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Inspection carried out on 25 January 2016

During a routine inspection

This inspection took place on 25 & 27 January 2016 and was unannounced. Rowan House provides accommodation and care for up to 16 older people with mental health needs or people living with dementia. At the time of our inspection there were 15 people living in the home.

The home had a registered manager who was also the registered provider. A registered manager is a person who has registered with the 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 felt safe. People and their families felt there were enough staff. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. People were supported to receive their medicines safely from suitably trained staff and were stored, administered and audited effectively. Relevant recruitment checks were conducted before staff started working at Rowan House to make sure staff were of good character and had the necessary skills.

Rooms were personalised and people told us the home was clean. However, floor coverings in bathrooms were worn and in need of replacement.

Activities were planned daily. However, people told us there was not much to do. Staff told us that activities could sometimes be cancelled due to people requiring personal care, which could leave the service short staffed at times and as a result of this activities were sometimes cancelled.

Staff sought consent from people before providing care or support. However, the ability of people to make decisions was not always documented in line with legal requirements to ensure their rights were protected and their liberty was not restricted unlawfully.

The risks to people were minimized through risk assessments which provided staff with clear guidelines to follow. Staff were aware of how to keep people safe. Staff were supported and received regular one to one sessions of supervisions to discuss areas of development. Staff completed a wide range of training which they felt supported them in their job role. New staff completed an induction period before being permitted to work unsupervised.

People received varied and nutritious meals including a choice of fresh food and drinks. Staff were aware of people’s dislikes and offered alternatives if people did not want the meal of the day. People were able to access healthcare services.

People were cared for with kindness, compassion and sensitivity. We observed positive interactions between people and staff. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

People were supported and encouraged to make choices and had access to a range of activities, when there were enough staff. ‘Resident meetings’ and surveys allowed people to provide feedback, which was used to improve the service.

People liked living at the home and felt it was well-led. There was an open and transparent culture. Staff felt the manager was approachable and felt their ideas were listened to. The manager used a series of audits to monitor the quality of the service.

A complaints procedure was in place. There were appropriate management arrangements in place and staff felt supported.

Inspection carried out on 7 February 2014

During an inspection to make sure that the improvements required had been made

At our previous inspection in August and September 2013 we found that essential standards were not being met in four areas. Medicines were not managed or recorded appropriately. There were not sufficient qualified, skilled and experienced staff to ensure people's safety and welfare at all times. Staff were not supported by an effective system of supervision and appraisal. The provider did not have effective processes to monitor and assess the quality of the service provided. We told the provider to take action to become compliant in these areas. They sent us their action plan. During this inspection we checked that their plan had been followed to improve the quality of care people received.

Since our last inspection, a new manager had been appointed who was working alongside the registered manager. We spoke with both managers and three members of staff, and we observed the care and support people received. We found medicines were managed and recorded appropriately. There were sufficient staff to support the needs of the people using the service. The managers had put in place a programme of supervision and appraisal, and a system to monitor and assess the quality of the service.

Inspection carried out on 16 October 2013

During an inspection to make sure that the improvements required had been made

At our previous inspection we had found that essential standards were not being met with respect to the care and welfare of people who use the service. We warned the provider they had to make improvements within a given timescale. During this inspection we checked that actions had been taken to improve the quality of care people received.

We spoke with two people who used the service, reviewed the care records of eight people, observed the care and support provided in the shared areas of the home and spoke with the manager and staff. We found steps had been taken to ensure people received care that was safe, effective and responsive to their changing needs.

Inspection carried out on 18, 19 August and 5 September 2013

During an inspection in response to concerns

At the time of our visits there were 16 people using the service. We spoke with three of them and two family members visiting their relative. Both visitors were satisfied with the care and support their relative received. One said their relative “seemed happy”.

One of the people using the service told us “things are OK”. Another did not want to say. A third person was dissatisfied with one part of their care and support. All the people we spoke with agreed there were enough staff to deliver care according to their needs.

We spoke with five members of staff who were on duty during our visits and looked at records relating to people’s care. We found there were periods during the day when there were not enough staff to support people according to their needs. Although staff had opportunities for appropriate training, they were not supported by a proper system of appraisals and supervisions.

We observed care and support being provided in the communal lounge, and saw that staff were caring and responsive to people’s needs. However, we found examples where the service was failing to provide appropriate care. Other people were exposed to unsafe care because risk assessments were incomplete or had not been followed up.

The service did not have effective systems to monitor and assess the quality of service provided. Its informal management systems were not ensuring that the care provided met people’s needs. Staff concerns and suggestions were not recorded and acted on.

Inspection carried out on 11 April 2013

During a routine inspection

At our previous inspection we had found that essential standards were not being met with respect to staffing. During this inspection we checked that actions had been taken to address this. We also inspected other standards as part of our planned schedule of inspections.

We spoke with five people out of 14 using the service and one visitor. They told us they were happy with the care provided and that staff made sure they had given their consent to care and treatment. One said, “They wouldn’t do anything you didn’t want.” People said there were enough staff to provide the care needed and they did not have to wait too long for support. They were aware they could complain about the service, but they had not had reason to do so. One said if they did have to complain to the manager they were “confident they would sort it out.”

We spoke with a healthcare professional who called on the service regularly. They told us the service was aware of risks and when to call in other health or social care providers. They said staff were receptive to guidance.

We found that where people could not consent to their own care and support, decisions were made in their best interests. People’s care needs were assessed and there were enough staff to ensure care was delivered according to people’s plans. People were protected from the risk of abuse and appropriate checks were carried out before staff started work. We saw that the care and support provided was person-centred, caring and timely.

Inspection carried out on 11, 12 December 2012

During a routine inspection

We spoke with seven people using the service who told us they thought Rowan House was "a good care home", they were well looked after and the staff "worked very hard." They said they or their relatives were involved in the planning of their care and support, and that they were treated with respect. People visiting friends and family members told us that people were "well looked after", that their preferences and choices were respected and they were generally happy with the service and the staff. One visitor said that although the care and support were satisfactory there were not always enough staff on duty. Staff told us that there were times when they found it difficult to maintain standards of care because there were not enough of them.

We found that staff treated people using the service with respect and that care and support were planned and delivered in line with people's need assessments. People were cared for in a clean and hygienic, if cluttered, environment. Staff were supported and received adequate training to do the job, but there were times when people's needs were not met because all the staff on duty were occupied . Procedures and processes were in place to monitor and improve the quality of the service.

Inspection carried out on 21 February 2011

During an inspection to make sure that the improvements required had been made

All people said that staff are kind and friendly and respect decisions they make. They also said they were happy with the care and support they receive.

People said they were happy with the standards of cleanliness at the service and that the new bathing facilities were much nicer than what was previously in place.

Generally, people expressed satisfaction with staffing levels. One person did say they sometimes have to call for assistance a number of times.

Inspection carried out on 7, 8 December 2010

During a routine inspection

People we were able to speak with were generally positive about the home and care they receive. They confirmed that food is good, that they feel protected from harm and that they are happy with the environment.

Comments include, “the meals are good, you get a good choice and when you move in they ask you what you like and dislike, and you get plenty of biscuits” and another person said, “staff are not staff to me, they are my friends, I’m independent, and they know this”.

All people that we spoke with praised the staff. One person did say that although they could get help from staff when needed they were not able to get a bedtime drink when they wanted, as they had to wait for the night staff to start work.

Staff told us that although staffing levels have increased they do not have time to read peoples care plans. They also told us that they do not have regular meetings with the manager where they can discuss the needs of people living at the service or any concerns they may have.

Southampton City Council safeguarding team informed us that concerns were raised with them in June 2010 about the care that people receive, staffing levels, records and the environment. They investigated these and instructed the provider to make improvements, which they inform us they did. The safeguarding team closed their investigation in October 2010.