Rowland House Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant people’s needs were not always met.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people were at the centre of their care and treatment choices However, they agreed, in partnership with people, how to respond to any relevant changes in people’s needs.

Although people’s care plans contained a good level of detail to enable staff to understand the persons care needs, we found there was little personal or background information on the person which would help staff to know the person before their move into Rowland House. Staff working at the service on the day of inspection appeared to know people well and were able to tell us some personal information such as people’s hobbies or jobs, but including a pen-portrait of a person is important, particularly where agency staff may be used, or the service is going through an on-going recruitment drive.

People’s care plans covered mobility, continence, food and nutrition, falls risks, personal care and behaviours of concern. Where people became anxious there was information in their care plans on potential triggers and how staff should respond to these. Some people had positive behavioural support plans in place which had been developed by the provider’s specialist team. These helped staff understand people better and gave them more guidance in how to adapt their approach and care towards people when becoming anxious. Where people had an acquired brain injury there was cognition information covering how the brain injury presented in the person.

Management and staff understood the diverse health and care needs of people. This included 1 person who was at risk of self-neglect. The interim manager had drawn up a goals and strategies plan of care for staff detailing out different stages on engaging the person slowly and gently towards allowing staff to be more involved in their care. The interim manager told us, “[Person’s name’s) room is cleaner than it has been for a long time because each time staff pass their room, they knock, open the door and say hello. They don’t go in but are gradually just getting [person’s name] used to seeing them. This has enabled them to clean their room at times. In addition, staff fill a bowl with water and put a sponge with it. They have been placing this in [person’s names] room to encourage them to have a wash. We don’t know if they do or not, but that doesn’t matter at this stage. However, we had a breakthrough as 3 weeks ago they came and asked staff for a bath.” This demonstrated a sensitive, respectful approach to supporting a person who may have complex needs, possibly related to past trauma, mental health, or neurodiversity.

Although information was provided to people in formats that were tailored to individual needs, relatives told us good communication was lacking by the provider and they felt ill informed at times. Relatives told us, “There have clearly been recent issues at the service, and the manager has changed, but nothing has been said to us. We feel we are owed an explanation and some information.”

Although people had communication care plans which contained good information around people’s level of comprehension, staff were not able to tell us how they communicated effectively with people who were non-verbal, other than telling us they asked closed questions. This meant some people may not receive the same information provided to others living at the service.

In contrast, 1 person’s plan recommended staff provide the person with no more than 1 or 2 pieces of information at a time. We observed this in practice between a staff member and this person. We saw and heard them not overloading the person with information and waiting for them to answer in their own time. A staff member told us, “We use easy digestible communication with [person’s name] and [person’s name] uses his iPad.”

The provider had not always considered different ways in which people could be given the opportunity to share feedback and ideas.

Although some people were involved in decisions around the running of the service, this was not always the case for everyone. The interim manager told us, “People were asked what they would like in terms of meals. We did chilli-con-carne the other day as [person’s name] requested this. [Person’s name and person’s name get involved]. We asked [person’s names] family what their favourite meal was.”

However, they had not considered other ways of supporting everyone to be involved, such as using pictorial prompts or objects of reference to obtain people’s views. This meant that people with communication needs may have been excluded from meaningful participation.

The provider did not always make sure that people could access the care, support

and treatment they needed when they needed it.

Staff ensured some people received support in line with their wishes and preferences. This included supporting 2 people to go to the local shop to purchase a daily newspaper. A relative told us, “They take him out to the local shops and the barbers.”

However, other people’s opportunities were restricted as staff had not always ensured there were suitable provisions in place to accommodate them in a meaningful and person-centred way. We heard that 1 person’s wheelchair was broken and staff told us they did not know when it would be fixed. Another person had a bed bath only as staff told us, “There are no ensuite facilities. I’m not sure if [person’s name] has the option of a shower or would like one.”

Staff and leaders were not always consistent in listening to people most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. A relative told us, “Previously there weren’t really any activities and [person] used to be in her room quite a lot. Staff make sure she is brought down if she wants to and is able. They take her outside as well. She plays cards with someone holding the cards for her. It’s really nice when they want to involve her.”

No resident meetings were held to help ensure that people were involved in the running of the service. This meant that only people who had some capacity were routinely asked for their views. Those who were non-verbal or who lacked capacity were not always given the opportunity to express their preferences or be meaningfully included in decision-making through alternative or accessible methods. This was resulting in a lack of equity in experiences and outcomes for people.

The interim manager told us, “There was a false set of activity programmes on the board which were not being followed. I’ve taken them down. But things are starting to improve. [Staff member] loves baking with [person’s name] and they do this every week. This didn’t happen before.” However, we found objectives, goals and preferences were lacking in people’s care plans. For example, one person’s community access plan only recorded how they could use the remote control in the service.

In addition, the service had a minibus but we heard that no staff were insured to drive it meaning people did not benefit from this facility. We also found the downstairs lounge was not being used. The interim manager told us, “Whilst it’s nice weather I’ve said it’s better for people to be up here (on the ground floor) as it’s brighter and they can access the garden.” However, we observed the lower ground room also had garden access and despite the weather being fine and warm during our inspection, we did not see anyone being supported into the garden. We also did not see any activities taking place with people during the day.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The interim manager confirmed that end of life care plans had not been developed with people. The only information relating to people’s end of life was whether they wished to be resuscitated or not. They told us, “I think in the past it’s been said that relatives do not wish to talk about it.” However, they had not considered that people themselves should be encouraged to be involved in these discussions where possible and that by having some information in place it would assist care staff to ensure they are providing care in line with people’s wishes at this stage of their lives.