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Rowanweald Residential and Nursing Home Good

Reports


Inspection carried out on 8 October 2020

During an inspection looking at part of the service

Rowanweald Residential and Nursing Home 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. Rowanweald Residential and Nursing Home is registered to provide accommodation for a maximum of 75 people who require nursing or personal care. Some of the people using the service may be living with dementia.

We found the following examples of good practice.

• The service had been diligent in their efforts to protect their staff and people who used the service. They had ensured that visitors to the home were carefully screened so that they do not present a risk to people in the home. Visitors had to complete a questionnaire providing information about their health condition and any potential risks they may have related to the corona virus infection. Their temperatures were then checked at the door. Personal protective equipment (PPE) including face masks, disposable gloves and aprons were then provided for visitors to wear before entering the home. This was aimed at preventing and controlling the spread of infection. To further minimise the risks, the home had allocated a room where visitors could meet with people they were visiting.

• The home had a caring approach regarding ensuring that people had contact with their friends and relatives. Contact was maintained via the telephone and internet. Effort had been taken by the home to ensure that numerous people can be visited by their relatives. Regular visits had been arranged each day where people can have face to face contact with their relatives.

• Staff had a good understanding of infection prevention and control measures. The home had sufficient and appropriate PPEs. The home had an area for staff to remove or put on PPEs. It had a poster and guidance showing staff how to remove PPEs correctly, hand washing facilities with sanitizer, and paper towels and foot operated large pedal bins lined with infected/clinical waste bags for the safe disposal of used PPE. There was also guidance for cleaning re-useable PPEs. The home also provided further support for staff by providing snacks and drinks for them and allowing their personal grocery shopping to be delivered to the home for them. The registered manager had also written to each staff member to express appreciation for their work.

• People were encouraged to continue participating in activities in small groups. Social distancing was observed with seating being spread out.

• To reduce exposure to infection resulting from admission or transfer to hospital, the home made effective use of the services of the local rapid response team and their GP. As a result, there was minimal use of the ambulance service and hospital admissions had been reduced.

•Throughout the pandemic, senior managers of the company were in constant contact with the home to receive updates and support the registered manager and his staff. This had sustained the morale of staff and it had also maintained good communication among staff. The registered manager had also been involved in organising the local monthly corona virus peer support meetings attended by managers of other care services. Such meetings enabled other care services' managers to be updated on how to improve care for people during the pandemic.

Further information is in the detailed findings below.

Inspection carried out on 11 December 2018

During a routine inspection

We undertook this unannounced inspection on 11 & 13 December 2018. Rowanweald Residential and Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission [CQC] regulates both the premises and the care provided, and both were looked at during this inspection. Rowanweald Residential and Nursing Home is registered to provide personal care and accommodation for a maximum of 75 older people some of whom may have dementia, mental health needs, physical disability or sensory impairment. The home is a detached house located close to transport and shops. Accommodation is provided on the ground floor, first floor and second floor of the building. The home is divided into five units called Arden, Magnolia, Oak, Pelenna and Rheola. People with nursing needs were accommodated on the second floor.

The last comprehensive inspection we carried out in October 2017 found a breach of Regulation 18 HSCA RA Regulations 2014 Staffing. The service did not have adequate staffing levels and adequate deployment of staff. This placed people’s welfare and safety at risk. During this inspection in December 2018, we found that the service had taken action to comply with the requirement and the care needs of people had been attended to. The staffing system had built-in safeguards to ensure that the staffing levels were adequate.

Our last comprehensive inspection of 2017 also found a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Person centred care. During this inspection in December 2018, we found that the service had taken action to comply with the requirement. The service had ensured that care provided was person centred and met the needs of people. Feedback from people and relatives indicated that improvements had been made and the care needs of people had been attended to.

At the last comprehensive inspection we found that the service did not have sufficiently effective quality assurance systems for fully assessing, monitoring and promptly improving the quality of care provided for people. We recommended that the service regularly audit progress and action taken to ensure that deficiencies are promptly identified and rectified. During this inspection in December 2018, we found that the service had taken action to address the deficiencies identified. The service had a system of checks to ensure people received the care they needed. Regular audits had been carried out since the last inspection. Following these audits, the service had taken action to improve areas identified.

The service had also been subject to inspections by the local authority’s commissioning and quality monitoring department. They reported that improvements had been made in the running of the home. This was also reiterated by people and relatives we spoke with. Further effort had been made to engage with relatives and people's representatives by moving the manager's office to a room next to the front entrance of the home. This was aimed at improving communication with people and their visitors.

People who used the service and their representatives informed us that people had been treated with respect and dignity. The service had arrangements to protect people from harm and abuse. Care workers were knowledgeable regarding types of abuse and were aware of the procedure to follow when reporting abuse.

Risks assessments had been carried out and risk management plans were in place to ensure the safety of people. The service followed safe recruitment practices and sufficient staff were deployed to ensure people’s needs were met. There were suitable arrangements for the administration of medicines and medicines administration record charts (MAR) had been properly completed.

There was a record of essential maintenance and inspections by specialist contractors. Fire safety arrangements were in place. These

Inspection carried out on 19 October 2017

During a routine inspection

We undertook this unannounced inspection on 19 and 24 October 2017. Rowanweald Residential and Nursing Home is registered to provide personal care and accommodation for a maximum of 75 older people some of whom may have dementia, mental health needs, physical disability or sensory impairment. The home is a detached house located close to transport and shops. Accommodation is provided on the ground floor, first floor and second floor of the building. The home is divided into five units called Arden, Magnolia, Oak, Pelenna and Rheola. People with nursing needs were accommodated on the second floor. At this inspection the home had 70 people who used the service.

At our last comprehensive inspection on 19 October 2015 the service met the regulations we inspected and was rated Good. At this inspection we found areas where improvement was needed and have rated the home as Requires Improvement.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

The service had arrangements to protect people from harm and abuse. Care workers were knowledgeable regarding types of abuse and were aware of the procedure to follow when reporting abuse. Risks assessments had been carried out and risk management plans were in place to ensure the safety of people. The service followed safe recruitment practices and records contained the required documentation. The staffing levels had been regularly reviewed. However, some people, relatives and three social and healthcare professionals told us that there were times when there was insufficient care workers available to attend to people's needs.

The arrangements for the administration of medicines were satisfactory and medicines administration record charts (MAR) and the controlled drugs register had been properly completed.

The premises were kept clean and tidy. Infection control measures were in place. There was a record of essential maintenance of inspections by specialist contractors. There were fire safety arrangements. These included weekly alarm checks, a fire risk assessment, drills and training. Personal emergency and evacuation plans (PEEP) were prepared for people to ensure their safety in an emergency.

The service worked with healthcare professionals and ensured that people’s healthcare needs were met. The service had experienced problems ensuring that the healthcare needs were met. However, improvements had been made and this was confirmed by three healthcare professionals. The dietary needs of people had been assessed and arrangements were in place to ensure that people’s dietary preferences were responded to. People informed us that the provision of meals had improved since the arrival of the new chef.

We noted from comments from some people, some relatives, two social and healthcare professionals and our observations that some people had not received all the required care. We also noted that the care of some people had not been subject to regular reviews with them or their representatives. This is needed to ensure people received the care they needed and in accordance with their preferences.

The home employed two activities organisers. There was a varied activities programme to ensure that people received social and therapeutic stimulation. People were satisfied with the activities provided.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. We noted that the hom

Inspection carried out on 22 October 2015

During a routine inspection

We undertook this unannounced inspection on 22 October 2015. Rowanweald Nursing Home provides nursing care and accommodation for a maximum of 45 older people some of whom may have dementia, mental health needs, physical disability or sensory impairment. The home is purpose built and on the ground floor and second floor of the building. It is subdivided into 3 units. At this inspection there were 35 people living in the home.

At our last inspection on 25 & 26 November 2014 the service did not meet Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010 Care and welfare of people who use services. This corresponds with Regulations 12 HSCA 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment. At that inspection the registered person did not always ensured that care plans included detailed guidance for staff to follow to minimise the risk of people acquiring pressure ulcers. At our inspection of 22 October 2015 we found that the service had suitable arrangements in place to provide safe care and treatment.

The home did not have a registered manager. The new manager was in the process of applying for registration with the Care Quality Commission (CQC) to manage the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

People and their relatives informed us that they were mostly satisfied with the care and services provided. They said that people were treated with respect and they were safe. There was a safeguarding adults procedure and suitable arrangements for safeguarding people. A number of concerns and safeguarding allegations had been received by us and the local safeguarding team. Some of these were substantiated while others were not. Staff co-operated with investigations carried out by the safeguarding team. Action was taken by the provider following recommendations made after these investigations.

People’s care needs and potential risks to them were assessed. Staff prepared appropriate care plans to ensure that that people received safe and appropriate care. Their healthcare needs were closely monitored and attended to. Staff were caring and knowledgeable regarding the individual choices and preferences of people.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Consultation meetings had been held for people and their representatives. The home had an activities programme but effort was needed to provide a more varied range of activities so that people could have regular access to adequate social and therapeutic stimulation.

There were suitable arrangements for the provision of food to ensure that people’s dietary needs were met. People were mostly satisfied with the meals provided. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory.

Staff had been carefully recruited and provided with training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from their managers. There were enough staff to meet people's needs. The staffing levels were satisfactory.

The home had comprehensive arrangements for quality assurance. Regular audits and checks had been carried out by the manager, the regional managers and directors of the company. Complaints made had been promptly responded to. We however, noted that previous audits and checks had not always identified and promptly rectified deficiencies with regard to the care provided to people. There is therefore a need for the provider to continue to carry out robust and comprehensive audits together with prompt action in response to deficiencies identified. This is necessary to ensure the safety and welfare of people who use the service.

We found the premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried out.

Inspection carried out on 25 & 26 November 2014

During a routine inspection

This unannounced inspection took place on the 25 and 26 November 2014. We told the provider we would be returning the next day to continue the inspection.

Rowanweald Nursing Home provides nursing care and accommodation for up to 45 older people some of whom may have dementia, mental health needs, physical disability or sensory impairment. The home is purpose built and located in Harrow Weald on the outskirts of Harrow. Public transport is accessible and a range of shops are within walking distance of the service. There were 33 people living in the service. At the time of our inspection the provider was in the process of completing an action plan to address some issues to do with the quality of the service and people had not been admitted whilst these improvements were being made. It was evident the provider was taking appropriate steps to improve the service and was aware there were some improvements that needed to be fully completed.

The registered manager was appointed in July 2014. 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 found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the planning and delivery of care You can see the action we have told the provider to take at the back of the full version of this report.

People told us that the service had improved since the appointment of the registered manager. They told us the registered manager was accessible and approachable and they felt able to speak to her and the nursing staff about the service and raise any concerns they had, which they were confident would be addressed appropriately.

People told us they were happy living in the home and felt safe. Staff were aware of their responsibilities in supporting people to be safe and protecting them from risk of harm. People and their relatives were complimentary about the care provided by the service. We saw staff interact with people in a friendly and courteous manner. However, on two occasions we found staff had a less respectful approach when they communicated with people.

We found some people’s care plans did not always reflect their specific needs and had not been recently reviewed.

For several months in 2014 there had been a significant reliance upon the use of agency nurses and care workers. People told us this had been unsettling and did not promote the building of positive relationships with staff who were very familiar with their particular needs and preferences. We found steps had been taken to address this issue by employing permanent staff and building up a team of regular ‘bank staff’ who could be called upon to work at short notice. People told us staff were available to help them when needed.

People were provided with a choice of food and drink which met their preferences and nutritional needs. People told us they enjoyed the meals.

Staff received relevant training and were supported to develop their skills so they were competent to meet people’s needs. People’s health was monitored and referrals made to health professionals when this was required.

The registered manager and other staff had an understanding of the systems in place to protect people who were unable to make decisions about their care and other aspects of their lives.

There were effective systems in place to monitor the care and welfare of people and improve the quality of the service. We inspected we found there had been significant progress made in completing the action plan of improvements to the service. We could see a number of areas where problems had been addressed or were in the process of being dealt with, such as recruitment of staff, staff conduct, and the promotion of better communication with people.

We have made recommendations about the management medicines and about end of life care.

Inspection carried out on 25 July 2013

During a routine inspection

During our inspection we spoke with four people who used the service, a relative and five members of staff.

Overall, people who used the service were satisfied with the care provided and said that they were treated respectfully. One person told us that they were happy and felt �part of a family� at the home. Another person told us that the staff were �friendly and helpful�.

We looked at five care records and these indicated that the individual needs of people had been attended to. The care records contained appropriate assessments, care plans and details of reviews. There was documented evidence that the healthcare needs of people had been attended to and there were records of appointments with healthcare professionals.

We observed that the home was clean and welcoming. There was a communal garden which was well maintained and was popular amongst people who used the service.

Staff we spoke with told us that they felt supported by management. During our inspection members of staff, one relative and people who used the service told us that the home would benefit from another member of staff during busy times.

Staff demonstrated that they were aware of what action to take when responding to allegations or incidents of abuse and had received training in safeguarding people.

Inspection carried out on 23 October 2012

During a routine inspection

People said the staff treated them with respect, listened to them and maintained their privacy and dignity. They said they could choose what they wanted to do with their time and were able to make choices for themselves. One person said �I can please myself� and another said �everybody respects me�.

People told us the staff cared for them well and met their needs. The care plans identified people�s needs and how these were to be met. Changes in needs were recorded to keep staff informed so they could care for people effectively. People described the care they received as ranging from �fair� to �brilliant�. One visitor said they �would highly recommend this home�.

Medications were being managed in the home. Two people confirmed they received their medications from the registered nurses and said their medication had been discussed with them so they knew what they were taking and why.

The home was being appropriately staffed and staff had relevant training and experience to care for people effectively. Staffing levels were monitored in line with people�s dependencies.

Systems were in place for monitoring the quality of service people received. People said they were encouraged to express their views and raise any concerns and that they were listened to, with action being taken promptly to address any issues they raised.

We spoke with nine people using the service, seven visitors and six staff.

Reports under our old system of regulation (including those from before CQC was created)