Archived: Rowde

Updated 28 July 2022

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 included checking the provider was meeting COVID-19 vaccination requirements. 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

This inspection was carried out by three inspectors, an assistant inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Rowde is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had two managers registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. 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.

During the inspection

We spoke with 16 people about their experiences of care and support. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with eight members of staff, the registered managers and one professional.

We are improving how we hear people’s experiences and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked that this was a suitable communication method and that people were happy to use it with us. In this report, we tried using this communication tool with eight people to tell us their experiences.

We reviewed 16 people’s care and support records, multiple medication records, meeting minutes, incident and accident forms and health and safety records and quality monitoring records. We also reviewed four staff files in relation to recruitment.

After the inspection

We arranged to speak with five relatives on the telephone for their views of people’s experiences of care. We also spoke with a further six members of staff, both registered managers and an acting manager.

We also reviewed further records including staff training data, communication profiles, quality monitoring records and policies and procedures.

Updated 28 July 2022

About the service

Rowde is a care home for up to 37 people with learning disabilities and/or autism. Accommodation is provided in five bungalows on one site. People had their own rooms, communal areas such as lounges and dining rooms and access to a garden. At the time of the inspection there were 28 people living at the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support

The service was five bungalows in a campus style setting on the outskirts of a village. Most people attended workshops on site in the providers day service. Whilst some people did access the local community for various activities there was a focus to use the facilities on site.

People relied on staff for transport for some activities and health appointments. We observed there were times either transport was not available or there was a shortage of staff who could drive. This meant people had not been able to attend their activity or on one occasion a health appointment was cancelled.

People had their own rooms and lived with friends they had known for many years in some cases. Staff had tried to make the bungalows more homely by involving people in decorating rooms and personalising both bedrooms and communal areas.

Right care

People were supported by staff who were caring and who knew people well. Whilst the provider was taking action to make improvements since the last inspection to embed person-centred care, we observed some care that did not promote people’s dignity and privacy.

People who had Makaton recorded as a preferred method of communicating were not always supported to use this as staff had not been trained in Makaton.

Right culture

Since the last inspection the provider and registered managers recognised the culture of the service was not always person-centred and had taken action to make improvements. Whilst the changes made had improved outcomes for people further improvement was required.

Staff were encouraged to promote people’s independence and enable people to be involved in activities of daily living. But we observed some incidents where staff were task focused and not supporting people to work at their own pace.

People could have visitors in their homes. All visitors were expected to complete a Lateral Flow Test prior to being allowed on site which had to show a negative result for COVID-19. People and staff were regularly testing for COVID-19 following the government guidance.

The service was clean and regular cleaning was taking place. Staff had received training on how to use personal protective equipment (PPE) correctly. We observed staff using PPE safely and they had plenty of stock available.

Staff had been recruited safety. Whilst there had been some incidents of staffing shortages during our inspection, we observed there was enough staff available to support people safely. People had their medicines as prescribed and we observed improvements to how medicines were managed.

People had health action plans and were able to see their GP when needed. Improvements had been made to make sure care plans were consistent with information in other records. Risk assessments were in place and staff reviewed management plans regularly.

Staff had been provided with training and had regular supervision to support them in their roles. All the staff told us they very much enjoyed their jobs and talked to us about how supported they felt by the provider and management.

There were registered managers in post who were supported by the provider to identify and carry out improvements needed. People, relatives and staff told us they knew who the managers were and felt able to approach them with any concerns or complaints. There had been no complaints made since the last inspection.

Quality monitoring systems were in place but had not identified and addressed some shortfalls we had found during this inspection. The provider took action during and after the inspection to carry out actions needed for some of the concerns. The provider had put in place additional resources to help the service make the required improvements. For example, quality support teams had visited to carry out audits and a project manager was employed to help review documentation and improve systems.

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 inadequate (published 14 September 2021) and there were three breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of two regulations.

This service has been in Special Measures since 14 September 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures. However, the service remains in breach of regulations and this is the sixth consecutive rating of requires improvement or inadequate.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of 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 Rowde on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.