Rowan Garth Care Home

Rowan Garth Care Home is a residential care home providing personal and nursing care to up to 150 people. Accommodation was spread across 5 separate units. Each unit specialised in different types of support for people with a variety of health and care needs, including people living with dementia. At the time of our inspection, 1 unit was not in use and there were 72 people using the service.

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

Systems had been introduced to improve the manager and provider oversight of the quality of the service people received. A new manager had recently been appointed. Changes in the management team had impacted on the embedding of these new systems. This meant positive progress against our last inspection findings had been made in many areas, but not all. Further improvements were needed to fully review aspects of peoples care which included the experiences of people living at the home at mealtimes and opportunities to reduce the risk of social isolation.

There was a lack of awareness of who the new manager was and further work was needed to develop and maintain positive and trusting relationships and to embed a person centred culture within the home.

Although we found some improvements were still required at Rowan Garth Care Home, most people did speak positively of the care they received.

Appropriate checks on staff were in place to ensure they were suitable for the role before working with people. We observed staff had a caring nature and knew people well.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. Policies and systems were in place to support best practice. The communication needs of people were clearly documented, and people had access to appropriate healthcare services.

Checks were in place to ensure people lived in a safe environment. Ongoing refurbishment and redecoration of the home was planned and ongoing.

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 10 November 2022) and the provider was in breach of multiple regulations. The provider submitted regular action plans after the last inspection to show what actions they were taking to improve. At this inspection we found the provider remained in breach of 1 regulation.

At our last inspection we recommended that the provider sought advice and updated their practices around the implementation of the Mental Capacity Act 2005. At this inspection we found they had made improvements.

This service has been in Special Measures since 9 November 2022. 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.

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.

Enforcement and Recommendations

We have identified an ongoing breach in relation to good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

We have also made recommendations to improve the choice and quality of food available and to ensure all people are supported in a way which reduces the risk of social isolation.

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.

Rowan Garth Care Home is a residential care home providing nursing and personal care to 95 people aged 65 and over at the time of the inspection. The service is registered to support up to 150 people over 5 single storey units. Each unit specialised in different types of support. These included residential or nursing care for people with a variety of health and care needs, including those living with advanced dementia.

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

There was a repeated failure from the provider to make and sustain improvements to the quality of care delivered. This is the third consecutive time the provider has been in breach of regulations.

People were at risk of harm because risks were not always assessed, recorded or manged effectively. Staff did not always effectively safeguard people or act on recommendations made by safeguarding professionals to reduce risks identified. Accidents and incidents were not effectively managed to prevent further incidents and lessons were not always learnt.

People were at risk of receiving inadequate care that did not meet their needs because some assessments and care plans were poorly completed and not person-centred. Records were either incomplete, inaccurate or lacked detail to provide staff with guidance on how to support people in line with their needs and preferences. People were not always supported to make informed decisions about their care in a person-centred or timely way.

The service was not well-led. The manager and provider failed to carry out their regulatory responsibilities. Quality assurance processes were ineffective. During the inspection the senior management team and nominated individual ensured immediate actions were taken to mitigate the failures highlighted in this report. However, we are not yet assured that these actions are effective or embedded to ensure that the quality and safety of the service is consistently monitored and improved to keep people safe.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We made a recommendation about this.

Infection control procedures were in place and followed by staff. Staff wore appropriate PPE and the home was clean throughout. Visiting was safe and followed current guidance. People were supported by staff who were kind and considerate in their approach.

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 12 February 2022) and there were breaches of regulation. 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 regulations.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service was a victim of alleged abuse. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of disinhibited behaviours and concerns with aspects of dementia care. This inspection examined those risks. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate based on the findings of 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.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse and governance.

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.

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.

Rowan Garth is a residential care home providing nursing and personal care to 85 people at the time of this inspection. The service is registered to support up to 150 people over five single-storey units.

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

Improvements had been made since the last inspection. However, some concerns remained regarding people's records, particularly in relation to the administration of medications and the recording of information in monitoring documentation such as food and fluid charts therefore we could not always be fully assured people had had their needs met. The provider and manager were aware of most of the concerns before our inspection and had put new processes in place to address these. These processes needed more time to embed.

Risks relating to people's health and wellbeing were appropriately assessed and managed. Care records had improved since the last inspection, however more improvement was needed in relation to the recording of medication and associated records, and people’s diet monitoring charts.

People were supported by caring and well-trained staff. Feedback from people showed they liked living at Rowan Garth and they felt safe.

The environment of the home was clean throughout, however some areas required redecoration and refurbishment, which the provider was aware of and had a plan in place to address this.

Staff followed appropriate infection and prevention control measures and COVID-19 related guidance. One unit in the home had been adapted to support people living with dementia.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

A new manager had started since the last inspection. Feedback from staff was positive and they felt improvements had been made in the home. Staff reported the atmosphere and culture of the home was more positive and they felt there was more engagement with the new manager and the management team as a whole.

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 15 July 2021) and there were seven breaches of regulation. 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 some, but not enough improvement had not been made and the provider was still in breach of regulation.

This service has been in Special Measures since 15 July 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.

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.

Whilst we found some improvements have taken place, we have identified a continued breach in relation to record keeping

Please see the action we have told the provider to take at the end of this report.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an unannounced comprehensive inspection of this service on 21 and 26 May 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, consent, good governance, dignity and respect, person centred care, and safeguarding. We issued warning notices for good governance and safe care and treatment. This inspection was to follow up on the warning notices we issued.

We undertook this comprehensive inspection to check they had followed their action plan and to follow up on the warning notices we issued 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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rowan Garth Nursing Home on our website at http www.cqc.org.uk.

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.

Rowan Garth is a residential care home providing nursing and personal care to 120 people aged 65 and over at the time of the inspection. The service is registered to support up to 150 people over five single storey units. Each unit specialised in different types of support. These included residential or nursing care for people with a variety of health and care needs, including those living with advanced dementia.

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

People were at risk of harm because risks were not assessed, recorded or manged effectively. Safeguarding procedures aimed to keep people safe were not consistently implemented and incidents had not always been reported or investigated.

Medicines were not administered safely. Not all staff with responsibility for administering medicines had received training or had their competency assessed. Training for staff in other areas such as the Mental Capacity Act, safeguarding and safe moving and handling was also poorly completed.

There were shortfalls in relation to the management of infection and prevention control. Used linen storage and clinical waste was not safely managed and this increased the risk of cross infection throughout the service. We raised the concerns with the registered manager after the first day of the inspection and action was taken to reduce the risk of infection.

There was a lack of working together with external agencies to deliver effective care and treatment and support people's access to healthcare services. This meant their needs were not being met and had a negative impact on people's well-being.

People were at risk of receiving inadequate care that did not meet their needs because assessments and care plans were poorly completed and not person-centred. Records were either incomplete, inaccurate or lacked detail to provide staff with guidance on how to support people in line with their needs and preferences.

People's rights were not always protected by the actions of the service and people were not always treated with dignity and respect. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There was lack of evidence to show that people were involved in decisions about their care, support and treatment. Some relatives told us there was lack of communication and involvement in care planning.

The management and leadership of the service was inadequate. Systems to monitor, assess and improve the safety and quality of service being provided were ineffective.

Relatives told us they felt communication with the staff and management team could be improved, but they felt staff were doing their best. Relatives were complimentary about arrangements made for visiting during COVID-19 and felt this had been done safely.

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

Rating at last inspection

The last rating for this service was good (published 7th March 2020).

Why we inspected

We undertook this inspection to follow up on concerns which we had received about the service. The inspection was prompted in part due to concerns received about standards of care, staffing and records. A decision was made for us to inspect and examine those risks under the key questions of Safe and Well-led.

We inspected and found there were further concerns, so we widened the scope of the inspection and looked at all five key questions.

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.

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

The registered provider has been responsive to concerns noted during the inspection and has started to take action to make improvements and promote safety within the home. We were sent an action plan shortly after the inspection.

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, dignity and respect, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, staffing and good governance.

Please see the action we have told the provider to take at the end of this report. 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.

Rowan Garth is a residential care home providing personal and nursing care to 105 people aged 65 and over at the time of the inspection. The service is registered to support up to 150 people across five units, however one of the units was not in use at the time of inspection.

People were accommodated in four purpose-built, single-story units. Each unit specialised in different types of support. These included residential or nursing care for people with a variety of health and care needs, including those living with advanced dementia. Rowan Garth is situated in a residential neighbourhood of Anfield in Liverpool.

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

People’s experience of using the service was overall positive. This was confirmed by our observations and the consistently good feedback we received from people, family members and staff. However, some of the systems, processes and records underpinning safe, quality and person-centred care at times needed to be more robust.

We therefore made recommendations to encourage the service to continuously improve some safety and governance aspects. These included aspects of risk management, recruitment checks, development of person-centred record keeping and service oversight. The provider had identified other improvement needs effectively. Action plans were actively driving the development of the service, for example person-centred records and refurbishment.

Feedback from professionals was complimentary about the service leadership, its transparency, dedication to improvement and active partnership working to develop people’s care . A credit to this was a noteworthy consistency in the positive, people-focused culture we found across the four units of this large service. We observed examples of support and activities that uplifted, engaged and stimulated people. Throughout the service, staff were welcoming, kind, respectful and clearly knowledgeable of people in their approaches.

People felt safe living at Rowan Garth and there was enough for them to eat and drink. The service worked effectively with other professionals to maintain people’s wellbeing or promote positive outcomes. Health professionals complimented the service on some particularly effective proactive care. This was supported by the registered manager, who continuously sought further learning opportunities for staff.

There were enough staff to meet people’s needs and staff felt well supported. The registered manager provided opportunities for people, relatives and staff to get involved in the development of the service through regular meetings and seeking their feedback. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

This service was registered with us on 6 March 2019 and this is the first inspection.

The last rating for this service was good (published 25 August 2018). Since this rating was awarded the registered provider of the service has changed.

Why we inspected

This was a planned visit in line with our inspection programme.

Follow up

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