Archived: Rowde

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.

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 and access to communal areas such as dining areas and lounges. At the time of inspection there were 31 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. This service did not provide a model of care that maximises people’s choice, control and independence. Accommodation was provided in a ‘campus’ style setting on the edge of a village. People were at times reliant on staff to access their local community and services.

Care was not always person-centred and did not promote people’s dignity at all times. People were not living in a service with the right person-centred culture. An incident had taken place whereby staff placed people at risk of harm. The provider had taken immediate action to deal with the incident but the ongoing mitigation of risk of reoccurrence was inadequate. This placed people at risk of harm.

People did not have their medicines as prescribed. There had been multiple medicines incidents and/or errors since the last inspection. Whilst people were not harmed the inadequate systems and governance around medicines management placed people at risk of harm.

Risk management was not safe. Since the last inspection we had been notified or made aware of six episodes of actual or near miss choking incidents. People were at risk of harm as safety measures put in place were not appropriate or personalised. People’s care plans and health action plans held conflicting information for staff which could cause confusion. This meant people might not receive the care and support they needed at all times.

Quality monitoring was not effective. This was the fifth consecutive rating of requires improvement or inadequate for this service. The provider had not been able to make sure their systems and processes identified improvement required. Action had not been carried out to improve on the last inspection’s findings, therefore the service remained in breach of Regulation. We also found a further two breaches of Regulation at this inspection.

There was enough stock of personal protective equipment (PPE) and we observed staff using it safely. Staff told us they had been provided with enough supplies of PPE throughout the pandemic and been trained on how to use it.

People and staff were being tested for COVID-19 as per the government guidance. People and staff had also been able to have a vaccination for COVID-19.

Systems were in place for visiting for relatives and friends. The service was clean, and staff carried out regular cleaning for high contact areas.

Sufficient numbers of staff were available. Where there were gaps in staffing numbers the provider used agency staff. To mitigate any risks of cross contamination the provider block booked agency staff to use the same staff at this location. This also provided a continuity of care and support for people.

Staff had been trained and able to have supervision with their line managers. Staff told us they were committed to staying at the service to provide support despite the uncertainty of the location. Staff enjoyed their jobs and the feedback about the staff approach from people and relatives was positive.

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 25 April 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations. This service has deteriorated to inadequate. This service has been rated requires improvement or inadequate for the last five consecutive inspections.

Why we inspected

The inspection was prompted to seek assurances about the safety and care of people following information received as part of ongoing safeguarding concerns and a police investigation. As investigations were ongoing this inspection did not examine the circumstances of those incidents. We wanted to seek assurance about the wider safety measures for people at the service. We undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

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.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report. 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

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to person-centred care, safe care and treatment and good governance. 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Rowde is registered to provide accommodation and personal care for up to 37 people with learning disabilities and associated health needs. People lived in five bungalows and attached self-contained flats on a central site. At the time of our inspection there were 34 people living at the service.

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

The service did not always (consistently) apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

This service had five bungalows all located on one site in a ‘campus’ style. This model of care would not be registered if an application were to be received now. The provider had not taken steps to ensure this service fitted into the residential area. There were identifying signs that this was a care home. For example, there was a large sign advertising the provider visible from the pavement and road.

Quality monitoring was not robust and did not give an accurate oversight of the service. We found healthcare records for three people were conflicting and did not always have the guidance staff needed. Two people had additional monitoring needs for their health, we found they were not always being carried out.

People were not living in an environment that was thoroughly cleaned. Accidents and incidents had been recorded but we found one incident where staff had not followed the provider policy in seeking medical help. Safety checks were carried out for any equipment or the premises. Risks to people’s safety were assessed and recorded.

People were supported by sufficient numbers of staff. There was still reliance on agency staff, but hours needed had reduced. The service tried to use the same agency staff for consistency. Staff were trained and supported by the registered manager. Staff told us they could ask for training on any area they needed. People were encouraged to do their own shopping and mealtimes were inclusive and social occasions.

People had a personalised care plan and a keyworker who helped them be involved in planning their own care. Care plans were reviewed and where needed, the service produced easy read care plans for people. Where people experienced distress reactions, there were clear guidelines in place for staff to know how to support people safely. People’s end of life wishes were not always recorded. We have made a recommendation about this.

People and relatives told us staff were kind, caring and professional. Relatives told us they thought the atmosphere in people’s bungalows was homely. People could personalise their room and had access to outdoor spaces.

People were treated with respect and their personal information was stored securely. People were able to express their views in ‘house meetings’ or ‘Voices to be heard’ meetings. These were held regularly and supported people to have a say in how things were managed. Activities were available and people supported to follow their interests as far as was practical. Some people had employment opportunities in the local community.

People had their medicines as prescribed. Any medicine incidents had been reported and action taken to try and prevent reoccurrence. There were two registered managers in post. Staff told us management was approachable, and the service was well-led.

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 20 March 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified one breach in relation to governance. Please see the action we have told the provider to take at the end of this report. This is the fourth consecutive requires improvement or Inadequate rating for this service.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People who use the service live in five bungalows and attached self-contained flats on a central site. The service is run by HF Trust Limited, a national charity providing services for people with learning disabilities.

At the last comprehensive inspection in July 2018, the service was rated Inadequate overall and was placed into 'Special measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Enforcement action was taken and a Notice of Decision was served against this location to impose urgent conditions. The provider is not allowed to admit any future people to this service without the prior agreement of the Care Quality Commission. Further to this, the provider must submit a monthly report detailing how they ensure the service people receive is safe. This includes information on risks, incidents and quality monitoring.

A further Notice of Decision was served to cancel the provider's registration for this location. The provider submitted representations to tribunal. This inspection took place to check if the provider had made sufficient improvements, in order for the Care Quality Commission to withdraw the Notice of Decision. Although there are still areas of improvement, enough progress had been made to withdraw our Notice of Decision. The provider will continue to provide monthly reports to The Care Quality Commission for ongoing monitoring and new admissions will not be admitted at this time. The service is no longer in special measures.

The service did not have a registered manager at the time this inspection took place. Two temporary managers were in place and a new manager who planned to register had been recruited. 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.

The care service has not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. This model of care at Rowde would not be registered if an application were to be received at this moment in time. The majority of people living at Rowde were from out of county Local Authorities. This meant that some people were living long distances from their relatives. A lot of people living at Rowde had moved to this site when another large residential home in Devon run by the previous provider had closed.

We saw that agency staffing was used in every bungalow which impacted the consistency and experience of care for people. For example, staff spoke about how people’s behaviour could change when they knew agency staff would be on shift. During our inspection we witnessed an incident by which an agency member of staff did not turn up for their shift. The management of this was not effective.

At this inspection we saw the provider had taken the required action to keep people safe from abuse and had ensured that staff had increased understanding about their role and responsibilities relating to safeguarding.

Risks had been identified and assessed. The risk assessments had improved since our last inspection and contained more detail and guidance for staff on how to safely manage identified risks.

Positive behaviour support plans were in place where people might experience distress. There were step by step guidelines for staff to follow to support people in a personalised way. We saw that further training and understanding was needed around the information that staff recorded on behaviour incident charts.

We reviewed some of the recorded incidents and accidents across the bungalows. We found there was improved recording on what had happened and the action taken in seeking medical advice. However, there was not always detail documented on preventative measures that were considered to reduce the risk from happening again, or if there were any lessons learnt from each incident.

Mental capacity assessments had now been completed where people lacked the capacity to make a decision about their care. The service had assessed people’s capacity to consent to support with their finances and consent to their care plan. Staff demonstrated an improved knowledge around understanding when people lacked capacity and how to support them.

People appeared comfortable and relaxed around the staff. Positive social interactions were observed between people and staff. Regular staff demonstrated that they knew people well and spoke easily about their life histories and preferences.

Staff were encouraged to promote an inclusive culture and received equality and diversity training. Staff spoke about the importance and increased opportunities people had now to access events and activities in the wider community and increase their networks.

Overall, we found the service to have made progress in starting to embed change and making improvements to the concerns identified. The provider had strengthened the quality monitoring process at this service ensuring that the necessary senior management level checks were being completed

The staff morale was an area that still needed work. Staff were open and honest about how they felt and this would only improve as the service continued to make the necessary changes and became stable and settled.

People who use the service live in five bungalows and attached self-contained flats on a central site. The service is run by HF Trust Limited, a national charity providing services for people with learning disabilities. At the last comprehensive inspection in February 2018, the service was rated Requires Improvement overall and in each domain apart from caring, which was rated as Good. A breach of Regulation 11 Consent and a breach of Regulation 12 Safe care and treatment were identified. The provider submitted an action plan to us on how they were going to address these concerns.

The inspection was prompted in part by notification of an incident following which alleged sexual abuse claims have been made concerning people who use the service. Some of these incidents are historical and occurred prior to HF Trust Limited taking over and others have continued during this providers governance. The notification was reported by the service to The Care Quality Commission and the Adults safeguarding team. This incident is currently being investigated by the Adults safeguarding team. The Care Quality Commission are reviewing the information and considering what regulatory action to take.

At this inspection we found the service remained Requires Improvement in the effective domain but was now rated as Inadequate in safe and well-led. We did not inspect caring or responsive at this time. We identified three new breaches of the Regulations, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 17 Good governance and Registration Regulation 18 Notification of other incidents. The service remains in breach of the two Regulations from our inspection in February 2018, Regulation 11 Consent and Regulation 12 Safe care and treatment.

The overall rating for this service is 'Inadequate'. This means that it has been placed into 'Special measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Following this inspection, we wrote a letter of intent to the provider to seek reassurance on how they would mitigate the immediate concerns and risks to people. The response received did not initially alleviate concerns and we requested further information be sent. The provider has now provided an action plan on how they will address these concerns.

We have served a Notice of Decision against this location to impose urgent conditions. The provider is not allowed to admit any future people to this service without the prior agreement of The Care Quality Commission. Further to this, the provider must submit a monthly report detailing how they ensure the service people receive is safe. This includes information on risks, incidents and quality monitoring.

The service did not have a registered manager at the time this inspection took place. Two managers were in place and were planning to jointly register for this service. Both were available throughout this inspection. 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.

The care service has not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. This model of care at Rowde would not be registered if an application were to be received at this moment in time. Fifty percent of people living at Rowde were from out of county Local Authorities. This meant that some people were living long distances from their relatives. A lot of people living at Rowde had moved to this site when another large residential home in Devon run by the previous provider had closed.

People had not been protected against the risks of potential and alleged abuse from one person in the service towards other people living at Rowde. Although staff continued to demonstrate their knowledge of different types of abuse and what they should do if they suspected abuse, when incidents had occurred this had not been followed in practice. There had been a significant failing in how to manage situations of abuse and a culture at Rowde had developed which normalised incidents as daily occurrences. Some staff had stopped seeing some incidents as reportable and referred to events as ‘just what certain people did.’

Risk assessments did not contain all the necessary information staff required. At this inspection we saw the provider had failed to take the required action to keep people safe. They had not followed the action plan submitted after the last inspection in February 2018. The service remains in breach for a second consecutive time. Two people at high risk of choking did not have support or risk assessments in place to manage this risk at night.

Staff were unclear about which incidents had to be reported. There was no systematic approach in reporting and managing incidents, this varied across the location. We found a number of incidents that had not been either recorded on the system or reported to management. These incidents included physical altercations between people where an injury was sustained and no medical help was sought, unexplained bruising, a person who had passed out with no medical attention called, unexplained blood found on a bedroom floor, and people being in pain and crying out. Following our inspection, we asked that investigations into these incidents were conducted. The provider has reported back that actions were found to have been taken in some of these incidents. Other incidents were found to be incorrectly documented by staff. For a small number of incidents, no further information on actions taken could be evidenced.

People’s rights were not protected in accordance with the Mental Capacity Act 2005. At this inspection we saw the provider had failed to take the required action to keep people safe and had not met this breach identified at our inspection in February 2018, as stated in their action plan. The service remains in breach for a second consecutive time. We identified that potentially 24 people were being deprived of their liberty unlawfully.

The provider’s quality assurance systems had failed to identify the significant concerns in the service and action had not been taken to keep people safe. The quality tool did not consider all aspects within the service or monitoring checks that senior staff should complete. For this reason, there were significant gaps in the provider oversight of the service and the service people received. The managers, senior management and provider had no awareness of a large numbers of incidents that had not been reported to them.

At this inspection we found that the provider had failed to notify us of five alleged abuse incidents and two injuries requiring medical intervention. The management were unaware of these incidents and they had not been reported internally in line with the provider’s protocols. This meant people had been left at risk of ongoing harm. Staff had lost a lot of confidence in the previous and current management team to take their concerns seriously and provide appropriate support.

The staff morale in the service was not good and was having a negative impact on the people being supported. Staff spoke of the effects of agency staff on the consistency of support provided to people, the conflicts between staff and the lack of faith and support they had experienced with management teams. Staff consistently spoke about feeling like they were working in isolation and there continued to be a disjointed service in terms of staff knowledge on the ground and the communication given to them from the management team.

At the last comprehensive inspection in February 2016, the service was rated Good overall with the responsive domain rated Requires Improvement. A breach of Regulation 9 Person centred care was identified. The provider submitted an action plan to us on how they were going to address this concern. A follow up inspection took place on 7 March 2017 to check that this had been done and following this inspection the responsive domain was rated Good.

At this inspection we found the service remained good in caring but was now rated Requires Improvement in all other domains and therefore overall. We identified two breaches of the Regulations, Regulation 12 Safe care and treatment and Regulation 11 Need for consent. You can see what action we told the provider to take at the back of the full version of the report.

The service did not have a registered manager at the time this inspection took place. The previous registered manager had left the service and two new managers were planning to jointly register for this service. One of these managers was present and available throughout our inspection; the other manager had yet to commence their employment. 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.

The care service has not been fully developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism who used the service could live as ordinary a life as any citizen. However the service supported 37 people. Whilst these were across five individual bungalows and adjoining self-contained flats this model of care would not be registered if an application were to be received at this moment in time.

Medicines were not always being safely managed. We found many medicine administration records had hand written entries. Individual protocols for the use of ‘when required’ (PRN) medicines were not always available, reviewed or updated. In two cases we found that protocols were in place for medicines that did not appear on the person’s medicine administration record. We found one example where medications listed on a person’s ‘emergency information sheet’ and ‘my health in hospital’ documents did not match those listed on their medicine administration record.

Although individual risk assessments were in place for people they did not always contain all the necessary information available for staff. One risk assessment was in place for a person being at home on their own. This person however had an application in place to the Local Authority because they needed continuous staff support and could not be left alone.

Health and safety checks around fire and portable appliance testing had not been reviewed within the appropriate timescales. One fire risk assessment was out of date and two fire extinguishers were overdue a service. Fridge and freezer temperature records had gaps in the recording and the temperature of hot foods was not recorded consistently.

Relatives and staff consistently raised their concerns with us about the staffing shortages they had experienced. During this inspection we saw staff were visible and available to support people. Although staff felt the issues were now being addressed by the management they spoke to us about how it impacted on people at times. One staff told us “The staffing is not enough and it’s not always right. People do get to go out but it would be nice to have more flexibility, but people are well looked after.”

Although staff we spoke with demonstrated a good awareness of supporting people around the principles of the Mental Capacity Act 2005, the recording of this was not always appropriate. We saw several people had capacity assessments in place that had not been reviewed for long periods of time to ensure they remained relevant.

Relatives and staff raised concerns regarding the communication they received from the office and senior management staff. The service was going through a period of change with a new manager and improvements being addressed and implemented. Some staff felt these changes had not been appropriately communicated

Care plans were personalised, however we saw large gaps in the recording of people’s daily record notes and the one to one staffing hours that people received. This meant it was unclear whether people were receiving their required support.

Quality assurance systems were in place to monitor the quality of service being delivered. Internal audits had identified most of the shortfalls we found during this inspection and the manager had an action plan in place and was working to address these.

People received care and support from staff who had got to know them well. Staff knew, understood and responded to people’s needs in a caring and compassionate way. One person told us “Staff are brilliant, they are so kind, they always say it’s not our workplace, it’s your home.”

We previously carried out an unannounced comprehensive inspection of this service on 16 February 2016. A breach of legal requirements was found. The service was rated Good overall and Requires Improvement in the ‘Responsive’ domain. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 9 of the Health and Social Care Act Regulated Activities Regulations 2014, Person Centred Care.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. 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. We found on this inspection the provider had taken all the steps to make the necessary improvements.

Whilst there was a registered manager in post they were unable to be present during our inspection. 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.

Care records showed how people were involved in developing their care and support plans. Care plans were personalised and detailed daily routines specific to each person. Care plans contained information about the person’s preferences, likes, dislikes and what was important to them. Staff were knowledgeable about people’s care and support needs and acted in accordance with the guidance in their care plans.

People had a range of activities they could be involved in. People were able to choose which activities they took part in at their home or in the wider community. People accessed activities such as arts and crafts, cooking sessions, skittles, visits to the local pub and shops and social clubs within the community. The organisation had a day centre which provided activities which people could attend if they so wished. People were supported to maintain contact with family and friends.

Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. Regular meetings took place where people using the service could provide feedback and make suggestions about the service they received.

The inspection took place on 16 February 2016. This was an unannounced inspection carried out by three inspectors. During our last inspection in May 2014 we found the provider satisfied the legal requirements in the areas that we looked at.

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.

Care plans contained information on people’s preferred routines, likes, dislikes and medical histories. We looked at six care plans and found that some guidance had not always been updated to identify how care and support should be provided when people’s care needs had changed. This meant that people were at risk of not receiving the care and support they needed.

People received care and support from staff who knew them well. Staff showed concern for people’s wellbeing in a caring and meaningful way and responded promptly to requests for assistance. Throughout our visit we saw people were treated in a kind and caring way and staff were friendly, polite and respectful when providing care and support to people.

People were protected from harm and potential abuse. Staff we spoke with knew what to do if they were concerned about the well-being of any of the people using the service. Risk assessments were in place to support people to be as independent as possible.

Staff were supported to carry out their role through supervisions, team meetings and training. People received individualised care from staff who had the skills, knowledge and understanding needed to carry out their roles.

Records relating to the recruitment of staff showed relevant checks had been completed before staff worked unsupervised. These included employment references and Disclosure and Barring Service (DBS) checks. The DBS helps employers to make safer recruitment decisions by providing information about a person’s criminal record and whether they are barred from working with vulnerable adults.

People had access to food and drink throughout the day and were encouraged to eat healthily and to maintain a balanced diet. People had access to a varied diet which included fruit and vegetables, healthy snacks and eating out in the community.

Medicines were managed safely and administered by trained staff. People received their medicines as prescribed and in their preferred manner. People were supported to access health care services and maintain good health.

People’s rights were protected because staff acted in accordance with the Mental Capacity Act 2005. People were able to make their own choices and decisions about the care and support they wished to receive.

The registered manager had quality assurance systems in place to regularly monitor the quality of the service. Where internal audits had identified shortfalls an action plan to address these areas had been put in place. The registered manager had notified CQC about significant events which had occurred in the service. We use this information to monitor and ensure the registered manager responds appropriately to keep people safe.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found '

Is the service safe?

We spoke with twelve people who lived at Rowde during our visit. They told us they felt safe living at Rowde. One person we spoke with told us 'I like living here, I get to go out to the shops on my own.'

People were aware of, and had access to advocacy services. People attended a 'speak out' group were they discussed ideas or concerns they had relating to the service.

People were safe because care staff knew what to do when safeguarding concerns arose. Staff had received appropriate training and followed policies and procedures. Information regarding safeguarding and what to do if people had any concerns was displayed in every bungalow.

Care plans provided guidance for staff on how to meet people's needs in a way which minimised the risk for the individual. Where people required support to help them manage their behaviour, appropriate guidance was in place. This ensured that staff were able to support people whilst respecting their dignity and protecting their rights.

The registered manager organised the rotas to ensure that staffing levels were sufficient to meet people's identified needs. There was a member of senior staff available on-call at all times in case emergencies arose.

Is the service effective?

People's care and welfare needs were assessed. It was clear from our observations and from speaking with care staff that they had a good understanding of the people's care and support needs. Care plans reflected people's current individual needs, preferences and choices.

People told us that staff asked for consent before offering support and that they were listened to. People told us they felt involved in planning their support and were given choice.

People were involved in assessing their needs. They met each month with care staff where they were able to discuss their current care and support needs.

The service had made links with the community to enable people to take part in volunteering or work placement opportunities. People who used the service were encouraged and enabled to be an active part of their community, accessing local facilities.

Is the service caring?

One person we spoke with said 'It's lovely living here, I have the best staff.'

We saw that staff showed concern for people's well-being. We observed staff seeking people's permission before undertaking any care or support.

People were treated with dignity and staff respected people's privacy. We saw that staff knocked on people's bedroom doors before entering. Staff called people by their preferred name.

People were supported to be as independent as they wanted to be. During our inspection we saw several people accessed the community independently. Care plans we reviewed reflected people's needs, preferences and diversity.

Is the service responsive?

People were encouraged to make their views known about the services they received. People in each bungalow met every Sunday to discuss any suggestions or concerns they had about the service they were receiving.

People living at Rowde had information on how to make a complaint available in an accessible format. We looked at how the service dealt with complaints. The service had not received any complaints since our last inspection.

The service worked well with other agencies, health professionals and family members to make sure people received consistency of care. Records contained details of appointments with health professionals and any outcomes. We saw that referrals were made to the appropriate health services when people's needs changed.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care settings. While no applications had been submitted, appropriate policies and procedures were in place. Staff had received training in the Mental Capacity Act 2005 and the application of DoLS. We saw that practices were monitored to ensure the least restrictive measures were in place.

Is the service well-led?

The service had a 'Fusion' model of support which was a statement of their intent. This ensured there was a clear set of values which included choice, specialist skills, person centred active support, health safety and well-being and involvement of families and other partnerships.

Care staff were motivated and caring and said they felt supported by management. They received regular supervision and appraisals were they could discuss personal development and learning opportunities.

Care staff were clear about their roles and responsibilities and the needs of the people they were supporting. This helped to ensure that people received a good quality service.

People who used the service received care and support from staff who were competent to carry out their roles. All staff received a comprehensive induction when they started their job. Further learning and development of staff was identified based on the needs of the people they were supporting.

The service had quality assurance systems in place which took into account feedback from people using the service or others acting on their behalf, observations of staff and complaints. Records we reviewed showed that where issues had been identified actions had been taken to resolve them.

There were arrangements in place to continually review safeguarding concerns, accidents and incidents. This ensured there were opportunities for learning or improvement.