Rowena House

Rowena House is a care home providing accommodation for up to 40 people, including people living with dementia. The home is purpose built and accommodation is provided on 1 level. At the time of the inspection there were 33 people living at the home.

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

People told us they felt happy and safe at Rowena House. Improvements have been made to make sure the service responded to risks related to people’s deteriorating health in a timely way.

The provider had effective systems in place to safeguard people from the risks associated with abuse. Staff were trained and deployed effectively to ensure people’s needs were met and people’s medicines were managed safely overall. We found people were protected from the risk and spread of infection.

There were effective systems in place to monitor the quality of service. There was an emphasis on learning lessons and improvement. There was evidence feedback from people who used the service and their relatives was routinely sought and acted upon. There was also evidence of staff working in partnership with other agencies. This helped staff to deliver individualised care and supported people’s access to healthcare services.

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.

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 requires improvement (published 17 May 2021). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service between 26 February and 1 April 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contain those requirements.

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 comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rowena House is a care home providing accommodation for up to 40 people, including people living with dementia. The home is purpose built and accommodation is provided on one level. At the time of the inspection there were 33 people living at the home.

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

We found the service had not always responded to risks related to people’s deteriorating health in a timely way. There were systems in place to monitor the quality of service. However, there was room to improve these as they had not picked up the shortfalls we identified during the inspection process.

The provider had effective systems in place to safeguard people from the risks associated with abuse. Staff were trained and deployed effectively to ensure people’s needs were met and people’s medicines were managed safely overall. We found people were protected from the risk and spread of infection.

There was a real emphasis on learning lessons and improving the service. There was also evidence that feedback from people who used the service and their relatives had been sought and acted upon.

People’s care plans and risk assessments were being improved. There was also evidence of staff working in partnership with other agencies. This helped deliver individualised care and supported people’s access to healthcare services.

Rating at last inspection

The last rating for this service was good (published 8 January 2020).

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

Why we inspected

Initially, we undertook this targeted inspection in part to follow up on specific concerns which we had received about staffing levels, medicines management and infection control. Following the visit, we received further concerns and a decision was made to extend the inspection to a focussed inspection, in order to review the two key questions of Safe and Well led only. We completed a second site visit in order to review these two key questions.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well led sections of this full report.

The provider has taken action to mitigate the risks during and after the inspection and this has been effective.

We have made a recommendation about the provider’s system of audit and monitoring.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rowena House is a residential care home providing personal and nursing care to 36 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

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

The provider had a system in place to ensure people were safeguarded from the risk of abuse. Lessons were learned when things went wrong. Risks associated with people's care were identified and actions taken to minimise them occurring. Actions were taken when things went wrong, and lessons were learned to prevent issues reoccurring. Medicines were managed in a safe way; however topical MAR sheets could be more detailed and completed more accurately.

People's needs were assessed, and care was planned in a way which met people's individual needs. Staff felt supported by the management team and received supervision sessions on a regular basis. People received a balanced diet which met their needs. People were offered choices of what they preferred to eat. We spoke with two healthcare professionals who felt the service referred people appropriately and took on board their advice.

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.

We observed staff interacting with people and found they were caring. An emphasis on dignity featured throughout the home and in the way, staff approached care.

Care plans we looked at were person-centred and people and their relatives were involved in reviewing them. The provider employed a wellbeing lead who facilitated a varied program of activities. The provider had a complaints procedure and dealt with complaints in accordance with company policy. The provider had an end of life care policy and a lead in this area.

The registered manager was supported by an operations director. The service was well managed and monitored to ensure the service met the standard of the organisation. Relatives, residents and staff felt the registered manager was approachable and responsive. The home had a development plan in place which detailed actions to improve the service. People were given opportunities to feedback about the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection - The last rating for this service was requires improvement (published 30 November 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rowena House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Rowena House is a care home situated in Conisborough, Doncaster and is registered to accommodate up to 40 people. The service is provided by Runwood Homes Limited. Accommodation is provided on both the ground and first floor. The service had several communal and dining areas and easily accessible secure gardens. On the day of inspection 33 people were living at Rowena House.

At the last inspection, on 14 November 2017, the service was rated requires improvement overall and in safe, effective, responsive and well led, and good in caring. Breaches of regulations 12, safe care and treatment and 17, good governance were found. This was because risks associated with people's care were identified but not always managed and systems in place to monitor the service delivery were not always effective.

At this inspection we found the service had made sufficient improvements to satisfy the previous breaches, although further improvements are required which require embedding into everyday practice.

A registered manager was 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.

Staff understood their responsibility to report any concerns and were aware of the action to take if they suspected abuse had occurred. People were supported to manage their risks by staff who were aware of the need to protect people from avoidable harm. There were sufficient numbers of staff available to meet people's care and support needs. The provider recruited staff safely.

Most people received their medicines as prescribed. Medicine stocks did not always tally with those determined by the medication administration record. The environment was maintained, generally clean but some areas were in need of redecoration. Systems were in place to monitor infection control.

There were enough staff to ensure people were safe and had their needs met in a timely way. Staff had the skills and knowledge to carry out their roles and were supported by a system of induction, relevant training, one-to-one supervision and appraisals.

Staff understood their responsibilities under MCA, people's capacity had been assessed and when required best interest's meetings had been held and recorded.

People told us that they enjoyed the food. People had a choice of meals and were supported to maintain a healthy diet in line with their choices, preferences and any healthcare needs. People's health was assessed and monitored. Staff took prompt action when they noticed any changes or decline in health. Staff worked closely with health professionals and followed guidance given to them to ensure people received safe and effective care.

People's dignity and privacy was maintained by staff. People told us staff were kind and caring. Staff maintained people's dignity and encouraged choice and independence. Staff supported people to maintain friendships and relationships. People's friends and family could visit when they wanted and without restriction.

There were some activities available for people to enjoy, although the home did not have a dedicated activities staff member. Care records were personalised and detailed how people wished to be supported. Most provided clear information to enable staff to provide appropriate and effective care and support. Risks were clearly identified and included guidance for staff on the actions they should take to minimise any risk of harm.

Information about how to complain was displayed in the service. People and relatives knew how to complain and were confident that any concerns they had would be listened to and acted on. People and their relatives were asked their opinions of the service and these were acted on. Staff meetings were held regularly and their feedback valued. Staff told us that they felt supported by the registered manager and that the service was a good place to work.

Audits were in place to monitor the quality of the service people received, although, they were not frequent enough to be effective. The registered manager reviewed the recorded accident and incidents. These were analysed to identify any patterns or trends and plans were put in place to reduce the risk of them happening again in the future.

Services that provide health and social care to people are required to inform the CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

Further information is in the detailed findings below.

The inspection took place on 14 November 2017 and was unannounced. The last comprehensive inspection took place in November 2016, when the service was rated requires improvement. We found that staff did not receive appropriate support to carry out their role effectively. The registered provider sent us an action plan indicating what action they would take to address this breach.

At this inspection we found the registered provider had taken appropriate actions to meet the requirements of the breach. However, we also found risks associated with people’s care were identified but not always managed appropriately and that systems in place to monitor the service delivery were not always effective. The service rating remained as ‘requires improvement.’

You can read the report from our last inspections, by selecting the 'all reports' link for ‘Rowena House’ on our website at www.cqc.org.uk.

Rowena House is a care home situated in Conisborough, Doncaster which is registered to accommodate up to 40 people. The service is provided by Runwood Homes Limited. Accommodation was provided on both the ground and first floor. The service had several communal and dining areas and easily accessible secure gardens.

At the time of our inspection there was a registered manager 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. However, the registered manager was also registered at another service.

We completed a tour of the home with the registered manager and identified some issues in relation to infection control. Some areas required attention and staff practice was not always in line with infection control procedures and guidance.

We looked at systems in place to ensure people received their medicines in a safe way. We found staff who administered medicines were appropriately trained to do so. Medicines were stored appropriately in a locked room. However, we found some concerns with the recording of medicines administered.

Risks associated with people’s care had been identified but appropriate actions had not always been taken to ensure people were safe.

We observed staff interacting with people and found there were enough staff to meet people’s needs. However, we received comments from people who used the service and their relatives, which indicated there were times that staff were not available.

The service had a safe recruitment system in place. Staff received an induction when they commenced employment at the service. This included shadowing other staff so they could get to know the people who lived at the home.

People had been referred to healthcare professionals when required but their advice was not always followed.

People we spoke with were complimentary about the meals they received. However, they were not always offered a meal which was suitable to meet their assessed needs.

The service was meeting the requirements of the Mental Capacity Act 2005. Where people lacked capacity, best interest decisions had been made.

The registered manager had a supervision and appraisal schedule in place. Staff we spoke with told us they received supervision on a regular basis.

People who used the service and their relatives were satisfied with the home and felt it provided a safe and comfortable environment where their preferences and wishes were upheld.

We looked at care plans and found they reflected people’s needs, although they lacked a person centred approach. We spoke with the registered manager about this and they informed us that they were currently working on the care plans.

We saw staff interacting with people and providing social stimulation. People who used the service told us they were involved in activities.

The registered provider had a complaints procedure which was available in the home. People felt able to raise concerns and felt they were listened to.

Systems in place to monitor the service delivery were not always effective. Issues we raised as part of this inspection had not always been highlighted and/or addressed effectively. The registered provider also failed to make significant improvements from our last inspection and was rated again as ‘requires improvement.’

People and their relatives had the opportunity to voice their opinions about the service and contribute their suggestions.

People who used the service, their relatives and staff, were complementary about the registered manager and felt the management team were approachable.

The service has a registered manager who had been registered with the Care Quality Commission since September 2013. 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.

Rowena House is a care home situated in Conisborough, Doncaster which is registered to accommodate up to 36 people. The service is provided by Runwood Homes Limited. At the time of this inspection there were 35 people living at the home. Accommodation was provided on both the ground and first floor. The service had several communal and dining areas and easily accessible secure gardens. The home was close to local amenities of shops and healthcare facilities.

At the previous inspection we found medication was not always administered as required by the prescriber. Gaps in the medication records meant some medications may have been missed. Some medication protocols were inaccurate which meant people may not have received 'as and when required' (PRN) properly. At this inspection we found improvements had been made and the registered manager had introduced weekly medication audits and PRN protocols had been put in place to direct staff when ‘as required’ medication was to be given. However we found some recently admitted people still required protocols to be put in place. These were in place before the inspection was concluded.

The requirements of the Mental Capacity Act 2005 were in place to protect people who may not have the capacity to make decisions for themselves. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made.

There were sufficient staff with the right skills and competencies employed to meet the assessed needs of people living in the home. Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food and drink. People we spoke with told us they enjoyed the meals and there was always something on the menu they liked.

People had limited access to activities. Staff were expected to include activities as part of their working routines. We observed an outside entertainer performing songs that were age appropriate on the first day of the inspection and the hairdresser was on site on the second day of the inspection.

We found the service had a friendly relaxed atmosphere which felt homely. Staff approached people in a kind and caring way which encouraged people to express how and when they needed support. Everyone we spoke with told us that they felt that the staff knew them and their likes and dislikes. One person said, “I like it here the staff are kind and friendly.” Relatives also confirmed to us that they thought the staff supported people appropriately and encouraged people to be involved in their care.

Formal supervision’s were not taking place at the frequency required by the provider. This had been highlighted by the regional care director at a recent audit. The registered manager was aware of this and was looking at ways to improve frequency. Five staff that we spoke with told us they had not recently received supervision and they told us that they felt the provider did not listen to their concerns over work pressures. You can see what action we told the provider to take at the back of the full version of the report.

There were effective systems in place to monitor and improve the quality of the service provided. We saw copies of reports produced by the registered manager and the provider. The reports included any actions required and these were checked each month to determine progress.

The service has a registered manager who has been registered with the Care Quality Commission since September 2013. 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.

Rowena House is a care home situated in Conisborough, Doncaster which is registered to accommodate up to 34 people. The service is provided by Runwood Homes Limited. At the time of this inspection there were 21 people living at the home. Accommodation is provided on both the ground and first floor. The service has several communal and dining areas and easily accessible secure gardens. The home is close to local amenities of shops and healthcare facilities.

Medication was not always administered as required by the prescriber. Gaps in the medication records meant some medications may have been missed. Some medication protocols were inaccurate which meant people may not have received ‘as and when required’ properly. Medication was stored correctly and returned to the chemist if they were no longer required. You can see what action we told the provider to take at the back of the full version of the report.

The requirements of the Mental Capacity Act 2005 were in place to protect people who may not have the capacity to make decisions for themselves. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made.

There was a recruitment system in place that helped the employer make safer recruitment decisions when employing new staff. We found staff had received a structured induction and essential training at the beginning of their employment. This had been followed by regular refresher training to update their knowledge and skills. Staff knew how to recognise and respond to abuse correctly. They had a clear understanding of the procedures in place to safeguard vulnerable people from abuse.

There were sufficient staff with the right skills and competencies to meet the assessed needs of people living in the home. Staff told us they felt supported by the manager and provider, formal supervisions were taking place and appraisals were planned for later in the year.

Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food and drink. People we spoke with told us they enjoyed the meals and there was always something on the menu they liked.

People were able to access some activities although there was no dedicated activity co-ordinator. People told us they had enjoyed baking and having entertainment from outside the home. They also liked involvement from the local community. Some people told us they would like more activities as sometimes there was not sufficient happening.

There was a strong and visible person centred culture in the service. (Person centred means that care is tailored to meet the needs and aspirations of each individual.) We found the service had a friendly relaxed atmosphere which felt homely. Staff approached people in a kind and caring way which encouraged people to express how and when they needed support. Everyone we spoke with told us that they felt that the staff knew them and their likes and dislikes.

Staff told us they felt supported and they could raise any concerns with the registered manager and felt that they were listened to. People told us they were aware of the complaints procedure and said staff would assist them if they needed to use it. We noted from the records that two formal complaints had been received since the transfer of services in September 2015.

There were systems in place to monitor and improve the quality of the service provided. However, we were unable to see how effective they were embedded as audits were relatively new following their registration in September 2015. We saw copies of reports produced by the registered manager and the provider. The reports included any actions required and these were checked each month to determine progress. The regional care director carried out monitoring visits and an action plan had been developed which the registered manager was working towards. The action plan related to objectives set by Runwood Homes Limited