Rowan House Residential Home

Updated 31 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors and 2 Experts by Experience inspected this service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Rowan House Residential Home is a ‘care home’. People in care homes receive accommodation and nursing care as a single package under one contractual agreement dependent on their registration with us. Rowan House Residential Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Rowan House Residential Home also operates as a domiciliary care agency. It provides personal care to people living in their own homes.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

A registered manager was working at the residential home. The manager of the domiciliary agency was in the process of applying for registration.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all this information to plan our inspection.

We reviewed information we had received about the service since the last inspection. We sought feedback from professionals who work with the service. We used all this information to plan our inspection.

During the inspection

In the care home, we spoke to 8 people who used the service about their experience of the care provided. We also spoke with 4 relatives and 1 professional involved in the care home. We spoke to 11 people and 6 relatives of people receiving a care at home service. Overall, we spoke to 13 staff members, including the registered manager, manager of the care at home service, deputy manager and care workers.

We reviewed a range of records. This included 6 people’s care records and 6 medicines records. We looked at 6 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures, were reviewed.

Updated 31 August 2023

About the service

Rowan House Residential Home provides care and accommodation for up to 26 people who may be living with dementia. On the day of the inspection 25 people were living at the care home. Rowan House also provides a personal care service to people living in their own home. On the day of the inspection 30 people were supported by the agency with their personal care needs in their own home.

The residential service and the domiciliary service each had a manager in place. The residential service had a registered manager in place and the manager on the domiciliary service had applied to be registered. However, both the residential and domiciliary service remain under the same registration of Rowan House Residential Home.

Rowan House Domiciliary Care Agency

Risks were not always identified, assessed and recorded. One person had been exposed to potential financial risk. There were no checks, monitoring or audits of staff financial transactions done on behalf of a person.

One person had specific care needs. There was not sufficient guidance and direction for staff to safely manage all potential risks associated with their care and support.

Recruitment processes were not entirely robust. We have made a recommendation about this in the safe section of this report.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. There was misleading and contradictory capacity assessments seen in two care plans.

People and their relatives spoke positively about staff and told us they were happy with the service they received.

We were told staff were friendly, they were treated with kindness and compassion and their privacy and dignity was respected. Comments included, “They are very nice,” “Marvelous,” “Such a good agency” and “They are really good.”

New staff had sufficient support during their induction before working alone with people.

There were sufficient staff employed to cover the visits required by people. Staff were provided with adequate travel time to enable them to carry out visits at the time of the person’s choosing.

Environmental risks to visiting staff were assessed. Care plans were completed for each person and contained details of the person’s needs and preferences. Care plans were reviewed regularly to help ensure they were up to date and relevant.

People told us they felt safe when being supported by staff. There were systems to help protect people from abuse and to investigate any allegations, incidents, or accidents.

There were audit processes in place at the time of this inspection. However, these audits had not identified the concerns found at this inspection.

People and staff were regularly asked for their views and experiences of the service.

The service had implemented some quality assurance systems to monitor the quality and safety of the service provided. Spot checks were carried out to monitor staff performance. Staff were well supported and asked for their views.

People were supported by staff who had been appropriately trained and were skilled in their role.

People received support to maintain good health and were supported to maintain a balanced diet where this was part of their care plan.

Staff understood the importance of respecting people's diverse needs and promoting independence. People were always asked for their consent prior to care being provided.

There were clear lines of responsibility which were known and understood by the staff team.

There was a manager who was in the process of registering with the CQC at the time of this inspection.

Rowan House Residential Home

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

People told us they were happy with the care they received, and people said they felt safe living there. Comments from people included, “I am safe, and staff help me” and “I can talk to (named registered manager).” Another said, “They are familiar faces. I don’t know all their names, but I do know their faces.” While a relative said, “I’m happy with everything and I know (named relative) is safe here.” Another relative said, “It’s wonderful, like a family, very friendly and lots of fun.”

People looked relaxed, happy, and comfortable with the staff supporting them. Staff were caring and spent time chatting with people as they moved around the service.

The environment was safe, and there was equipment available which protected people from harm and supported staff. Health and safety checks of the environment and equipment were in place.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. Medicines were ordered, stored, and disposed of safely. However, we did find a discrepancy in the number of medicines held and what was recorded. The registered manager actioned this immediately and put additional audits and monitoring in place.

People were protected from abuse and neglect. The service used a computerised care planning system. People's care plans and risk assessments were clear. Records were accessible and up to date.

The management and staff knew people well and worked together to help ensure people received a good service.

People were supported by staff who completed an induction and received appropriate training and support to enable them to carry out their roles safely. This included fire safety and dementia care training. Staff were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for people to have social interaction, and an outside entertainer was in the service during our inspection. Staff knew how to keep people safe from harm.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s communication needs were identified, and where they wanted, people had end of life wishes explored and recorded.

Staff told us the registered manager was available, assisted them daily and moved into the service and helped cover shifts when some staff had been absent with COVID-19. They went on to say how the registered manager was approachable and listened when any concerns or ideas were raised. One staff member said, “Very friendly person” and another “Very approachable.” One relative said, “Yes, I’m confident in the management, they always let me know how she is and are responsive.”

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 good (published 30 September 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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 changed from good to requires improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to the oversight of the service. 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 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.