Archived: The Rowans - Care Home

At this inspection we found that improvements had been made to the premises, although some re-decoration was still outstanding. Care plans recorded people’s ability to consent to their care and there were effective quality monitoring systems in place.

The home is registered to provide accommodation and care for up to 53 older people, including people who are living with dementia. On the day of the inspection there were 48 people living at the home, either within the ‘residential’ or ‘dementia’ areas of the home. The home is situated in Kirkella, a village in the East Riding of Yorkshire but also close to the city of Kingston upon Hull. The premises are on one level and there is easy access into the premises.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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.

People were protected from the risk of harm or abuse because there were effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

There was evidence that the registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had received training on these topics and understood their responsibilities.

Care plans were a good reflection of people’s individual needs and how these should be met by staff.

There were recruitment and selection policies in place and these had been followed to ensure that only people considered suitable to work with vulnerable people had been employed. On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs, although we felt that the deployment of staff to ensure they were always visible could be improved.

Staff told us they received the training they needed to carry out their roles effectively and confirmed that they received induction training when they were new in post. Staff told us that they were well supported by the registered manager.

Senior staff had received appropriate training on the administration of medication. We checked medication systems and saw that medicines were stored, recorded and administered safely.

People who lived at the home told us that staff were caring and that they respected people's privacy and dignity. We saw that there were positive relationships between people who lived at the home and staff, and that staff had a good understanding of people's individual care and support needs.

A variety of activities were provided and people were encouraged to take part. People's family and friends were made welcome at the home.

People told us that they were satisfied with the food provided. We saw that people's nutritional needs had been assessed and individual food and drink requirements were met.

The registered manager was aware of how to use signage, decoration and prompts to assist people in finding their way around the home.

There were systems in place to seek feedback from people who lived at the home, relatives, staff and health and social care professionals. People told us they were confident their complaints and concerns would be listened to. Any complaints made to the home had been investigated and appropriate action had been taken to make any required improvements.

Quality audits undertaken by the registered manager and senior managers were designed to identify that systems at the home were protecting people's safety and well-being.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that the provider had taken sufficient steps to improve infection control systems and practices to ensure people that used the service were at low risk of harm from infection. The provider had improved the environment and documentation held and ensured checks were undertaken on infection control safety in general.

Below is a summary of what we found. We used a number of different methods to help us understand the experiences of people who used the service, because some of the people who used the service had complex needs which meant they were not able to tell us their experiences. The summary is based on our observations during the inspection, speaking with people who used the service, with visitors and with the staff who supported them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The home had proper policies and procedures in relation to Deprivation of Liberty Safeguards (DOLS) although no application had needed to be submitted. The manager had a good understanding of when an application should be made and how to submit one. This meant that people were safeguarded as required.

The service did not have effective infection prevention and control systems in place. We found some areas of the home were not clean and hygienic and three visitors commented "Certain parts of the home smell unpleasant".

The home was designed to meet the needs of people who lived there and the provider ensured the environment was regularly maintained, safe and fit for purpose. People were protected from unsafe or unsuitable equipment because the provider had ensured the equipment used in the service was serviced and maintained and service certificates were available for inspection.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the prevention and control of infections.

Is the service effective?

People's health and care needs had been assessed and care plans were in place. There was limited evidence of people being involved in assessments of their needs and planning of their care. However, people said they could discuss their care with the staff or manager and on the whole felt well supported and cared for.

One person who used the service told us 'It is great here. The staff are lovely and look after me well. I like to be independent when possible and the staff let me get on with things, but give me help when I need it.'

Our checks of the records and documents within the service showed that staff received training in safe working practices. Health and safety risk assessments were in place with regard to fire, moving and handling and daily activities of living.

People's needs were taken into account with pictorial signs on doors to bedrooms and bathrooms and the layout of the service, which enabled people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with dementia and conditions relating to old age.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One person told us 'I am well looked after. The staff are brilliant.' A visitor told us 'I have no concerns about the care and support here. The personal care given to my relative is excellent and the staff approach towards them is very good.'

Feedback from people who used the service, relatives and staff was obtained through the use of satisfaction questionnaires, meetings and one to one sessions. This information was usually analysed by the provider and where necessary action was taken to make changes or improvements to the service.

Is the service responsive?

Individuals who spoke with us during the inspection said they were involved in their care and were able to input to their care records. One visitor told us 'I know about my relative's care plan and I attend their care reviews. The staff are always there to answer any questions about X's health and they discuss their care and treatment with me.'

People we spoke with said they were confident of using the complaints system if they needed to. They told us that they would speak to the staff or the manager about any issues and that when this happened action was taken quickly to resolve any problems.

Is the service well led?

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was always improving.

Staff told us they were clear about their role and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure people received a good quality of service at all times.

Care records were detailed and were reviewed regularly to ensure care records accurately reflected people's current needs. People told us they were satisfied with their care. One person said 'I am very satisfied. The carers are lovely and they look after you'.

All staff had a good awareness of the dietary requirements of people who used the service. People were supported to eat in the manner that suited their needs and preferences.

We considered the safeguarding of vulnerable adults as our records showed there had been a large number of safeguarding notifications. We found the provider had acted in accordance with the local safeguarding authority's reporting protocol and had taken all reasonable steps to try to reduce the number of safeguarding incidents.

Recruitment processes ensured people were protected from the risks of being supported by unsuitable staff.

The manager explained the staffing levels employed at the service and that the needs of potential new people were assessed prior to their admission to the service to ensure their needs could be met within the staffing structure.

The manager worked in accordance with the provider's quality assurance policy to ensure they monitored the quality of the service provided.

A relative of a person who used the service told us that there was always plenty of staff about when they visited and that 'I have never heard any staff say 'In a minute', there has always been an immediate response'.

Another relative of a person who used the service explained that they had been involved in dementia care mapping with the former deputy manager which had helped her understand her father's condition and how the staff at the service supported him.

A visiting health professional who we spoke with told us that staff always made contact where they had concerns and that all instructions were carried out consistently for all people who used the service. They also told us that they saw carpet cleaning taking place on a daily basis.

Staff told us they felt supported by the manager and were confident that they could go to the manager if they had any concerns regarding the care and welfare of the people who used the service and that these would be addressed.