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Rowena House Limited Requires improvement

Inspection Summary

Overall summary & rating

Requires improvement

Updated 7 October 2021

About the service

Rowena House Limited is a residential care home providing personal care for up to 22 people aged 65 and over in one adapted building. There were thirteen people living at the home at the time of this inspection.

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

People were not always protected from improper treatment as inappropriate restraint was used on some occasions to ensure some people remained seated during a meal. People were not always treated with dignity and respect or their equality characteristics considered.

Risks to people in relation to their health or care needs were not always identified or assessed. The provider’s policies and current government guidance was not consistently followed in respect of visiting or discharge from hospital. Some risks in respect of some equipment and premises risks were not identified.

The provider’s quality monitoring system was not effective in identifying or addressing risks to people’s health and safety. The culture of the service was not always empowering or inclusive.

We observed that people were relaxed in the presence of staff and each other. Staff understood how to raise any safeguarding concerns and where to go if they felt these were not acted on by the provider. Relatives were positive about the care provided and told us it was a warm friendly service.

Improvements had been made to the cleanliness and hygiene measures to prevent and control infection risks. Regular infection control audits were completed to ensure these remained effective.

Staff were positive about the way the registered manager led the staff team and managed the home. They said he had made a number of improvements.

Safe recruitment processes were followed. There were enough staff to meet people’s needs. We have made a recommendation for the provider to review their domestic staffing levels to ensure people’s needs are met at all times.

For more details, please see the full report which is on the CQC website at

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 14 January 2021).

At this inspection we found some improvements had been made but enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on July 2020. Breaches of legal requirements were found. We imposed urgent conditions on the provider’s registration in respect of infection prevention and control.

We undertook this focused inspection to check they met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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.

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 remains requires improvement. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rowena House on our website at


We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have

Inspection areas


Requires improvement

Updated 7 October 2021

The service was not always safe.

Details are in our safe findings below.



Updated 7 October 2021



Updated 7 October 2021



Updated 7 October 2021


Requires improvement

Updated 7 October 2021

The service was not always well-led.

Details are in our well-led findings below.