Rowan Lodge

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. People’s relatives told us that if any falls or accidents happened, they were informed about these. Incidents and accidents had been reported, investigated and analysed monthly to identify any trends. Lessons learned from incidents were shared with staff.

Daily nurse meetings took place; we sat in on one of these meetings. Incidents were discussed and actions arising from incidents reviewed. This included nurses confirming they had updated care plans and risk assessments when needed. The registered manager said, “Most of our incidents are falls, slips and trips. We assess people and those who are a high falls risks, we have sensors in use depending on the resident. Staff do hourly checks, or more if needed. The lounge is always monitored, to make sure people are kept safe.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Pre-assessment tools were completed, which linked with the electronic care planning system to form a baseline plan when people moved to the service. Records showed people were referred to other healthcare professionals when needed. There was a weekly GP review and nurses told us it was easy to contact a GP for advice between weekly visits. People’s relatives told us people were supported to attend appointments.

Staff told us they worked well with health and social care professionals and had developed good working relationships. There were clear processes to ensure people’s current information was safely shared and we saw records of this during the inspection.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Overall people told us they felt safe at the service. For example, one person said, “I like it here, and I do feel safe.”

People’s relatives said they felt confident that their loved ones were safe living at the service and had seen staff supporting people safely and kindly to stay safe. One person’s relative told us “Yes, [name] is safe. Sometimes I am sitting in [their] bedroom and the staff don’t know I’m there, and they speak so nicely to [name]. I get a warm feeling that even when I am not there, that [name] is well looked after.” Staff had received safeguarding training and knew how to raise concerns.

There were safeguarding and whistleblowing procedures in place. The management team understood their responsibilities regarding the action to take to protect people from harm and we saw examples where action had been taken to protect people where required. The necessary internal documentation was completed including accident/incidents logs, body maps and falls protocols. The provider ensured referrals and notifications were made to both the local authority and safeguarding teams in a timely manner.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People had been assessed for risks such as skin damage, falls and choking. Risks had been regularly reviewed, including following an incident such as a fall, to ensure appropriate measures were in place to mitigate or prevent future risk. When risks were identified, care plans provided information for staff on how to reduce the risk of harm to people.

Some people had been assessed as being at risk of malnutrition or dehydration. In these instances, care plans included information for staff such as food preferences, frequency of monitoring people’s weight and any specialist advice that had been sought. When people were having their food and fluid intake monitored, records showed people were provided with enough to eat and drink. Additionally, staff had recorded when people had refused food or fluid and had also recorded when they been offered again later. The electronic care planning system in use enabled nurses to highlight people who needed to be encouraged to drink more. Nurses showed us how they used the system to monitor throughout the day that people were having enough to drink. We saw people were offered regular drinks and snacks during both days of the inspection.

The chef was kept informed of people’s dietary needs and was provided with speech and language therapy (SALT) guidance for those people who required a textured diet.

The head of care carried out analysis of incidents such as falls data each month. They told us they had reviewed and updated the falls risk assessment and were introducing a multi factorial falls tool. This is a tool which allows interventions to be targeted at a person's specific risk factors to help prevent future falls.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. There was a maintenance person who undertook regular health and safety checks. Certificates were available to demonstrate all necessary routine maintenance and safety checks had been completed. A fire risk assessment was in place, and actions identified had been completed. Ongoing fire drills and evacuations were undertaken. Personal emergency evacuation plans were in place. The contents of the fire ‘grab bag’ did not align with the provider’s policy. We fed this back to the registered manager who told us they would address it.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. People gave mixed feedback about staffing levels. Although some people felt there were enough, others told us they often had to wait for staff to be available. Some staff also told us they felt an extra staff member would be useful. The registered manager used a dependency tool to help assess people’s needs and make sure there were enough staff on duty to manage everyone’s care needs, and the staffing levels matched the tool. Despite some people’s and some staff comments, nobody told us their needs were not being met. People and relatives told us staff knew people well. Training compliance rates were high. Nurses told us they could access further training to maintain their registration. Staff told us they had completed inductions and had received supervisions. People told us staff appeared well trained, and said they were “impressed” with staff. Some people told us they did not feel as confident about a named agency staff member who worked at the service. We fed this back to the registered manager who took immediate action to not use the staff member again.

Safe recruitment processes were in place. This included right to work information, references and disclosure and barring service (DBS) checks. We identified an issue with one staff member’s risk assessment which was not person specific which we fed back to the registered manager.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff had been trained in infection prevention and control and told us there was enough personal protective equipment available such as gloves and aprons. There were audits in place to oversee the cleanliness and safety of the environment. Monthly environmental cleanliness audits were carried out for each floor which identified and analysed trends and actions to be taken. There was also evidence of communication with staff and people’s relatives following a recent outbreak of Covid. The service was visibly clean and tidy. There was handwashing signage and facilities throughout the building. There were appropriate clinical waste facilities and colour coded cleaning materials. Food safety was maintained. Kitchen monitoring checks were in place.

The service did not always make sure that medicines and treatments were safe and met people’s needs, decision making capacity and preferences. Our observations and records we looked at showed people were having their medicines administered as prescribed. However, we identified an area for concern in relation to record keeping for when medicines were being crushed for people who were having their medicines administered covertly. Medicine care plans and PRN (as required medicines) protocols were mostly in place to help staff understand and support the health needs of people living at the home. However, we saw an isolated instance of where this information was not available for a person prescribed anticipatory palliative care medicines.We saw one example of thickener not being safely stored. We raised these areas of concern to the registered manager during the inspection. Following the inspection, we received assurances from the registered manager that these concerns had been addressed.

Other medicines, including controlled medicines were stored safely.

Staff were trained and had their competencies assessed to use the electronic MAR (medicines administration record) system and to handle medicines safely. Staff carried out audits to identify gaps and make improvements. However, the audits failed to identify the concerns for medicines management we found during the inspection. Medicine reviews were carried out by the clinical pharmacist from the local GP practice. There was a process to report and investigate errors and incidents.