We carried out a review of the data available to us about Rowan Close on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Rowan Close, you can give feedback on this service.
Rowan Close is a residential care home providing accommodation and personal and care to older and younger adults with a learning disability, physical disability and / or autism. At the time of the inspection there were six people living at Rowan Close. The service can support up to six people.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
The service applied 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.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
People living at Rowan Close were very much at the heart of the service. We received positive feedback from relatives, staff and a health professional about the care provided.
Relevant recruitment checks were conducted before staff started working at the service to make sure they were of good character and had the necessary skills.
Medicines administration records (MAR) confirmed people had received their medicines as prescribed.
Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.
Staff working at the service understood people’s needs and supported people in a personalised way. Care was provided respectfully and sensitively, considering people’s different needs.
Staff received frequent support and one to one sessions or supervision to discuss areas of development. They completed training and felt it supported them in their job role.
People were supported with their nutritional needs when required. People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes
Staff had developed positive and caring relationships with people and their families. Staff were highly motivated and demonstrated a commitment to providing the best quality care to people in a compassionate way. People’s privacy and dignity was always maintained.
Regular audits of the service were carried out to assess and monitor the quality of the service. There were appropriate management arrangements in place and staff felt supported in their role.
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
The last rating for this service was requires improvement (published 21 December 2018).
Why we inspected
This was a planned inspection based on the previous rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 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.
Rowan Close provides accommodation and personal care for up to six people with a learning disability, physical disability and/or autism. The home is set at the end of a small cul de sac close to local amenities. The home comprises a large bungalow with two lounges, two kitchen/diners, a sensory room and a choice of bathrooms and showers. The home has its own private garden which has sensory mobiles and chimes.
Rowan Close 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.
The care service has 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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
There was no registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The current manager was in the process of applying for their criminal records check at the time of our inspection.
Quality assurance and auditing systems were in place. However, these needed to be fully embedded to ensure they were implemented consistently. Safety of equipment and infection control checks were not always effective in identifying issues.
The management of medicines had improved significantly although improvements to the quality of information when changes were made to people’s MARs was still required. People received their medicines as prescribed from staff who had been trained and were competent to do so.
Staff received guidance in how to keep people safe from harm and abuse and understood how to report any concerns.
Risks associated with people’s health, safety and welfare had been identified and assessed. Emergency evacuation procedures were in place and known to staff.
There were sufficient staff deployed on all shifts with the right skills to meet people’s needs and keep them safe. Recruitment procedures were in place to ensure only suitable staff were employed.
Improvements had been made to ensure staff received training, supervision and appraisal to provide them with the required skills, knowledge and competencies for their roles.
People’s rights were protected because staff understood the principles of the Mental Capacity Act (MCA) 2005) and asked for their consent before providing any support. Deprivation of liberty safeguards had been submitted to the local authority for authorisation when required.
People were offered a choice of fresh, home cooked food and a choice of drinks that met their preferences and dietary needs. People were supported by staff to maintain their health and wellbeing and had access to a range of healthcare services when required.
Staff were kind and caring and treated people with dignity and respect. People were encouraged to make choices and retain their independence and maintain relationships with people who were important to them. Family and friends could visit at any time.
People and their relatives were involved in planning their support and care. Support plans were detailed and described how people wanted to receive their support. People took part in a wide range of activities and events both at home and in the community.
The provider was working towards meeting the Accessible Information Standards. Staff used a variety of communication methods to communicate with people, including nationally recognised sign language, which helped them to make decisions about their support.
People and relatives were offered opportunities to feedback their views about their care and this was used to help improve the service.
The provider had a complaints procedure and any complaints were investigated and responded to appropriately.
There was a positive, supportive and open culture within the home. Staff felt supported and listened to by the manager and management team who were visible and approachable.
Although not yet registered, the manager understood their responsibilities under the Health and Social Care Act 2008, including submitting notifications of events as required to the commission.
We last inspected the service in February 2018 when we rated the service inadequate with seven breaches of regulations. The home has made significant improvements and these now need to be embedded to ensure consistency of the delivery of the service.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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 Close is a ‘care home’. People in care homes receive accommodation, nursing and/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. Rowan Close provides accommodation and personal care for up to six people living with a learning disability, physical disability and autism. The home is positioned at the end of a cul-de-sac within walking distance of local shops and amenities. The accommodation is in a single storey bungalow and comprises two lounges, both overlooking the garden and one with sensory facilities. There are two kitchen/diners, one with accessible work surfaces for people using a wheelchair. People’s bedrooms are accessed by a central corridor.
At the time of our inspection six people were living at the home.
The inspection was unannounced and was carried out on 31 January & 2 and 9 February 2018 by one inspector.
We identified a number of serious concerns during our inspection and made several safeguarding referrals to the local authority following our inspection. The Head of Operations visited the home on the third day of our inspection and told us they would put an action plan in place. This was sent to us following our inspection. The provider had also employed a consultant to help support the registered manager and a senior manager to identify areas for improvement.
There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.
The care service has 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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, we found people living at Rowan Close were not always offered choices or supported to experience inclusion.
The culture within the home was not open, transparent or supportive. The home was not well led and the provider had lacked oversight of the culture that had developed within the home. Concerns raised by staff had not been listened to, investigated and responded to effectively. Staff did not feel respected, valued or listened to and no longer felt able to raise concerns and issues for fear of recriminations.
Medicines were not managed safely. There were numerous issues with the stockpiling and unsafe storage of medicines, and large quantities of unused medicines were found in boxes, cupboards and drawers with no audit trail. The provider could not be assured people had received their medicines as prescribed.
Risks were not always safely managed. Unsafe and unsuitable foods were prepared in a way which increased people’s choking risks. Risk assessments had not always taken place before community activity as required in people’s support plans. Equipment checks had not taken place or were ineffective leading to the use of unsafe and potentially unsafe equipment.
Not all staff had completed the required training to ensure they could meet people’s needs effectively. Staff were not trained appropriately or in a timely way to manage a new resident’s specialist feeding equipment. Staff supervision had not taken place for all staff and no staff had received an appropriate appraisal.
Staffing was not sufficient or appropriately deployed to meet people’s needs. Staff worked in a way that was task focussed. They did not have time to sit and chat with people or meet their social/emotional/recreational needs.
The provider could not be assured that all incidents, accidents or near misses had been reported or acted upon. Incidents and near misses that we observed or were told about during our inspection had not been recorded.
Assessments were not always carried out effectively and information was not always communicated to staff in a timely way to ensure they knew how to provide care and support for people when they moved in to the home.
The provider could not be assured healthcare recommendations were always followed. There was evidence of some health referrals and input from GPs, dentists and district nurses. However, follow up actions were not always recorded and staff were unable to say if these had taken place.
People were not supported to follow a balanced diet and the quality of food offered to people was poor. Support plans did not contain information about people’s food likes and dislikes. There was some evidence that this had started to be addressed by end of our inspection.
People’s rights had not always been protected because the registered manager had not always followed the principles of the MCA 2005. MCA assessments and best interest decisions had not been recorded for most significant decisions or restrictions such as bedrails and lap belts.
People were not always supported to access their community to reduce isolation. They did not always receive care that was responsive to their needs and were often not supported to follow their support plans, interests and community activities due to lack of staffing. One person had not been supported to maintain relationships with people that were important to them leading to isolation from their community. Their communication needs had not been addressed as English was not their first language.
There were no recorded complaints and the Head of Operations was not aware of any although they could not be assured there had not been any complaints or that they had not been reported.
Staff did not feel involved in developing the service. They told us the registered manager did not delegate anything, was not responsive to feedback and did not empower the staff to share ideas. Senior staff had stood down as they were not enabled or allowed to carry out their senior roles.
Systems to monitor and assess the safety and quality of the service were in place, however they were not always effective. Many of the issues we found during our inspection had not yet been identified by the provider. The Head of Operations told us they had introduced a consultant and senior staff member into the home to help support the manager. They later told us they had also started to identify some concerns and shared these with us throughout the inspection. However, systems and processes required significant improvement to detect warning signs sooner in order to prevent such a decline in service.
People’s records were often out of date and inaccurate. There was no audit trail for medicines that were unused. The registered manager filled in gaps in witness charts retrospectively and we could not be assured all staff could remember what they had witnessed three weeks earlier. Support plans and other records were cut and pasted, and did not always reflect individual people’s needs. Management record keeping was disorganised and not accessible. The registered manager was not always able to provide information about the running of the home when requested.
Staff were kind and caring in their interactions with people. Staff knew people very well and understood their behaviour and body language to help support their communication. Staff understood where people wanted private time and respected this.
Relatives felt welcome and could visit any time. People and their families were involved in making decisions about their care, as much as they could be.
The environment was all on one level, purpose built and fully wheelchair accessible for the people who lived there.
This inspection was carried out by an inspector on 5 and 6 October 2015.
Rowan Close provides accommodation for up to six people who require personal care. They provide support for people who may have a severe learning disability, complex physical needs, sensory impairments and epilepsy. The home has its own adapted vehicle. The service can offer a variety of activities in the local community and can also support holidays and trips away.
The home had a registered manager. 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 and associated Regulations about how the service is run.
Staff showed a good understanding of the needs of the people they supported. People were offered a choice of food and drinks which were sufficient for their needs and that met their dietary requirements. People’s hobbies and interests were documented and staff accurately described people’s preferred routines. Staff supported people to take part in activities both within the home and in the community.
There was a strong, visible person centred culture within the home. Staff identified creative and innovative solutions to delivering care that supported people to maintain their independence and to provide re-assurance when needed.
People, their families and their advocates were involved in planning and review of their care. Care plans were personalised and support was tailored to their individual needs. People’s risk assessments and care plans had been reviewed regularly to take account of their changing needs. Staff were knowledgeable about people’s health conditions and made referrals to health care professionals quickly when people became unwell or if they had concerns.
Relatives told us they were happy with the care people received. Staff treated people with kindness and compassion and respected people’s privacy and dignity. People’s end of life wishes were discussed, recorded and enabled and relatives told us their feelings were acknowledged and respected at these difficult times.
There were sufficient numbers of staff on duty to support people safely and meet their assessed needs. The provider had appropriate systems in place to recruit staff and appropriate checks were carried out before they commenced employment to ensure they were suitable for the role. Staff received an induction before they started work and were appropriately trained and skilled to deliver safe care. Staff undertook reflective practice which helped them improve the way they supported and interacted with people.
Safeguarding people was understood by staff who knew about their responsibilities to report any concerns of possible abuse. Individual and environmental risk assessments had been carried out and measures put in place to mitigate risks to people. There were robust systems in place to effectively manage the ordering, storage and administration of medicines.
Staff understood the requirements of the Mental Capacity Act 2005 and best interest decisions were made, where appropriate, and recorded in line with the Act.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm. We observed people’s freedoms were not unlawfully restricted and staff were knowledgeable about DoLS. Applications for DoLS had been made to the local authority when appropriate.
There were systems in place to monitor the effectiveness and quality of the service provided. Incidents and accidents were recorded and analysed, and lessons learnt were communicated to staff to reduce the risk of these happening again. Complaints procedures were in place although the home had not received any complaints.
There was an open and transparent culture within the home and staff and relatives said the manager was approachable. Staff understood the vision and values of the service and were actively involved in the development and improvement of the service. The provider understood their responsibility to inform the commission of important events and incidents that occurred within the service, such as safeguarding concerns and DoLS authorisations.
People who lived at the home were able to communicate using different forms of communication. Staff told us that Makaton signs ' used for people with learning disabilities ' were used for some people whilst others it was non-verbal communication such as touch and smell. When we visited Rowan Close we met three of the people living at the home and observed how they were cared for and treated. We observed two senior support workers and activities co-ordinator engaged with people in a positive way.
People were asked for their consent for some day to day care needs in an appropriate way. They received nutritious meals and had a choice of what and where they ate. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.
The service has appropriate recruitment and selection procedures in place and there was an effective complaints system available.
The atmosphere within the home was calm and relaxed with two people finishing their breakfast at the time of our visit. One person was in bed and did not wish to be disturbed and the staff respected their wishes.
We were introduced to people and observed staff use different communication methods with each person that ensured they knew we were there and visiting their home.