Bowland Lodge

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The governance and quality assurance processes were not effective in addressing issues quickly and promoting sustained improvement. As a result, there continued to be significant shortfalls which potentially placed people at risk. The provider was not effective in learning from incidents and encouraging sustained improvement. Staff gave positive feedback about the registered manager’s oversight of the home.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was little clarity about the provider's role to promote a positive culture. They said they got experts in and did not have a separate development plan for the home. However, they did tell is they do a regular walk around. Bowland Lodge had a diverse resident group, with a wide range of ages and care needs. Some people needed sporadic or rare prompts to manage their own personal care; others required personal care support from staff. Staff understood this and were clear about their role to help make the home a comfortable and safe place for people to lead their lives. Staff said the new management arrangements were good and lots of improvements were happening. Staff said they felt included and involved, and there was a good staff culture in the home. Staff confirmed there was “good teamwork” and said the registered manager shared the same values with them to make Bowland Lodge a good place for people to live.

The provider lacked a clear vision and set of values to promote high quality care, person-centred care for people and to develop and value staff.

Although staff gave positive feedback about the registered manager’s leadership and the changes they had made, there were still significant on-going shortfalls. Staff said the registered manager had a significant impact on staff morale. They praised the registered manager for the improved communication between staff and the improved social care of people. Staff comments: “[RM] is amazing and is making a real difference. Things are being put into place, people.

Care staff were very positive about the new registered manager and the changes that were taking place. They stated this had a significant impact on staff morale. The registered manager had experience of management positions in other care services where they had supported the rating of good for that service. However, the provider openly stated they did not govern the service and were heavily reliant on external contractors and auditors to check the compliance of the service. This meant the provider did not understand their regulatory responsibilities and did not monitor safety at the service with their own audits or checks.

The culture within the home was improving, with staff commenting the registered manager had fostered an open culture. Staff were now encouraged to raise issues and had confidence they would be acted upon.

Although the provider had an up-to-date whistle blowing policy, it was unclear how staff could raise concerns directly with the provider. Staff were aware of and had access to the provider’s whistle blowing and safeguarding policies.

Staff said the registered manager was making improvements to the home. Staff did not raise any concerns with us about equality and diversity issues. The home had a diverse staff group with a range of age, gender and cultural backgrounds. Staff were clear about their role to make the home a comfortable and safe place for people to live.

The provider had up to date policies and procedures relating to equality, diversity and inclusion. Some staff had completed equality and diversity training as part of the Care Certificate.

The registered manager was undertaking a fundamental review of the home. They said, “We have had to go back to basics, as starting after a long history of things needing doing. We feel we have now started to sort things out in priority order and are now on the right road. It’s not perfect by any means but we are on the right track now. [Provider] has given whatever I have asked for.” The provider told us they had used a consultancy company to inspect the home and they had identified improvements. However, apart from using the consultancy company, it was unclear what the provider’s oversight of the home entailed.

Quality assurance processes were not always effective in identifying or monitoring issues. This included the issues we identified with medicines management and the environment. Audits had been carried out, but some issues were not identified in audits and actions were not always signed off as complete. The provider's development plans for the home identified where progress had been made. However, further work was required to address the outstanding issues in the plans.

People accessed the local community either with support or independently, depending on their needs. A person told us, “I can go out when I want but there isn’t much I want to do.” Another person said, “It's okay here, the staff are okay. I can come and go as I want.”

There was good collaboration with visiting professionals, such as the GP and community nurse. The registered manager was a member of Skills for Care Manager’s Forum and used their guidance. However, the home was not meeting national best practice guidance and there were still several areas of improvement to make.

Professionals commented the registered manager and provider had responded to recommendations and had made some progress towards making improvements. They felt further improvements were possible with closer management oversight of the service.

The provider was working with partners to deliver improvements to the home. Progress had been made but further work was needed. Improvements included an upgraded medicines treatment room, more accurate record keeping, completing essential maintenance and updating the environment in the home. However, there were still areas for further improvement identified, such as increasing staff knowledge about the rationale for completing certain tasks and further environmental improvements.

The provider told us they were looking at various systems of regular checks and audits to enable it to get to a position of stability. Staff said they found the registered manager approachable. A staff member said, “[registered manager’s] door is always open. She’s very approachable.”

The provider continued not to have effective systems which ensured issues were identified, acted on and lessons were learnt. We continued to find significant shortfalls in medicines management, managing risk and the environment and the provider was again in breach of the regulations. These issues had been evident during previous inspections of this service and continued to be the case at this inspection. The registered manager had not yet introduced formal surveys of people and staff to determine their views of the home. Staff meeting minutes showed staff were able share feedback and make suggestions. This included activities and support for people to go out into the community.