Rowland House Care Home

Rowland House is a care home without nursing for up to seven adults. The service specialises in the care of people with acquired brain injury, including Huntington’s disease. There were seven people living at the home at the time of our inspection.

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

Staff had the knowledge and skills they needed to provide safe and effective care. They understood people’s individual needs and the conditions they lived with. Any risks involved in people’s care were mitigated and managed effectively.

The provider operated safe recruitment procedures. Staff understood their responsibilities in safeguarding people from abuse and know how to report any concerns they had.

People’s medicines were managed safely. Staff maintained appropriate standards of infection prevention and control.

The provider’s quality monitoring systems helped ensure people received safe care. Adverse events were analysed to identify any actions that could reduce the risk of a similar incident happening again and learning was shared with staff. Notifications of significant events were submitted to CQC appropriately.

The registered manager and staff worked effectively with other professionals involved in people’s care. Staff communicated well with people’s families and ensured they were kept up to date about people’s health and wellbeing.

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 9 June 2018).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 30 April 2018. We rated the Well-led key question requires improvement. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to meet the breach of legal requirements.

We undertook this focused inspection to check they had made the required improvements. This report only covers our findings in relation to the key questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at 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.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The registered manager had a pre-booking system for visits to take place. Visitors could come as often as they liked providing the visit was booked. To limit contact with people and staff, the room had external access and furniture was spaced to promote social distancing. The registered manager told us she’d had positive feedback from relatives stating they felt safe when visiting.

Staff were aware of people’s risks in relation to social distancing during visits with their relatives. If people were unable to socially distance, the registered manager provided personal protective equipment (PPE) for the relative to wear. This included a protective gown and visor to keep the person safe.

People were supported by staff to go out and use the local shops. Staff supported people to wear a facemask as per government guidelines and follow the safe visiting procedure on their return.

To reduce the risk of exposure to COVID-19, people were encouraged by staff to shield in their room if they were assessed as clinically vulnerable.

Rowland House Care Home is registered to provide care, support and accommodation for up to seven people who have an acquired brain injury. At the time of our visit there were seven people living at the 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.

At the time of our visit a registered manager was present and 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.

We found that there was no over view or system of recording and monitoring all of the incidents and accidents. We also found that when certain events occured, the provider had failed to notify CQC where necessary. You can see what action we told the provider to take at the back of the full version of the report.

Relatives told us they felt their family member was safe living at the service. Staff had received training in relation to safeguarding and were able to describe the types of abuse and processes to be followed when reporting suspected or actual abuse. Risks to people were assessed and considered consistently.

There were sufficient staff present to safely meet people's needs. We observed staff being consistently present with each person throughout the day. We also saw that safe and correct checks had been completed in the recruitment process for all of the staff.

Staff were seen to check the medicine administration record (MAR) to check what medicine was required at what particular time. When medicine was given to people, staff explained what it was and made sure they had a drink, or other fluid to make it easy to swallow. People were protected against the risk of the spread of infections. The home environment was clean with no malodours.

Peoples’ needs and choices were assessed to make their care, treatment and support as effective as possible. In two care plans we saw clear and detailed pre admission assessments which assessed the care required for people. People’s relatives were very positive about the food at this service. We observed that people’s nutritional ad hydration needs were being met.

All staff had been trained in areas relevant to their role which was in line with the Care Certificate. The Care Certificate is an identified set of standards that health and social care workers adhere to in their daily working life. All staff were supported with frequent supervision by the manager.

We saw evidence of people being supported to access healthcare professionals when needed. The home had a gym in the basement which was frequently used by people and occupational therapists (OTs). The environment was suitably adapted for the people living there.

Where there were restrictions in place, staff had followed the legal requirements to make sure this was done in the person's best interests. Staff consistently sought consent from people. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way.

Relatives told us that they felt staff treated their family member with kindness, respect and compassion. Staff promoted people’ privacy, dignity and independence. Peoples independence was promoted.

Where there had been complaints made there had been clear action taken to address the concerns.

There were plans in place for person centred end of life care in each care plan. We saw one care plan which had a detailed booklet specifying the steps, contacts and relevant facts to one person and their preferred arrangements. People had access to a wide range of activities specific to their interests.

There was a clear vision and credible strategy to achieve good outcomes for people. This was to rehabilitate people and promote their independence so that they could be discharged. Since the last inspection in 2016, five people have been discharged to either live with their families or independently with partners.

Staff were positive about the manager and the culture of working at this service. We saw minutes of meetings held with staff where they discussed ideas about the home relating to people’s care, staffing and training. People, the public and staff were actively engaged and involved in the service.

Quality assurance checks were completed around the home, to spot where areas of improvement were needed. Health and safety checks were completed on a weekly and monthly basis. Areas covered included cleanliness and infection control, fire safety checks, including reviewing the last evacuations, and condition of the environment.

Rowland House Care Home is registered to provide care, support and accommodation for up to seven people who have an acquired brain injury. At the time of our visit there were seven people living at the home.

At the time of our visit 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 the time of our visit the registered manager was on annual leave, however a senior member of staff assisted us with our inspection. We had a telephone conversation with the registered manager following the inspection.

Not all records at the home had been accurately maintained. We found there were gaps in the recordings of medication people had received and the daily recording of the temperatures where medicines were stored. However, these issues had been identified in the quality assurance monitoring as were being addressed by the registered manager.

People told us they felt safe living at the service. Staff had received training in relation to safeguarding and were able to describe the types of abuse and processes to be followed when reporting suspected or actual abuse.

Staff had received training and regular supervisions that helped them to perform their duties. New staff received a full induction to the service which included training.

Where there were restrictions in place, staff had followed the legal requirements to make sure this was done in the person’s best interests. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way.

People and relatives we spoke with were positive about the care provided and their consent was sought. People were positive about the caring nature of the home and all the people we spoke to consistently said that they liked the home. People told us that staff treated them with respect and attended to their personal care needs in private.

People’s care and health needs were assessed and they were able to access all healthcare professionals as and when they required.

People’s nutritional needs had been assessed and people were supported by staff to eat and drink as and when required. The menus provided a choice of meals and people were able to choose a meal that was different to the menu choices. People and their relatives were complimentary about the food provided.

Documentation that enabled staff to support people and to record the care and treatment they had received was up to date and regularly reviewed. People had signed their care plans and were involved in writing and reviewing their plans of care. People’s preferences, likes and dislikes were recorded and staff were knowledgeable about the care needs of people.

Relatives, partners and friends were encouraged to visit and people were supported to go out with their visitors.

Staff showed kindness and compassion and people’s privacy and dignity were upheld. People were able to spend time on their own in their bedrooms and their personal care needs were attended to in private.

There were enough staff to ensure that people could undertake their activities and to meet the assessed needs of people. Staff encouraged people to be independent and to do things for themselves, such as cooking and doing their own laundry.

People and relatives told us they thought the home was well run and they were able to have open discussions with staff. People told us they were able to raise concerns and make complaints if they needed to.

Staff were knowledgeable about the values and visions of the service and worked in line with these. Staff were also aware of the whistle blowing procedures and would not hesitate to report bad practice.

Quality assurance processes were in place to help drive improvement at the home.

People who used the service told us they were happy living at the service. People told us they had a care plan and this was discussed with them. One person told us, 'I look at my care plan with my key worker every month.'

People told us they made decisions for themselves but staff helped them if they found things difficult to understand. One person told us, 'Staff helped me to understand why I had to attend a hospital appointment for my toe.'

People told us that the food was always good and they chose the menu every week. One person told us, 'I cook my own meal once a week.' Another person told us, 'I make soup for everyone on a Monday.' People also told us that the home was always clean, tidy and never had any smells.

We found the service was non-compliant with one of the six outcomes we looked at.

We saw two care plans that were person centred and provided information for staff on how the person liked their assessed needs to be attended to.

Staff were knowledgeable about safeguarding adults and we saw that they had received training in regard safeguarding adults.

We saw records of supervision and appraisals. This demonstrated that staff were able to discuss their performance with the manager and identify training and development needs.