Archived: Rowan Garth Care Home

Updated 9 December 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The last inspection was undertaken on 11, 12 and 13 April 2016. During that inspection, the home was rated ‘requires improvement’ overall and we found that legal requirements were not being met in relation to safe care and treatment and good governance and we issued warning notices in relation to these areas. We issued a requirement notice regarding protecting people from abuse and improper treatment as this legal requirement was not being met. After the last inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breaches. This inspection was planned to check whether the provider had made necessary improvements to ensure they are meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to provide a rating under the Care Act 2014.

Prior to this inspection we had received concerns relating to staffing levels and poor quality of care and we reviewed these areas as part of our inspection.

This inspection took place on 18 and 19 October 2016 and was unannounced. The inspection team included two adult social care inspectors, a pharmacist inspector, a specialist advisor whose specialist area was nursing and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before our inspection we reviewed the information we held about the service. This included the statutory notifications sent to us by the provider about incidents and events that had occurred at the service. A notification is information about important events which the service is required to send to us by law. We also contacted the commissioners of the service.

The provider had completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and any improvements they plan to make. We also contacted the commissioners of the service.

We used all of this information to plan how the inspection should be conducted.

During the inspection we spoke with the registered manager, quality manager, regional director, the maintenance person, chef, an activity coordinator, 12 members of the care staff, a trainer, an admiral nurse (dementia specialist), 17 people living in the home, nine relatives and a visiting health professional.

We looked at the care files of 12 people receiving support from the service, four staff recruitment files, medicine administration charts and other records relevant to the quality monitoring of the service. We also observed the delivery of care at various points during the inspection.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 9 December 2016

This inspection took place on 18 and 19 October 2016 and was unannounced.

Rowan Garth Care Home is a large care service in Liverpool which comprises of five separate units, set within extensive grounds, the service can accommodate up to 150 people. Each of the five units are single-storey and can accommodate up to 30 people. The service supports people with a range of care needs from nursing and end of life care, to short term respite care and residential care. Rowan Garth is situated in a suburb of Liverpool, close to transport links. Clover unit closed on 30 September 2016 so only 4 units were occupied at the time of the inspection. The units provide residential, nursing, dementia residential and dementia nursing care. The provider is BUPA Care homes (CFH) Limited.

During the inspection, there were 112 people living in the home.

During the last inspection on 11, 12 and 13 April 2016, we found the provider was not meeting legal requirements in relation to safe care and treatment and good governance and we issued warning notices in these areas. The provider was also not meeting legal requirements in relation to protecting people from abuse and improper treatment and we issued a requirement notice regarding this. During this comprehensive inspection we checked to see whether improvements had been made in these areas and to ensure legal requirements were being met.

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.

At our previous inspections of Rowan Garth in September 2015 and April 2016 we had concerns about the way medicines were managed throughout the home. After our last inspection in April 2016, we issued a warning notice telling the provider that improvements must be made by May 2016 as they were in breach of legal requirements. We found during this inspection however, that medicines continued not to be managed safely and legal requirements were still not being met.

Staff had completed risk assessments to assess and monitor people’s health and safety. We found however, that not all identified risks were managed safely.

We looked at how the home was staffed. Most staff told us there were usually enough staff on duty to meet people’s needs, but people living in the home had mixed views on staffing levels and relatives felt there were not always enough staff on duty. Our observations showed us there were not always enough staff on duty to meet people’s needs in a timely way as we observed people having to wait significant periods of time to receive support they had requested. The registered manager told us they completed an assessment of people's needs to help determine how many staff were required to ensure people's needs could be met and that this assessment was reviewed regularly. The registered manager told us that based on the number of staff the tool suggested were necessary, the home was overstaffed.

Most people we spoke with told us they felt safe living in Rowan Garth and relatives agreed. All staff we spoke with told us they had completed safeguarding training and knew how to report any issues. We found that appropriate safeguarding referrals had been made. Accidents were reported and actioned appropriately. Records showed that most safe recruitment practices were followed.

Arrangements were in place for checking the environment to ensure it was safe. Internal checks were completed and external contractors were utilised to ensure equipment remained safe.

During our last inspection we found that DoLS applications were not always submitted when required and people were being deprived of their liberty unlawfully. During this inspection we found that although improvements had been made and most applications had been made appropriately, not all restrictions had been identified and acted upon.

When people were unable to provide consent, most care records showed that mental capacity assessments were completed and decisions made in people’s best interest through consultation with the relevant people in line with the MCA.

We looked at ongoing support provided to staff and found that although staff told us they felt well supported, supervisions and appraisals were not always provided regularly to help support staff in their roles. Staff underwent a period of induction and completed training that the provider considered mandatory as part of the induction process and on an on-going basis.

People living in the home were supported by the staff and external health care professionals to maintain their health and wellbeing.

Feedback regarding meals was positive. There were choices available to people and specific dietary needs were catered for.

The registered manager had taken steps some within the units for people living with dementia, towards the environment being appropriate to assist people with orientation and safety, such as memorabilia displayed along the corridor walls and pictorial signs.

People living at the home told us staff were kind and caring and relatives we spoke with agreed. We observed a number of interactions between staff and people living in the home that were warm and caring. We found however, that people were not always treated with dignity and respect and their privacy was not always maintained. We observed one person wearing items of clothing that did not belong to them and on occasion, people had to wait significant periods of time to receive support.

We observed relatives visiting throughout both days of the inspection. The registered manager told us there were no restrictions in visiting and people we spoke with agreed.

The level of detail within plans was inconsistent. Care files showed that not all identified needs were reflected within people's plans of care, plans sometimes lacked detail as to how to manage identified needs and planned care was not always recorded as provided in a timely way. There was limited information regarding people’s background, lifestyle and preferences in relation to their care and support. This meant that it would be difficult to provide person centred care based on people’s preferences.

Due to the recent closure of one of the units within the home, there had been some staff changes within the units and not all staff knew the people they were supporting.

The care files we viewed contained a pre admission assessment; this ensured the service was aware of people’s needs and that they could be met effectively from admission.

We found that there were a limited number of activities available to people and relatives we spoke with agreed.

Relatives we spoke with told us they were kept informed of any changes to their loved one’s health and wellbeing. Feedback was sought through the use of quality assurance surveys and resident committee meetings. Resident and relative meetings were advertised regularly but often nobody attended as relatives told us they were able to raise issues at any time. People we spoke with told us they knew how to raise concerns and relatives agreed.

In April 2016 we found that the quality monitoring systems in place were not always effective and that they had not highlighted the concerns identified during the inspection and we issued a warning notice. During this most recent inspection, we found that sufficient improvements had not been made and the provider was still not meeting legal requirements.

We observed a range of completed audits; however they did not highlight all of the issues we identified during this inspection, such as the significant risks regarding medicines management. When areas for improvement were identified, actions were not always taken or maintained to ensure adequate improvements were made. There was inconsistency in the quality and safety of care between the units within the home. There were more significant concerns identified on the units that provided nursing care.

Staff and relatives we spoke with told us the registered manager was, “Approachable.” Staff told us they enjoyed their job and felt able to share their views. Other staff however, were not always satisfied with how the home was managed.

Staff were aware of the home’s whistle blowing policy and told us they would not hesitate to raise any issue they had.

The registered manager had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with our statutory requirements.

The home has been rated as ‘inadequate’ overall and will therefore, be placed in special measures. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve; they will be kept under review and inspected again within six months.

• 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.

• If we do not take immediate enforcement action, special measures provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action.

We are considering our regulatory response.