Our inspection of Rowland House took place on the 30 April 2018 and was unannounced.Rowland House Care Home is registered to provide care, support and accommodation for up to seven people who have an acquired brain injury. At the time of our visit there were seven people living at the 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.
At the time of our visit a registered manager was present and in post. 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.
We found that there was no over view or system of recording and monitoring all of the incidents and accidents. We also found that when certain events occured, the provider had failed to notify CQC where necessary. You can see what action we told the provider to take at the back of the full version of the report.
Relatives told us they felt their family member was safe living at the service. Staff had received training in relation to safeguarding and were able to describe the types of abuse and processes to be followed when reporting suspected or actual abuse. Risks to people were assessed and considered consistently.
There were sufficient staff present to safely meet people's needs. We observed staff being consistently present with each person throughout the day. We also saw that safe and correct checks had been completed in the recruitment process for all of the staff.
Staff were seen to check the medicine administration record (MAR) to check what medicine was required at what particular time. When medicine was given to people, staff explained what it was and made sure they had a drink, or other fluid to make it easy to swallow. People were protected against the risk of the spread of infections. The home environment was clean with no malodours.
Peoples’ needs and choices were assessed to make their care, treatment and support as effective as possible. In two care plans we saw clear and detailed pre admission assessments which assessed the care required for people. People’s relatives were very positive about the food at this service. We observed that people’s nutritional ad hydration needs were being met.
All staff had been trained in areas relevant to their role which was in line with the Care Certificate. The Care Certificate is an identified set of standards that health and social care workers adhere to in their daily working life. All staff were supported with frequent supervision by the manager.
We saw evidence of people being supported to access healthcare professionals when needed. The home had a gym in the basement which was frequently used by people and occupational therapists (OTs). The environment was suitably adapted for the people living there.
Where there were restrictions in place, staff had followed the legal requirements to make sure this was done in the person's best interests. Staff consistently sought consent from people. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way.
Relatives told us that they felt staff treated their family member with kindness, respect and compassion. Staff promoted people’ privacy, dignity and independence. Peoples independence was promoted.
Where there had been complaints made there had been clear action taken to address the concerns.
There were plans in place for person centred end of life care in each care plan. We saw one care plan which had a detailed booklet specifying the steps, contacts and relevant facts to one person and their preferred arrangements. People had access to a wide range of activities specific to their interests.
There was a clear vision and credible strategy to achieve good outcomes for people. This was to rehabilitate people and promote their independence so that they could be discharged. Since the last inspection in 2016, five people have been discharged to either live with their families or independently with partners.
Staff were positive about the manager and the culture of working at this service. We saw minutes of meetings held with staff where they discussed ideas about the home relating to people’s care, staffing and training. People, the public and staff were actively engaged and involved in the service.
Quality assurance checks were completed around the home, to spot where areas of improvement were needed. Health and safety checks were completed on a weekly and monthly basis. Areas covered included cleanliness and infection control, fire safety checks, including reviewing the last evacuations, and condition of the environment.