Rowans Care Centre

We found the following examples of good practice.

The provider had made changes to the layout of the home to accommodate the needs of people during the COVID19 pandemic and provide safe and effective care. A five-bed isolation unit had been created to enable the safe and effective admission of people from hospital and the community. New residents were admitted to isolation unit where they would remain until there 14-day isolation was completed.

At the time of the inspection visits to the home were only allowed in exceptional circumstances such as end of life. At such time special arrangements were made, sensitive to the needs of the person and their visitors to ensure the safety and well being of all concerned.

People could keep in touch with their relatives by phone, video calls and closed window visits arranged with the home. In preparation for future visits alterations had been made to the ground floor lounge and conservatory with the addition of a floor to ceiling screen fitted with a Perspex window and intercom. In future visitors will be able access the conservatory externally, so they can visit their relatives safe in the knowledge there is no possibility of cross infection.

People told us that they felt safe and well cared for and made positive comments about the staff including: “the staff are lovely” and “staff are always very nice”.

Whole home testing was in place for residents and staff and the registered manager maintained detailed records of each test, its reference number and outcome.

Staff had benefited from training, support and guidance on infection control including COVID19 and demonstrated skill and confidence in the way they carried out their duties and responsibilities.

Staff had access to the personal protective equipment (PPE) they needed and there were PPE ‘stations’ situated at various locations around the home.

The home was clean and free of malodour throughout. Enhanced cleaning schedules had been introduced and monitored closely by senior staff to reduce the risk of transmission of COVID-19.

People’s experience of using this service:

People received good standards of care. The atmosphere at Rowans Care Centre was welcoming, friendly and sociable. The registered manager and staff had developed good relationships with people. Throughout the inspection staff were seen to provide sensitive and compassionate care.

Staff worked together as an effective team because they benefited from having shared aims and objectives. The registered manager was highly visible in the home providing guidance and leadership, so staff were clear about their roles and responsibilities and knew what was required to ensure the service provided good care to people. Everyone we spoke to during our inspection had something positive to say about the home and the standard of care provided.

People felt safe living at the home and had confidence in the management and staff teams. Risks to people’s health safety and welfare were identified and plans were put in place to ensure risk of harm was minimised, so people were safe. Medicines were managed safely, and people received their medication at the right times. The environment was safe, and people had access to appropriate equipment where needed.

There was enough suitably qualified and skilled staff to meet people's individual needs. Staff told us that morale was good, they were very well supported and received a range of training opportunities appropriate to their role and people's needs. Staff appreciated the support and leadership provided by the registered manager. They had received guidance on the provision of person-centred care and equality and diversity. This produced a positive caring working environment where staff shared a clear vision and credible strategy to deliver high-quality person-centred care and support.

People were involved in every aspect of delivery of care. Their personal needs and preferences were reflected in care plans so staff knew how to meet their needs in a person-centred way. Staff had a good understanding of people’s individual needs and preferences and worked effectively to ensure people’s needs were met.

People received the right care and support to eat and drink well and their healthcare needs were understood and met. People who were able, consented to their care and support. Where people lacked the capacity to make their own decisions they were made in their best interest and in line with the Mental Capacity Act 2005.

Effective quality assurance process were in place.

Rating at last inspection: Requires improvement (report published 8 September 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

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

We undertook an unannounced focused inspection of Rowans Care Centre on 30 January 18. The urgent focused inspection was triggered following a serious incident which other agencies including the police were looking into. We found concerns on the focused inspection and we therefore undertook a full comprehensive inspection on 31 January and 2 February 18.

The service is a 36 bedded care home providing nursing care. At the time of our inspection there were 33 people living in the care home. There were two floors with a lift and adapted facilities.

We found concerns on this inspection related to safe care and treatment, staffing levels/deployment, care planning, person centred care and governance.

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

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.

We looked into staffing levels and found they were not always sufficient to meet the needs of people. There were a high number of people remaining in bed and staffing levels were inconsistent on the rotas.

A safe level of care was not always being provided. Care plans we viewed were lacking in specific detail required to safely care for people.

During our inspection we found one person had not been supported to eat and drink according to their speech and language therapist's recommendations to reduce the risk of aspiration. Aspiration is the risk of a substance entering the lungs such as food/drink debris.

Risks were not being actioned upon or escalated in a timely way to always protect people from harm. For example, the registered manager was aware there were some areas within the care home where the call bell system was not working but had not escalated this to be repaired in a timely manner.

Staffing levels were inconsistent. The dependency tool was not being used in conjunction with other methods of assessing an appropriate staffing ratio in line with National Institute of Health and Care Excellence and Royal College of Nursing guidance.

The system of communicating important clinical information to care staff was at handover or to ask the nurse in charge. We were therefore, concerned care staff were not provided opportunities to read the care plans to appraise themselves of the important details they needed to know to care for a person. Care staff were seen asking the nurse in charge their queries and were not seen accessing the care plans.

The premises were in the process of some refurbishment. The garden/exterior of the care home was not being utilised. Its design required further adaptation to meet people's needs.

People's dignity was not always being upheld. A high number of people were seen remaining in bed when some people were able to sit out but were not being encouraged to. We observed staff rushing when delivering care leaving one person with a wet top on after providing them with care.

People were not always being provided with choices. Staff were unable to provide person centred care when information in care plans had not always been kept up to date for staff to know how to best support each individual person.

There was a system of recording when deprivation of liberty applications (DOLs) were being sent to the Local Authority and approved.

Further systems of communication were needed to obtain people's views about how the service could be improved. We found only one concern had been logged in the complaints file. Although the complaints procedure was on display there were no easier methods for people to raise a concern such as suggestion boxes/complaints forms at reception.

The registered manager was not undertaking spot checks within the care home to identify any immediate concerns or observe how staff were being deployed to deliver care of the highest possible standard and quality. Governance and quality assurance systems had not identified all the concerns we found on this inspection.

People told us they felt cared for and staff were caring. We observed staff were caring and respectful towards people and their relatives. Staff had developed efficient task based systems to deliver compassionate care as much as possible.

We observed a medicines round and inspected how medicines were stored. Medicines were being managed safely within the care home.

Staff understood the different types of abuse and had received training in Safeguarding. There was a system of logging and reporting incidents and accidents in the care home.

There was a training matrix system in place. Staff were receiving supervision and appraisals. Staff recruitment practices were looked into and included safety checks such as Disclosure and Barring Service (DBS) checks. Most staff were receiving an induction with the exception of one agency worker who told us they had not received an induction.

You can see what action we told the provider to take at the back of the full version of the report.

Rowans Care Centre Care Centre provides nursing and personal care for up to 36 people. It provides nursing and personal care, including care for people living with dementia. On the day of the inspection 34 people were living at the service, 33 of whom required nursing care.

Accommodation is provided on two floors, with lounges available on both floors. A passenger lift and stairs provide access to the first floor. The main dining area is on the ground floor. There is a small car park at the front. Assisted bathing facilities are provided.

At our last inspection we found that some of the more vulnerable people who lived at the home were at risk of their needs not being met because of a lack of management oversight and poor communication between staff. Risks were not being managed effectively and medicines were not always stored and administered safely. There were processes to monitor the quality of the service but these were not being used effectively so problems were not always identified or addressed in a timely manner. There was a lack of attention to nutrition and hydration for those who required assistance and care was not carried out in accordance with people’s care plans. The provider had also failed to notify us of two significant events they were required to.

At this inspection we found that all these issues had been addressed.

The service had a registered manager in post who had worked at the home for about a year and a half. 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.

Prior to this inspection we received feedback from the local authority contract monitoring team, who said that the home had been subject to an improvement plan but the actions required were completed. We looked at the carehome.co.uk website and saw the following review from October 2016, left by a relative of someone who used the service: “There is an unhurried pace to The Rowans, not regimented, residents choose how to spend the day, not all placed in the lounge at 9.00am. The rooms, activities, garden, vegetable plot are all well kept and the staff are caring and fond of the residents in my experience.”

We found that the service provided good care and support to people enabling them to live fulfilling and meaningful lives. People that were able to talk to us said they were happy in the home and with the people they lived with. The interactions we observed between people and staff were positive.

People told us they felt safe living at the home, staff were kind and compassionate and the care they received was good. Comments included: “I have no concerns at all, I am happy here”; “I have been here a year and I find it fine”; “All X’s needs are catered for and X is happy here”; “I get everything I need”; “This place is like a proper home to my Mum and when I come it’s not like visiting a business it’s like I am coming to her home”.

The staff ensured people’s privacy and dignity were respected. We saw that bedroom doors were always kept closed when people were being supported with personal care.

People remarked that the food was good and there was plenty of it.

People could choose how to spend their day and they took part in activities in the home. The home employed activity organisers who engaged people in activities in small groups and individually during the day. They also occasionally took people out in the local community.

People’s needs were assessed and care plans were developed to identify what care and support people required.

People's health and well-being needs were well monitored. There were regular reviews of people’s health and staff responded promptly to any concerns. People were referred to appropriate health and social care professionals when necessary to ensure they received treatment and support for their specific needs.

Quality assurance officers from the local authority's adult safeguarding unit visited the home in February 2014 and identified further concerns regarding the planning and delivery of care. The provider informed us of a change in management at the home and the appointment of a peripatetic manager. The provider developed a more detailed action plan which indicated that improvements would be made by the end of April 2014. This included strengthened quality assurance arrangements, overseen by the regional manager who monitored and supported the home's progress and development.

Quality assurance officers from the local authority carried out further audits in March, April, May and June 2014. They identified that whilst further improvements were required in some aspects of provision including staff training, and record keeping progress had been made in the overall management of the home and the planning and delivery of care.

We were informed that a new manager was appointed and started work at the home during the second week in June 2014 and the peripatetic manager would remain at the home in support of the new manager for the foreseeable future.

We carried out a further inspection on the 13 and 17 June to follow up on action taken by the provider to ensure people were receiving safe and appropriate care.

We identified that there were still a number of issues and made compliance actions against outcome 1, Respecting and involving people who use services, outcome 2, Consent to care and treatment and served warning notices against outcome 4, Care and welfare of people who use services and outcome 21, Records.

Following the inspection the provider sent us an action plan which explained how and by when the compliance actions and warning notices would be complied with.

This visit was undertaken to confirm the issues identified had been dealt with appropriately and to assess if the service was now compliant.

During the inspection we spoke with 10 of the people using the service, four visiting family members and a total of seven staff members including the regional manager.

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?

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

Is the service safe?

We found that the people who lived at the home were now receiving safe and appropriate care and support and could see that improvements had been made in the delivery of care since our last inspection. We saw examples of good practice, particularly in the way staff interacted with the people living in the home.

People were receiving care in accordance with their assessed needs and the records being maintained were protecting them from receiving inadequate or unsafe treatment and care.

Is the service effective?

Everyone we spoke with was positive about the quality of care being provided, however we did receive some negative comments regarding the high use of agency staff at night. One person we spoke with described it as, 'The weak link'. We discussed this with the regional manager who confirmed that she was aware of this and was trying to address it as soon as possible. A new night carer was due to start, they were actively recruiting staff and staff from another home that was due to close would be transferring to the Rowans in the immediate future.

Is the service caring?

Comments from the people using the service included, 'The girls are very good, they always treat us with respect and dignity and don't talk over me', 'Staff are very good', 'The staff are very nice' and 'The staff are good, I have no concerns'.

We also spoke to four visiting relatives during our visit. Comments included, 'Staff are wonderful, treasures, I have no complaints and they look after my relative really well'.

Is the service responsive?

Since our last inspection the provider had responded to concerns we raised and had taken action address them. A visiting relative told us, 'It has a lot more order. I feel more relaxed and can see improvements'.

The staff members we spoke with were also positive about the changes that had been implemented since the last inspection, these included, 'Things are improving'

Since our last inspection the provider had responded to concerns we raised and had taken action address them.

Is the service well led?

The provider has responded to the concerns raised previously and the regional manager plus peripatetic managers have worked hard to address them. The manager appointed in June left shortly after the inspection took place so the service had no registered manager in place at the time of our inspection. We were informed that a new manager had been recruited and would commence at the home in the near future. This person will continue to be supported by the regional manager in order to ensure that the improvements made are sustained.

Quality assurance officers from the local authority's adult safeguarding unit visited the home in February 2014 and identified further concerns regarding the planning and delivery of care. The provider informed us of a change in management at the home and the appointment of a peripatetic manager. The provider developed a more detailed action plan which indicated that improvements would be made by the end of April 2014. This included strengthened quality assurance arrangements, overseen by the regional manager who monitored and supported the home's progress and development. Quality assurance officers from the local authority carried out further audits in March, April, May and June 2014. They identified that whilst further improvements were required in some aspects of provision including staff training, and record keeping progress had been made in the overall management of the home and the planning and delivery of care.

We were informed that a new manager was appointed and started work at the home the 2nd week in June 2014 and the peripatetic manager would remain at the home in support of the new manager for the foreseeable future.

We carried out this inspection to follow up on action taken by the provider to ensure people were receiving safe and appropriate care. As part of this inspection we spoke with a number of representatives of the local authority, the recently employed manager who had been in post for less than one week, the peripatetic manager and 10 staff members. We also spoke with 12 of the people who lived at the home, four of their relatives and a doctor who was visiting.

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?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with the people who used the service, their relatives, 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 people who lived at the home were at risk of receiving unsafe and inappropriate care and support. We could see that improvements had been made in certain aspects of the delivery of care since our last inspection and we saw some examples of good practice, particularly in the way some staff interacted with the people who had a dementia. We also observed poor and inadequate care practice which put the health, safety and welfare of the people who lived at the home at risk.

We identified examples of poor care planning and poor communication between nurses and nurses and care staff which resulted in some people not receiving care in accordance with their assessed needs. Records, vital to the health and welfare of the people who lived at the home were found to be inaccurate or incomplete so people were not protected from receiving inadequate or unsafe treatment and care.

The Mental Capacity Act sets down legal requirements that need to be followed to ensure decisions made about people who do not have capacity are made in their best interests. They are designed to ensure that people who are unable to give consent for certain aspects of their care and welfare receive the right type of support to make a decision in their best interest.

We found that the manager and staff routinely involved people in decision making but had not followed correct procedures when there were doubts that the person had capacity to give informed consent. A compliance action has been set and the provider must tell us how they plan to improve.

People were safeguarded from the risk of abuse because the provider had taken steps to ensure that staff had the skills to recognise and respond promptly and effectively to any evidence or suspicion of abuse. All the people spoken with during our inspection told us that they felt safe living at the home.

Is the service effective?

Our observations, staff rotas and staff training records showed that that there were a sufficient number of nursing and care staff with the right skills, experience and training to meet the needs of the people who lived at the home. However, some of the people spoken with raised concerns about staffing levels and we could see that the nurses and care staff did not always communicate well or work together as a cohesive team. This lack of cohesion and poor communication meant that some of the people who lived at the home were at risk of receiving inadequate treatment and care.

Is the service caring?

Some of the people spoken with made positive comments about the staff and the care provided but their views were mixed. Two people commended the staff and the standard of care provided. Another person told us that care was satisfactory but gave an example when they had not been treated with respect and another person told us that they were dissatisfied with the care provided by some of the staff.

We observed the ways in which staff interacted with and supported the people who lived at the home and we saw differing standards of care practice. Some of the staff demonstrated good care practice in the way that they actively engaged with the person when they were assisting them. However, we also observed care staff talking over the heads of the people who lived at the home and one occasion an experienced care worker was seen to ignore a person's call for help and walked past them. A compliance action has been set and the provider must tell us how they plan to improve.

Is the service responsive?

Since our last inspection the provider had responded to concerns we raised and had taken action to improve the management of the home and thereby the standard of care provided. Information provided by the local authority showed us that the provider, managers and staff were working in partnership with them and other service commissioners to improve the standard of care provided. The provider had identified staff training and development needs and a staff training and a supervision programme had been put in place. The peripatetic manager responded to concerns raised during our inspection and took action to ensure the quality of treatment and care was improved.

Is the service well led?

The home was not well led at the time of our inspection. There was a lack of cohesion and poor communication between the various staff groups. This was more apparent on the first day of our inspection when the home was being managed by the recently appointed manager. There was a lack of staff management overview and we could see that this had a negative impact on the quality of care being provided.

The peripatetic manager presented as a knowledgeable, competent, caring professional and we could see from reports provided by the local authority that there had been significant improvements in the delivery of care since they had taken up post at the home. Nursing and care staff spoke highly of the peripatetic manager praising them for clear and supportive direction and leadership. The recently appointed manager who had been in post for less than a week at the start of our inspection resigned shortly after . A representative of the provider contacted the commission and informed us that the peripatetic manager would remain in management control of the home until such time a suitably qualified and competent manager was appointed.

We spoke to a visiting relative of one of the people who lived at the home. They told us that they were impressed with the quality of care provided, the dedication of the manager and overall positive attitude and presentation of staff.

We looked at the care records for a number of people who lived at the home and could see that people had been involved in an assessment of their needs but found examples where care planning was inadequate or inappropriate and did not reflect the person's individual needs and personal preferences.

We looked at the arrangements made for ensuring people were protected from abuse and found that the provider had appropriate systems in place but these had not been used effectively. Nursing staff had identified poor care practice but this had not been acted upon so people remained at risk of receiving poor or inadequate care.

We found that there were areas where improvements were needed including care and welfare, safeguarding and record keeping to ensure the health and welfare of the people who live at the home.