Bowland Lodge

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

The provider had made some improvements to improve safety, however there were still on-going significant issues with medicines management, managing risks and the maintenance and cleanliness of the environment and equipment. The provider had systems to deal with incidents and accidents appropriately. Staff were recruited safely and were visible around the home.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People confirmed staff were supportive and helped them to feel safe. However, people’s safety was impacted due to on-going significant shortfalls with the safety of the environment, medicines management and IPC. Systems were not effectively ensuring improvements or good practice were being embedded.

Staff felt improvements were being made since the registered manager had been employed. One staff member commented, “I can’t tell you how much better it is than before. This manager is trying so hard and making a difference.”

The provider lacked effective systems to ensure lessons were learnt and outcomes used to promote sustained improvement. The provider investigated and acted on individual incidents, accidents and complaints.

People did not report any concerns about the safety of their placements. With the support of staff and legal advice, some people were challenging restrictions placed on them.

The registered manager worked with other professionals to support the appropriate transition of some residents to alternative placements.

Partners did not raise any concerns about people’s transition into the home.

There had been no new admissions to Bowland Lodge since we last inspected. A new digital care planning system had been implemented which would be used to develop assessments of people’s care needs. The registered manager intended to review the pre-admission assessment process to ensure this was fit for purpose. The management team worked with external health and social care professionals to support the on-going health and well-being needs of people living at Bowland Lodge.

Although people did not raise any concerns about their safety, on-going shortfalls in the quality of care continued to place people potentially at risk. People said staff were available to help them, if needed. A person said, “The staff are always there if you need anything.”

Staff felt people were safer now living at Bowland Lodge. A staff member commented, “It’s definitely safer for people. The building is old but the care is good. All the staff I work with are really great.” Staff understood the safeguarding processes and felt able to raise concerns, if required.

On-going shortfalls with the environment impacted on people using the service. Staff were supportive towards people and assisted people to meet their needs.

The provider had an up-to-date safeguarding policy. Most allegations of abuse had been referred to the local authority safeguarding team and investigated. Some staff had completed safeguarding training as part of the Care Certificate. 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 (BI) 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 provider was meeting the requirements of the MCA. Where needed, authorisations for people being deprived of their liberty had been approved.

People said staff supported them safely. One person told us, "Anything they can help you with they do." However, people continued to be placed at risk due to on-going shortfalls with the safety of the environment, medicines management and IPC.

The registered manager described the actions staff took to support a person who experienced confusion and whose falls risk had increased. A falls sensor had been installed as the accident analysis identified they were most at risk when getting up in the morning. A staff member commented, “[Person] is now confused so we make sure one carer sits with him whilst he is in the lounge. There is a sensor in his bed so if we hear that we run to him.”

The provider was not always proactive in identifying and managing risks. We identified a potential risk relating to the external access to the building. Although the provider dealt with this straightaway, they had not identified the risk themselves. We also saw an exposed electrical circuit panel.

Although risk assessments had been carried out to identify measures to manage potential risks, staff were not consistently following these. There were wires hanging down in one person’s room, even though their risk assessment stated staff should report any issues with loose ‘carpets, flooring or cables’.

People gave mixed review about the environment. Some people described the décor as tired and old-fashioned, whilst others described how the provider was redecorating some rooms. One person commented, “I'd like to have it [their room] painted as it isn’t how I would do it.”

Staff said the registered manager was making a difference and making changes to improve the environment. A staff member told us, “[Registered manager] is amazing and is making a real difference. Things are being put into place, people have activities now and repairs are getting done.” Staff gave positive feedback about the newly employed maintenance person and the improvements they had made. A staff member commented, “[Maintenance person] is doing a fantastic job to tidy it (the home) up.”

Although improvements to the safety of the environment were being made, some areas still needed addressing. This included dirty and peeling window frames, a rusty fridge and a leaking skylight.

The provider was not proactive in ensuring a safe environment as risks were not managed robustly. There were some safety concerns identified which the provider had not addressed prior to our visit. This included an on-going issue with a rotting and leaking window, unsafe access to the rear of the building, uncollected rubbish and an insecure drain cover. There was an exposed circuit board in the passenger lift, a large crack in the lounge ceiling and a broken hoist in a bedroom. The home had employed a full-time maintenance person who had started to complete health and safety checks routinely. They were responsible for completing a range of health & safety related checks, such as portable appliance testing (PAT testing) and fire safety. The registered manager had developed a plan of outstanding maintenance, however there were no timescales attached to when these would be completed. People had personal emergency evacuation plans (PEEPs) which described the support they needed to leave the building quickly in an emergency.

Most people said there were enough staff to meet their needs. They also said staff were usually quick to provide support if needed. A person told us, “The staff are lovely really. Anything they can help you with they do.”

The registered manager said the home was fully recruited to all posts, except activities. They said they had recruited new staff since the last inspection, although there was not a high staff turnover and a lot of very longstanding staff. Staff felt staffing levels had improved. A staff member said, “[Registered manager] has made sure we have more staff and more support. We’ve got more training now.”

Staff were visible and active around the home. They supported people straightaway and did not rush or hurry people. Staff also had time to have meaningful interactions with people. People had also developed good relationships with staff. A person commented, “You can have a good laugh with the staff and they listen to you.”

New staff were recruited safely. The registered manager used a dependency tool to assess the number of staff required to meet people’s needs.

People did not comment specifically on the cleanliness of the home.

Staff felt IPC practices in the home had improved. Staff members said, “We’ve got much better cleaning products since [the registered manager] started” and “It’s very safe. The premises have really improved.”

Equipment was not always clean and hygienic, such as a stained shower chair stained, a stained lift door and clogged extractor fans. Flooring in the kitchen, laundry and shower room was not suitable for effective cleaning to minimise the risk of infection.

Staff kept cleaning records to confirm which areas of the home had been cleaned, and when. However, these records were not always fully or accurately completed. The provider had an up-to-date IPC policy. Some staff had completed training in promoting good IPC as part of the Care Certificate. IPC processes were not effective to ensure the premises were adequately cleaned. Soap dispensers in some bathrooms and toilets were empty, preventing good hand hygiene. A leaking window still needed repairing and could not be cleaned effectively. A fridge currently in use was dirty and stained, as well as kitchen surfaces, teaspoons and dining room tables not being clean. The provider had not been proactive in addressing these shortfalls and they had not been identified in audits. Staff were not following good IPC practices, as disposable PPE was not in use. A passenger lift was also not cleaned effectively and some flooring in the home could not be cleaned adequately due to materials used.

People did not raise any concerns about the support they received to take their medicines. A person said, “They do my medicines, but I could do them myself at home.” However, there were on-going shortfalls with the management of medicines.

Senior management informed us they were working towards the issues identified previously, however we still identified similar issues whilst on this inspection. A new medicines policy had been implemented in February 2024. This was not robust and had not been made service specific. Audits were taking place with some showing 100% compliance. Issues identified during the course of the inspection demonstrated these governance processes were not effective.

There continued to be no assurance medicines were stored in line with the manufacturer’s guidance. Temperatures in medicine fridges were out of range with no action taken and large gaps found in records. This placed people at risk of receiving medicines with a potential loss of efficacy. Systems did not provide assurance people received their medicines as prescribed. We found medicine records with no dosage instructions or frequency, no record of variable dosing and anomalies with stock counts. Processes relating to topical medicines continued to not be robust and records did not provide assurance people received their medicines as prescribed. Guidance to support staff in the safe administration of when required medicine was not always in place. Where it was, some contained incorrect information and also lacked person specific information. This placed people at risk as staff lacked guidance to enable them to act in a consistent way and in accordance with guidance from a prescriber. Medicines administration records were not always accurate and up to date. We found inconsistences with the recording of allergies, and transcription of warning labels, which was not in line with NICE guidance. Care plans continued to not always be in place, and some did not contain core information required to safely care for people. Care plans for people with complex conditions such as diabetes continued to not be in place despite this being raised at the previous inspection.