach in relation to safe care and treatment and a continuing breach of good governance at this inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

People’s experience of using this service: Improvements had been made since our last inspection with regards to fire safety and the premises. A new snack kitchen had been built, which when open, would be available for people and relatives to use. A hydration station had been introduced. People were able to access drinks when they wanted. A new entry gate had been fitted at the bottom of the drive. Further work was being carried out to ensure the security of the garden, so people could access the garden safely.

There were structures and systems in place to support people’s health and wellbeing, such as helping them reduce their alcohol intake. However, some people told us they would prefer to live at home without the organised supervision and therefore their answers to our questions were not as positive as others.

People received individualised care, however, further action was required to ensure that care plans reflected people’s needs and identified risks. There was an activities programme in place. People were supported to access the local community.

The management and governance of the service had been strengthened. Audits and checks were carried out on all aspects of the home. These however, had not identified the issues with the maintenance of records. In addition, the systems and changes which had been introduced, were still in the process of becoming embedded into practice.

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

Rating at last inspection: Inadequate (previous report published 28 January 2019). We identified multiple breaches of the regulations. We took urgent enforcement action and placed conditions upon the provider's registration, including the suspension of admissions. We asked the provider to complete an action plan to show what they would do and by when to improve.

This service has been in Special Measures. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Why we inspected: This inspection was carried out to follow up action we told the provider to take at the last inspection.

Enforcement: We identified a breach in relation to good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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 also meet with the registered manager and provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

The home consists of two large three storey Victorian semi-detached houses joined together. The provider had used the land behind the home and built a new care home extension. Staff told us this had been built for a number of years but it was not fully completed. Therefore, it was not in use and the provider had not applied to us to vary their conditions and add an extra number of places.

This inspection took place on 24 September 2018 and was unannounced. We carried out two further announced visits on 3 and 9 October 2018 to complete the inspection.

At our last inspection in December 2017, we identified three breaches of the regulations. These related to safe care and treatment, premises and equipment and good governance. Risks to people had not been fully mitigated. Water temperatures exceeded recommended limits and there were concerns regarding infection control. The home had not been adapted to meet the needs of people with dementia type conditions and the provider did not have any monitoring or oversight arrangements in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of people.

Following our inspection, the registered manager sent us an action plan which stated what actions they were going to take to improve and meet the regulations.

We brought forward our planned inspection because we had received several anonymous concerns about the environment, staff conduct and a dangerous dog on the premises. Concerns about the environment were corroborated during the inspection; however, no concerns were identified regarding staff conduct. The registered manager brought in their puppy who was a Cockapoo. He was very friendly and people appreciated seeing him.

There was a registered manager in post at the time of our inspection. 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 inspection, we found that action had been taken to address some of the issues identified at the previous inspection. A representative of the provider now carried out finance audits and special valves had been fitted to limit water temperatures. However, we found continued and new shortfalls and omissions with certain aspects of the service.

Systems for ensuring the premises were safe and clean were not effective. The provider had not fully checked and addressed all the shortfalls identified by Tyne and Wear Fire and Rescue Service on 14 June 2018. Not all window restrictors conformed to the Health and Safety Executive guidelines because they could be overridden. Fixtures and fittings were not always well maintained and due to damage, some areas could not easily be cleaned. Following our inspection, the registered manager wrote to us and stated that these issues had been addressed. She explained that all issues raised by Tyne and Wear Fire and Rescue Service had been checked and action taken where required. She stated that the fire alarm system and risk assessment already met the required regulations and no further action was required.

Risks to people’s safety were not fully assessed and staff did not always have access to written plans of care relating to meeting the needs of people who displayed behaviour which the service found challenging,

There were shortfalls in the management of medicines. We identified omissions with the management of prescribed topical creams and ointments. The controlled drugs cabinet was not securely fixed to the wall.

The design of the premises and facilities did not fully support people’s independence or wellbeing. Some people’s bedrooms were impersonal and had limited furniture. Support provided to meet people’s nutrition and hydration needs was not always person-centred and did not promote people’s involvement and independence.

There was a lack of evidence to demonstrate that people who had issues with alcohol had been asked if they would like to be referred for external help and support. We did not see that people were supported with hobbies or take part in social activities relevant to their interests.

People spoke positively about the caring nature of staff. However, an effective system was not fully in place to promote people’s independence. Some people could not access the garden independently because it was not secure. Facilities to promote people’s daily living skills were not fully available.

Most people told us that staff promoted their privacy and dignity. Several people told us that staff routines on a morning sometimes took priority over their preferences. They explained that sometimes staff encouraged them to wake early when they preferred a longer lie in.

In response to the concerns identified we took urgent enforcement action. We imposed conditions on the provider's registration to minimise the risk of people being exposed to harm. This included imposing a suspension of admissions to the home.

Since 2011, we found the provider was breaching one or more regulations at five of our 10 inspections. Most of these breaches related to regulations regarding infection control and the premises. At this inspection, we found that improvements had not been fully made. This meant that compliance with the regulations was not sustained and consistency of good practice was not demonstrated. This is the second consecutive time the service has been rated requires improvement.

During the inspection we identified shortfalls regarding the environment, medicines management, the assessment of risk, promoting independence and activities provision. Audits and checks were carried out to monitor aspects of the service. However, these did not identify all the shortfalls and omissions we found.

The overall rating for this service is inadequate and the service is therefore in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, person-centred care, dignity and respect, meeting nutritional and hydration needs and good governance.

You can see what action we told the provider to take at the back of the full version of the report.

At our last inspection in 2015 we found the provider was not meeting the requirements of Regulation 9 of the Health and Social Care Act Regulations 2014 - Person-centred care. They had not always carried out an assessment of the needs and preferences for the care and treatment of people; and had not always designed their care and treatment in line with such needs and preferences. During this inspection we found improvements had been made in this area.

During this inspection we found breaches of Regulations 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not done all that was reasonably practicable to mitigate risks to people including responding to high water temperatures and ensuring the cleanliness of the home. The home had not been adapted to meet the needs of people with dementia type conditions. The provider did not have any monitoring or oversight arrangements in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users.

Bowland Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home accommodates up to 36 people in one building. There were 30 people using the service during our inspection. People who used the service had enduring mental health needs or dementia type conditions.

There was a registered manager in post at the time of our inspection. 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.

Before the current registered manager came into post people who used the service had been the victims of theft in the home. Lessons had been learnt by the current registered manager who developed new systems to prevent thefts happening again. However, the provider failed to carry out reasonable checks to ensure people’s finances were being managed correctly.

The registered manager had arrangements in place to monitor the effectiveness of the service. We found the provider failed to have oversight of these arrangements to ensure improvements were made to the service.

We checked on records of health and safety checks. Whilst staff were given guidance on bathing temperatures for people we found people who used the service had access to basins where the water temperatures were in excess of those recommended by the Health and Safety Executive to minimise the risk of scalding. A plumber was called to the service during our inspection to assess the situation.

We found cleaning took place in the home, however due to the condition of some of the equipment and flooring cleaning could not be carried out to an acceptable standard to reduce the risks of cross infection.

Some people who used the service were living with dementia type conditions. We found the home had not been adapted to meet people’s needs. People could not access the garden independently as there were no front gates to ensure people could be kept safe.

We found window frames which had rotted and some windows could not be opened. The registered manager showed us an email from a builder who having received a payment from the provider was preparing to start work on the windows.

The service had appropriate systems in place to protect people from harm. Staff were trained in how to safeguard vulnerable adults and told us they felt able to approach the registered manager with any concerns about people who used the service.

People were supported as appropriate to receive their medicines safely from staff assessed as competent to do so. Records of medicine stocks were correct.

People had the opportunity to give their views about the service and a complaints procedure was available to them. The registered manager showed us they had investigated complaints and provided an outcome to the complainant to their satisfaction.

We looked at staff recruitment records and saw that appropriate checks had been undertaken before staff began working for the service.

The registered manager reviewed accidents and incidents which took place in the home on a regular basis to see if there were any patterns or trends which could be avoided in the future.

We found the registered manager and the staff had advocated on behalf of people to secure their rights and prevent them from becoming distressed.

Everyone we spoke with was complimentary about the caring approach taken by staff towards people and their relatives. We found staff knew people well and were able to provide individual care for people using well timed words and shows of affection. We observed people being cared for with the utmost kindness and patience.

People had care plans in place which were accurate, up-to-date and were reviewed by staff on a regular basis.

Some people living in the home were able to access the community by themselves. Other people required staff assistance to leave the home. We found staff when they were able provided activities for people, however there was not a programme of stimulating activities in place for people who could not access the community independently.

The registered manager carried out audits and surveys to monitor the quality and effectiveness of the service. These audits identified where improvements needed to be made, however they did not identify all the improvements which were required to the building.

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.

We found the registered manager was proactive in supporting people and they showed great care towards people who lived in the home.

The service worked in partnership with health and social care professionals. Professionals told us they were welcomed into the service and facilities were provided for them to carry out their respective roles.

We have made recommendations about activities provisions and the accessibility of the building for people with physical disabilities. .

You can see what action we told the provider to take at the back of the full version of the report.

We carried out this inspection in response to anonymous concerns received that the home did not have sufficient staff to meet the care needs of the people living there.

We spoke with staff and people living in the home, checked with the local authority safeguarding and commissioning teams and looked at staff records.

We found the home was being staffed at an appropriate level and that people's needs were being met. We found suitable arrangements were in place for determining the necessary level of staffing to meet people's needs, and found that the home was routinely staffed to meet those needs. We found that appropriate arrangements were in place for covering staff sickness.

We also looked at outstanding areas of non-compliance from the previous inspection in June 2014. We found that significant improvements had taken place in the cleanliness of the home and in the arrangements to prevent infection, and that people now lived in a clean and hygienic environment.

We also found that all the issues of poor maintenance and lack of repair to the facilities and the fabric of the building identified at the previous inspection had been addressed. This meant people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We carried out this inspection to check that areas of non-compliance identified at our last inspection had been addressed.

We found that people living in the home were now being given the necessary information about what they were being required to pay towards their care, and what services they could expect in return for their fees. This included information about how their benefits were calculated. People who were privately funded had been issued with appropriate contracts. This meant people were clear what they were responsible for paying towards their care.

We found that people living in the home had also been given written information about their financial benefits, including the amount of 'personal allowance' (pocket money) they were entitled to each week. We saw improvements to how such personal allowances were recorded and accounted for, with better book-keeping and evidence of any purchases made on a person's behalf. This meant people were being given improved protection against the risk of financial abuse.

We saw that there was a greater awareness that significant events needed to be reported to the appropriate authorities, including the Care Quality Commission. We saw appropriate arrangements were now in place to make sure such events were reported promptly.

In addition, we looked around the building. We found the home had not been well maintained and had many areas of neglect and disrepair. Some of these issues posed risks to the safety of people living in the home and to staff and visitors. Other issues involved inadequate cleaning resources and inappropriate furnishings that were difficult to keep clean. This had resulted in cleanliness and odour problems in some areas of the home and the risk of cross-infection. We have asked the provider to tell us how they will address these issues. We were told the necessary resources have already been made available, and that remedial work had already started.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

People were cared for in a safe environment. Equipment at the home had been well maintained and serviced regularly. People's needs had been assessed and their care was planned to meet their needs. There were enough staff on duty to meet the assessed needs of the people living at the home, and staff were experienced and skilful in meeting those needs. People living in the home were treated as individuals. Staff were encouraged to take up all training opportunities, but did not always have access to systems to keep fully up to date with their training needs. Staff were alert to any signs of abuse and were trained to report any concerns. People we spoke with told us they felt safe in the home. The provider had failed to make suitable arrangements to prevent the possibility of financial abuse in that the the provider had not given people a clear written statement of what levels of personal allowances they were entitled to receive.

Is the service effective?

Care records showed most people's health and well-being had improved since coming into the home, and most people we spoke with confirmed they felt well cared for. Chronic health conditions were managed appropriately and people were properly nourished. Appropriate referrals for specialist professional assistance were made, and advice and guidance followed by staff. This resulted in improvements in people's independence and a reduction in behaviours that caused distress to the person, or others around them. We saw comments in a survey carried out by the home in 2013 included, 'Bowland Lodge is an excellent home with a good care team and management team' (from a visiting professional) and, 'We cannot recommend Bowland Lodge highly enough' (from a relative).

Is the service caring?

People told us they were happy with the care and support they received, and had no complaints. Most people said they were settled and contented in the home. They all spoke highly of the manager and staff. People's comments included, 'We've got no problems, here'; 'The staff are fine ' they treat you well'; 'I like it here'; and, 'I'm settled.' No one told us they had any worries about their care, and all those we asked said they knew how to raise any concerns they might have. We saw that staff were kind, attentive, and knew their residents well. The atmosphere in the home was relaxed and calm, and people said they felt free to come and go as they wished. Relatives and visiting professional had made positive comments about the care in the home in a recent survey.

Is the service responsive?

No one told us they had any worries about their care, and all those we asked said they knew how to raise any concerns they might have. The manager operated an 'open door' policy to people living in the home, and we saw she responded promptly and with great care and sensitivity to people's comments and requests. This meant any possible complaints were dealt with swiftly and informally, and people felt listened to. Staff knew people's personal preferences and worked proactively to meet their wishes. An annual survey was carried out of the views of people living in the home, their relatives and representatives, and of visiting professionals. We noted the manager responded positively to any issues raised.

Is the service well-led?

Staff members told us they felt involved and supported by the manager in their work, and told us they took pride in their caring duties. Staff were clear about their roles and what was expected of them. They received regular supervision and appraisal of their work and told us they felt valued. The manager set a clear example for good values, good care and encouraged her staff to contribute ideas for improving practice in the home. Since recently taking up her post as manager, she had kept CQC informed of all significant events. However, prior to her being appointed as manager, the provider had failed to notify CQC of a significant event relating to the previous manager. We also found that people's fees and levels of personal contributions to those fees had not been clearly set down in writing by the provider. Compliance actions have been set in relation to these two issues and the provider must tell us how they intend to improve.

We found that food was being used within its 'use by' dates, although labelling was not always consistent.

We found there were enough staff to meet the assessed needs of the people living in the home, and there were appropriate systems in place for covering staff sickness.

We found the home was carrying out appropriate checks before employing new staff.

This was a 'follow up' inspection to check that the provider had carried out the necessary actions to become compliant in these areas.

We found that the kitchen had been properly cleaned and that kitchen cleaning schedules were being closely monitored.

The availability and accessibility of protective clothing such as disposable gloves and aprons had been improved in toilets and bathrooms, and, where assessed as being necessary, in people's bedrooms. Paper towel and liquid soap dispensers were being kept stocked.

Better use of staff at peak times such as meal times meant that more staff were available to meet people's needs, and their mealtime experiences were improved.

People told us they were happy living in the home. They said they were well cared for and were treated with respect by the staff. One person told us, "I like living here"; another said, "I'm very well looked after, indeed. It's alright, here." Visiting healthcare professionals confirmed that the quality of the care was good.

There was a risk of cross-infection due to the lack of protective clothing available to staff in bedrooms, bathrooms and toilets.

There were concerns that the kitchen cleaning schedules were not effective in maintaining adequate levels of cleanliness and hygiene.

Appropriate arrangements were in place to manage medicines.

The home had appropriate processes in place to make sure that unsuitable people were not employed as members of staff.

There were enough staff to meet people's needs, except at meal times.