Bowes House

On this page

• 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

Staff received training to allow them to support people safely and effectively. Medicines were overall safely managed and administered. People’s concerns were listened to and acted upon. Risks to people’s health and support were assessed and managed well by staff. Staff were trained in safeguarding and understood how to protect people from the risk of abuse.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us staff knew people well and understood their needs. One relative said, “Some of the staff are excellent, they deal with very challenging situations.” Feedback we received from people told us that people felt safe and that staff had received the necessary training to promote people’s safety and wellbeing.

Staff told us, “The training is good, we learn a lot. This is important for new staff on their induction.” Staff said they use incidents or complaints as a tool for learning and improving. They explained how they have regular meetings where they discuss the service, people they support and training.

Accidents and incidents had been recorded and analysed to determine the cause, and actions had been planned to reduce the likelihood of recurrence. Risk assessments had been regularly reviewed and updated to mitigate increasing risks. There were systems in place for families, people and staff to raise concerns or share their views.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe living at the service and that staff supported them well. One person told us, "There has never been any form of abuse from the staff."

Staff were all very clear about their role in safeguarding people. They had received training and felt confident about raising concerns and who to contact.

We observed staff attended to people in a safe and timely manner. It was clear staff wanted to ensure people were kept safe and well supported.

Staff had received training in safeguarding and there was an up to date safeguarding policy in place. The organisation had followed safeguarding procedures and made referrals to the local authority as well as notifying the Care Quality Commission when required. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS) The service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty. The documentation supported that each DoLS application was decision specific for that person. For example, regarding restrictive practices such as locked doors, sensor mats and bed rails. We saw that the conditions of the DoLS had been met.

People told us staff involve them in decisions about their care and how to keep them safe. A relative told us, “They do a lot of work with [my relative’s] walking, they inform me of the progress. I think he is very safe.” Another person described their risks to us and said they felt involved in managing the aspects of their life where they required support.

Staff understood how to manage and mitigate risks, and how to use the Mental Capacity Act to underpin decision making. Staff gave us examples of where reviews of risks had been carried out and appropriate measures taken and recorded to further reduce risks. Staff told us how they use risk assessments in a positive way to enable people to be more active and independent.

Staff were visible throughout our visit and were mindful of where people were and checked on them regularly. People had a range of call bell devices appropriate to their ability, to summon staff support when they needed it. We observed when people pressed their call bell, staff responded promptly. Equipment was well maintained and clean, fire safety equipment had been regularly checked and fire exits were clear from obstruction. Emergency information in case of fire was stored correctly and appropriately.

Care plans and risk assessments identified specific risks to each person and provided guidance for staff on how to minimise or prevent the risk of harm. These included risks associated with diabetes, mobility, skin integrity and eating and drinking.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives told us there were enough staff to meet their needs. One person told us, “Staff answer the call bells as quickly as they can.” Another person said, “Staff come quickly if I ring, I shower several times a week.”

Staff spoke positively about staffing levels. One member of staff told us, “I think we have enough staff, well on my unit anyway.” Another member of staff said, “We have a good team, sometimes we’re a bit short, but we have agency and we support each other.”

We observed people being responded to promptly when they required support. Staff had time to spend with people, having time for conversations and laughter. We saw people were spending meaningful time with staff, such as being supported with an activity.

Staff rotas showed there were sufficient numbers of suitably qualified and trained staff consistently deployed to fully meet people’s needs. Staff deployment ensured people’s needs were met in a timely manner and in a way that met their preferences. The provider followed safe and effective recruitment practices. This included checks with the Disclosure and Barring Service (DBS), requesting references from previous employers about their conduct in previous jobs and health checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Records showed staff belonged to the relevant professional body. Documentation confirmed that all nurses employed had an up to date registration with the Nursing Midwifery Council (NMC).

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People received their medicines in a way that met their individual needs and preferences. Staff showed kindness and respect to people within the service. One person told us, “We all get our medication correctly and on time, no concerns.”

Staff told us that there were good working relationships with external healthcare professionals, to provide a good standard of care for people within the service.

The service had safe systems for appropriate and safe handling of medicines. However, on occasions these were not fully effective. Risks had not always been appropriately risk assessed. PRN protocols (documents to support staff to know how and when to administer a ‘when required’ (PRN) medicine), did always not contain enough information to support staff in administering medicines consistently, as intended.