Archived: Rowan Garth Care Home

Rowan Garth Care Home is registered to provide nursing and residential care for up to 120 people. The service is set in pleasant spacious grounds and is situated in a suburb of Liverpool close to the city centre. The service consists of four single-storey units and provides care to people with both nursing and residential needs. Two of the units specialise in dementia care. Each of the units has its own dining room, lounge, quiet/library area and unit manager’s office. At the time of the inspection 106 people were living at the service.

Rowan Garth is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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.

At the time of our inspection a temporary manager was in post as the registered manager had recently left the service. A registered manager is a person who has registered with CQC 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.

Each of the people we spoke with told us they felt safe living at Rowan Garth. Staff we spoke with understood their responsibilities in relation to safeguarding people from abuse and mistreatment and were able to explain how they would report any concerns.

Arrangements were in place with external contractors to ensure the premises were kept safe.

We found that medicines were managed safely. Medicines were stored correctly and were administered by staff who were trained to do so.

We looked at how accidents and incidents were reported in the service and found they were managed appropriately.

Staff's suitability to work at the home had been checked prior to employment to ensure that they were suitable to work with vulnerable people.

People’s care requirements were identified and recorded in their care records. We also saw that people were appropriately referred to external health professionals when required. This helped to maintain people’s health and well-being.

People and their relatives were involved in the formulation of their care plans. We saw that people’s preferences were considered. Staff supported people in a person-centred way and treated them with respect.

Staff sought consent from people before providing support. Staff we spoke with understood the principles of the Mental Capacity Act 2005 (MCA) to ensure people consented to the care they received. The MCA is legislation which protects the powers of the people to make their own decisions.

We found there were enough staff on duty to meet people’s needs. Interactions we observed between staff and people living in the service were warm and caring. Staff treated people with respect and took care to maintain people’s privacy and dignity.

There was an open visiting policy for friends and family. This helped people feel supported. For people who had no one to represent them, the service supported them in finding an advocate to ensure that their views and wishes were considered.

The service employed three activities co-ordinators who facilitated varied daily social activities between the units. People told us they could take part and have a say in what activities they would like to do.

We asked people what they thought about mealtimes and feedback was mixed. People told us they had a choice of main meal and the menu rotated monthly. We spoke with staff and found they were knowledgeable about people’s preferences and dietary requirements.

The home had a complaints procedure in place. People and staff told us they would feel comfortable in raising any concerns they had with the manager.

The service was clean and easy for people to navigate. We have made a recommendation about making the environment more suited to the needs of people living with dementia. For example, better signage to help orientate people to toilets and bathrooms and painting doors to people's bedrooms different colours to help them identify their own room.

Rowan Garth Care Home is a large care service in Liverpool which comprises of five separate units, set within extensive grounds, the service can accommodate up to 150 people. Each of the five units are single-storey and can accommodate up to 30 people. The service supports people with a range of care needs from nursing and end of life care, to short term respite care and residential care. Rowan Garth is situated in a suburb of Liverpool, close to transport links. Clover unit closed on 30 September 2016 so only 4 units were occupied at the time of the inspection. The units provide residential, nursing, dementia residential and dementia nursing care. During the inspection, there were 99 people living in the home.

At the last inspection in October 2016 the provider was found to be in breach of Regulations in relation to medicines management, risk management, staffing and staff support systems, application of Deprivation of Liberty Safeguards (DoLS), person centred care, dignity and the governance of the service. Following the inspection the service was rated as inadequate overall and placed in special measures. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate

care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Since the last inspection the registered provider for the service has changed, but remains part of Bupa and its senior management structure. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

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 last inspection we identified breaches of regulation in relation to keeping people safe. The breaches were in relation to staffing, medicine management and risk management. During this inspection we found that improvements had been made and the provider was no longer in breach of regulations regarding these areas.

During the last inspection we found that medicines were not always managed safely as prescribed directions were not always followed, there was no guidance to advise when to give PRN (as required) medicines and stock balances were not all accurate. During this inspection we looked at the way medicines were handled in all four units within the home. We looked at records about medicines, arrangements for ordering and storing medicines and we observed medicines being administered. We found that medicines were managed safely.

At the last inspection we found that when people were identified as at risk, actions taken were not clearly recorded. We also found that the environment was not always maintained safely and vulnerable people had access to areas of the home that could pose risk to them. During this inspection we reviewed how risk was managed and found that improvements had been made.

The care files we viewed showed that staff had completed risk assessments to assess and monitor people’s health and safety and records reflected that appropriate actions had been taken to address identified risks. Areas of the home that could pose risk to people were kept locked when not in use.

Arrangements were in place to monitor the environment to ensure it was safe. External contracts were in place to check the safety of gas, electrics, fire equipment, lifting equipment and water safety and internal checks were regularly made in other areas. We found that risk was assessed and managed safely for people living in the home and the provider was no longer in breach of regulation regarding this.

In October 2016 we identified that there were not always adequate numbers of staff on duty to meet people’s needs in a safe and timely way. During this inspection people living in the home told us there were enough staff on duty to meet their needs and staff we spoke with told us staffing levels had improved. The provider was no longer in breach of regulations regarding this.

In October 2016 we identified breaches of regulation in relation to staff support systems and the use of restrictive practices. During this inspection we checked whether the necessary improvements had been made and found that they had.

DoLS applications had been made appropriately and included any restrictions in place and consent was sought in line with the principles of the Mental Capacity Act 2005. The provider was no longer in breach of regulation regarding this.

At the last inspection we found that staff were not always supported sufficiently in their role. During this inspection staff told us they received regular supervisions and an annual appraisal and that the registered manager was always available for support. All new staff completed an induction that met the requirements of the Care Certificate and records showed that most staff had completed refresher training in areas the provider considered mandatory. We found that systems were in place to support staff and the provider was no longer in breach of regulation regarding this.

At the last inspection we found that care was not always provided in such a way to ensure people’s dignity was maintained as staff interactions were not all caring, people’s clothes went missing and there were no locks on communal bathrooms. We also saw that people became distressed when they had to wait to receive care. During this inspection we looked to see whether people’s dignity was protected and found that it was.

Interactions we observed between staff and people living in the home were warm and caring and people did not have to wait long for support. Locks had been installed on communal bathroom doors since and no concerns were raised regarding laundry services during this inspection.

People we spoke with told us staff were kind and caring and treated them well. We found that improvements had been made and people’s dignity was maintained and promoted. The provider was no longer in breach of regulations regarding this.

In October 2016 we identified breaches of regulation in relation to person centred care and care planning. Care plans did not provide sufficient information, care provided was not always recorded accurately or timely and not all staff knew the people they were supporting. During this inspection we reviewed care planning records and found that improvements had been made.

Most care plans were detailed, person centred and informative and plans were in place for all identified needs. Staff were very knowledgeable regarding people’s needs, but this was not always clearly recorded in care plans. We found that the planned care was evidenced as provided, such as regular blood sugar monitoring.

Systems were in place to help ensure people and their families were involved in the plan of care.

Improvements had been made and the provider was no longer in breach of regulations regarding person centred care and care planning.

At the last inspection we found that there was a lack of meaningful activity available to people. During this inspection we reviewed activities available and saw that improvements had been made.

Activities were now provided both in groups and on a one to one basis, based on people’s preferences.

When we carried out a comprehensive inspection in October 2016, we identified a breach of regulation in relation to how the service was ran and the systems in place to assess and monitor the quality and safety of the service. During this inspection we found that improvements had been made and the provider was no longer in breach of regulations regarding this.

Audits were completed regularly by the registered manager and clinical services manager and when actions were identified, we found that they were addressed. The regional manager visited at regular intervals and completed a ‘First impressions’ audit of the home. Daily walk around checks of all units were also undertaken and actions taken appropriately to drive forward improvements.

We found that staff were recruited safely to ensure they were suitable to work with vulnerable people.

Appropriate safeguarding referrals had been made and staff were knowledgeable about safeguarding processes and how to report any concerns. We looked at accident and incident reporting within the home and found that incidents were recorded and reported appropriately.

Feedback regarding meals was positive. People told us they had a choice of meal and they always had enough to eat and drink. Staff we spoke with were knowledgeable about people’s dietary needs and preferences and when required, people’s intake was monitored and recorded.

Staff told us there was no set daily routine. People living in the home confirmed they had choice regarding daily routines and records showed that when people refused care, this was respected.

People’s preferences were reflected throughout care plans we viewed. This helped staff to get to know people and provide care based on their needs and preferences.

We observed relatives visiting at various times throughout the day. We saw that visitors were welcomed by staff and people living in the home told us their relatives could visit them at any time. For people who had no family or friends to represent them, contact details for