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We are carrying out a review of quality at Rowde. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 13 July 2021

During an inspection looking at part of the service

About the service

Rowde is a care home for up to 37 people with learning disabilities and/or autism. Accommodation is provided in five bungalows on one site. People had their own rooms and access to communal areas such as dining areas and lounges. At the time of inspection there were 31 people living at the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. This service did not provide a model of care that maximises people’s choice, control and independence. Accommodation was provided in a ‘campus’ style setting on the edge of a village. People were at times reliant on staff to access their local community and services.

Care was not always person-centred and did not promote people’s dignity at all times. People were not living in a service with the right person-centred culture. An incident had taken place whereby staff placed people at risk of harm. The provider had taken immediate action to deal with the incident but the ongoing mitigation of risk of reoccurrence was inadequate. This placed people at risk of harm.

People did not have their medicines as prescribed. There had been multiple medicines incidents and/or errors since the last inspection. Whilst people were not harmed the inadequate systems and governance around medicines management placed people at risk of harm.

Risk management was not safe. Since the last inspection we had been notified or made aware of six episodes of actual or near miss choking incidents. People were at risk of harm as safety measures put in place were not appropriate or personalised. People’s care plans and health action plans held conflicting information for staff which could cause confusion. This meant people might not receive the care and support they needed at all times.

Quality monitoring was not effective. This was the fifth consecutive rating of requires improvement or inadequate for this service. The provider had not been able to make sure their systems and processes identified improvement required. Action had not been carried out to improve on the last inspection’s findings, therefore the service remained in breach of Regulation. We also found a further two breaches of Regulation at this inspection.

There was enough stock of personal protective equipment (PPE) and we observed staff using it safely. Staff told us they had been provided with enough supplies of PPE throughout the pandemic and been trained on how to use it.

People and staff were being tested for COVID-19 as per the government guidance. People and staff had also been able to have a vaccination for COVID-19.

Systems were in place for visiting for relatives and friends. The service was clean, and staff carried out regular cleaning for high contact areas.

Sufficient numbers of staff were available. Where there were gaps in staffing numbers the provider used agency staff. To mitigate any risks of cross contamination the provider block booked agency staff to use the same staff at this location. This also provided a continuity of care and support for people.

Staff had been trained and able to have supervision with their line managers. Staff told us they were committed to staying at the service to provide support despite the uncertainty of the location. Staff enjoyed their jobs and the feedback about the staff approach from people and relatives was positive.

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

Inspection carried out on 11 March 2020

During a routine inspection

About the service

Rowde is registered to provide accommodation and personal care for up to 37 people with learning disabilities and associated health needs. People lived in five bungalows and attached self-contained flats on a central site. At the time of our inspection there were 34 people living at the service.

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

The service did not always (consistently) apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

This service had five bungalows all located on one site in a ‘campus’ style. This model of care would not be registered if an application were to be received now. The provider had not taken steps to ensure this service fitted into the residential area. There were identifying signs that this was a care home. For example, there was a large sign advertising the provider visible from the pavement and road.

Quality monitoring was not robust and did not give an accurate oversight of the service. We found healthcare records for three people were conflicting and did not always have the guidance staff needed. Two people had additional monitoring needs for their health, we found they were not always being carried out.

People were not living in an environment that was thoroughly cleaned. Accidents and incidents had been recorded but we found one incident where staff had not followed the provider policy in seeking medical help. Safety checks were carried out for any equipment or the premises. Risks to people’s safety were assessed and recorded.

People were supported by sufficient numbers of staff. There was still reliance on agency staff, but hours needed had reduced. The service tried to use the same agency staff for consistency. Staff were trained and supported by the registered manager. Staff told us they could ask for training on any area they needed. People were encouraged to do their own shopping and mealtimes were inclusive and social occasions.

People had a personalised care plan and a keyworker who helped them be involved in planning their own care. Care plans were reviewed and where needed, the service produced easy read care plans for people. Where people experienced distress reactions, there were clear guidelines in place for staff to know how to support people safely. People’s end of life wishes were not always recorded. We have made a recommendation about this.

People and relatives told us staff were kind, caring and professional. Relatives told us they thought the atmosphere in people’s bungalows was homely. People could personalise their room and had access to outdoor spaces.

People were treated with respect and their personal information was stored securely. People were able to express their views in ‘house meetings’ or ‘Voices to be heard’ meetings. These were held regularly and supported people to have a say in how things were managed. Activities were available and people supported to follow their interests as far as was practical. Some people had employment opportunities in the local community.

People had their medicines as prescribed. Any medicine incidents had been reported and action taken to try and prevent reoccurrence. There were two registered managers in post. Staff told us management was approachable, and the service was well-led.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update) - The last rating for this service was requires improvement (published 20 March 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based

Inspection carried out on 21 January 2019

During a routine inspection

Rowde is a 'care 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. The service is registered to provide personal care and accommodation for up to 37 people with learning disabilities and associated health needs.

People who use the service live in five bungalows and attached self-contained flats on a central site. The service is run by HF Trust Limited, a national charity providing services for people with learning disabilities.

At the last comprehensive inspection in July 2018, the service was rated Inadequate overall and was placed into 'Special measures' by CQC. 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.

Enforcement action was taken and a Notice of Decision was served against this location to impose urgent conditions. The provider is not allowed to admit any future people to this service without the prior agreement of the Care Quality Commission. Further to this, the provider must submit a monthly report detailing how they ensure the service people receive is safe. This includes information on risks, incidents and quality monitoring.

A further Notice of Decision was served to cancel the provider's registration for this location. The provider submitted representations to tribunal. This inspection took place to check if the provider had made sufficient improvements, in order for the Care Quality Commission to withdraw the Notice of Decision. Although there are still areas of improvement, enough progress had been made to withdraw our Notice of Decision. The provider will continue to provide monthly reports to The Care Quality Commission for ongoing monitoring and new admissions will not be admitted at this time. The service is no longer in special measures.

The service did not have a registered manager at the time this inspection took place. Two temporary managers were in place and a new manager who planned to register had been recruited. 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.

The care service has not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. This model of care at Rowde would not be registered if an application were to be received at this moment in time. The majority of people living at Rowde were from out of county Local Authorities. This meant that some people were living long distances from their relatives. A lot of people living at Rowde had moved to this site when another large residential home in Devon run by the previous provider had closed.

We saw that agency staffing was used in every bungalow which impacted the consistency and experience of care for people. For example, staff spoke about how people’s behaviour could change when they knew agency staff would be on shift. During our inspection we witnessed an incident by which an agency member of staff did not turn up for their shift. The management of this was not effective.

At this inspection we saw the provider had taken the required action to keep people safe from abuse and had ensured that staff had increased understanding about their role and responsibilities relating to safeguarding.

Risks had been identified and assessed. The risk assessments had impr

Inspection carried out on 12 July 2018

During an inspection looking at part of the service

Rowde is a 'care 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. The service is registered to provide personal care and accommodation for up to 37 people with learning disabilities and associated health needs. At this inspection 35 people were being supported by this service.

People who use the service live in five bungalows and attached self-contained flats on a central site. The service is run by HF Trust Limited, a national charity providing services for people with learning disabilities. At the last comprehensive inspection in February 2018, the service was rated Requires Improvement overall and in each domain apart from caring, which was rated as Good. A breach of Regulation 11 Consent and a breach of Regulation 12 Safe care and treatment were identified. The provider submitted an action plan to us on how they were going to address these concerns.

The inspection was prompted in part by notification of an incident following which alleged sexual abuse claims have been made concerning people who use the service. Some of these incidents are historical and occurred prior to HF Trust Limited taking over and others have continued during this providers governance. The notification was reported by the service to The Care Quality Commission and the Adults safeguarding team. This incident is currently being investigated by the Adults safeguarding team. The Care Quality Commission are reviewing the information and considering what regulatory action to take.

At this inspection we found the service remained Requires Improvement in the effective domain but was now rated as Inadequate in safe and well-led. We did not inspect caring or responsive at this time. We identified three new breaches of the Regulations, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 17 Good governance and Registration Regulation 18 Notification of other incidents. The service remains in breach of the two Regulations from our inspection in February 2018, Regulation 11 Consent and Regulation 12 Safe care and treatment.

The overall rating for this service is 'Inadequate'. This means that it has been placed into 'Special measures' by CQC. 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.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Following this inspection, we wrote a letter of intent to the provider to seek reassurance on how they would mitigate the immediate concerns and risks to people. The response received did not initially alleviate concerns and we requested further information be sent. The provider has now provided an action plan on how they will address these concerns.

We have served a Notice of Decision against this location to impose urgent conditions. The provider is not allowed to admit any future people to this service without the prior agreement of The Care Quality Commission. Further to this, the provider must submit a monthly report detailing how they ensure the service people receive is safe. This includes information on risks, incidents and quality monitoring.

The service did not have a registered manager at the time this inspection took place. Two managers were in place and were planning to jointly register for this service. Both were available through

Inspection carried out on 19 February 2018

During a routine inspection

Rowde is a ‘care 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. The service is registered to provide personal care and accommodation for up to 37 people with learning disabilities and associated health needs. At this inspection 36 people were being supported by this service. People who use the service reside across five bungalows and attached self-contained flats on a central site. The service is run by HF Trust Limited, a national charity providing services for people with learning disabilities.

At the last comprehensive inspection in February 2016, the service was rated Good overall with the responsive domain rated Requires Improvement. A breach of Regulation 9 Person centred care was identified. The provider submitted an action plan to us on how they were going to address this concern. A follow up inspection took place on 7 March 2017 to check that this had been done and following this inspection the responsive domain was rated Good.

At this inspection we found the service remained good in caring but was now rated Requires Improvement in all other domains and therefore overall. We identified two breaches of the Regulations, Regulation 12 Safe care and treatment and Regulation 11 Need for consent. You can see what action we told the provider to take at the back of the full version of the report.

The service did not have a registered manager at the time this inspection took place. The previous registered manager had left the service and two new managers were planning to jointly register for this service. One of these managers was present and available throughout our inspection; the other manager had yet to commence their employment. 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.

The care service has not been fully developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism who used the service could live as ordinary a life as any citizen. However the service supported 37 people. Whilst these were across five individual bungalows and adjoining self-contained flats this model of care would not be registered if an application were to be received at this moment in time.

Medicines were not always being safely managed. We found many medicine administration records had hand written entries. Individual protocols for the use of ‘when required’ (PRN) medicines were not always available, reviewed or updated. In two cases we found that protocols were in place for medicines that did not appear on the person’s medicine administration record. We found one example where medications listed on a person’s ‘emergency information sheet’ and ‘my health in hospital’ documents did not match those listed on their medicine administration record.

Although individual risk assessments were in place for people they did not always contain all the necessary information available for staff. One risk assessment was in place for a person being at home on their own. This person however had an application in place to the Local Authority because they needed continuous staff support and could not be left alone.

Health and safety checks around fire and portable appliance testing had not been reviewed within the appropriate timescales. One fire risk assessment was out of date and two fire extinguishers were overdue a service. Fridge and freezer temperature records had gaps in the recording and the temperature

Inspection carried out on 7 March 2017

During an inspection looking at part of the service

Rowde offers personal care and accommodation for up to 37 people with learning disabilities and associated health needs. People who use the service reside in bungalows on a central site. On the day of our inspection we visited four bungalows. The service is run by HF Trust Limited which is a national charity providing services for people with learning disabilities.

We previously carried out an unannounced comprehensive inspection of this service on 16 February 2016. A breach of legal requirements was found. The service was rated Good overall and Requires Improvement in the ‘Responsive’ domain. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 9 of the Health and Social Care Act Regulated Activities Regulations 2014, Person Centred Care.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rowde on our website at www.cqc.org.uk. We found on this inspection the provider had taken all the steps to make the necessary improvements.

Whilst there was a registered manager in post they were unable to be present during our inspection. 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.

Care records showed how people were involved in developing their care and support plans. Care plans were personalised and detailed daily routines specific to each person. Care plans contained information about the person’s preferences, likes, dislikes and what was important to them. Staff were knowledgeable about people’s care and support needs and acted in accordance with the guidance in their care plans.

People had a range of activities they could be involved in. People were able to choose which activities they took part in at their home or in the wider community. People accessed activities such as arts and crafts, cooking sessions, skittles, visits to the local pub and shops and social clubs within the community. The organisation had a day centre which provided activities which people could attend if they so wished. People were supported to maintain contact with family and friends.

Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. Regular meetings took place where people using the service could provide feedback and make suggestions about the service they received.

Inspection carried out on 16 February 2016

During a routine inspection

Rowde offers personal care and accommodation for up to 36 people with a learning disability. People who use the service reside in bungalows on a central site. On the day of our inspection we visited five bungalows. The service is run by Hft which a national charity is providing services for people with a learning disability. Hft had a 'Fusion' model of support which was a statement of their intent. This ensured there was a clear set of values which included choice, specialist skills, person centred active support, health safety and well-being and involvement of families and other partnerships.

The inspection took place on 16 February 2016. This was an unannounced inspection carried out by three inspectors. During our last inspection in May 2014 we found the provider satisfied the legal requirements in the areas that we looked at.

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.

Care plans contained information on people’s preferred routines, likes, dislikes and medical histories. We looked at six care plans and found that some guidance had not always been updated to identify how care and support should be provided when people’s care needs had changed. This meant that people were at risk of not receiving the care and support they needed.

People received care and support from staff who knew them well. Staff showed concern for people’s wellbeing in a caring and meaningful way and responded promptly to requests for assistance. Throughout our visit we saw people were treated in a kind and caring way and staff were friendly, polite and respectful when providing care and support to people.

People were protected from harm and potential abuse. Staff we spoke with knew what to do if they were concerned about the well-being of any of the people using the service. Risk assessments were in place to support people to be as independent as possible.

Staff were supported to carry out their role through supervisions, team meetings and training. People received individualised care from staff who had the skills, knowledge and understanding needed to carry out their roles.

Records relating to the recruitment of staff showed relevant checks had been completed before staff worked unsupervised. These included employment references and Disclosure and Barring Service (DBS) checks. The DBS helps employers to make safer recruitment decisions by providing information about a person’s criminal record and whether they are barred from working with vulnerable adults.

People had access to food and drink throughout the day and were encouraged to eat healthily and to maintain a balanced diet. People had access to a varied diet which included fruit and vegetables, healthy snacks and eating out in the community.

Medicines were managed safely and administered by trained staff. People received their medicines as prescribed and in their preferred manner. People were supported to access health care services and maintain good health.

People’s rights were protected because staff acted in accordance with the Mental Capacity Act 2005. People were able to make their own choices and decisions about the care and support they wished to receive.

The registered manager had quality assurance systems in place to regularly monitor the quality of the service. Where internal audits had identified shortfalls an action plan to address these areas had been put in place. The registered manager had notified CQC about significant events which had occurred in the service. We use this information to monitor and ensure the registered manager responds appropriately to keep people safe.

We found a breach of the Health and Social Care Act 2008 (Regulated Ac

Inspection carried out on 29 May 2014

During a routine inspection

At the time of our inspection there were 34 people living at Rowde. Due to the size of the service two inspectors carried out this inspection.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well-led?

This is a summary of what we found �

Is the service safe?

We spoke with twelve people who lived at Rowde during our visit. They told us they felt safe living at Rowde. One person we spoke with told us �I like living here, I get to go out to the shops on my own.�

People were aware of, and had access to advocacy services. People attended a �speak out� group were they discussed ideas or concerns they had relating to the service.

People were safe because care staff knew what to do when safeguarding concerns arose. Staff had received appropriate training and followed policies and procedures. Information regarding safeguarding and what to do if people had any concerns was displayed in every bungalow.

Care plans provided guidance for staff on how to meet people's needs in a way which minimised the risk for the individual. Where people required support to help them manage their behaviour, appropriate guidance was in place. This ensured that staff were able to support people whilst respecting their dignity and protecting their rights.

The registered manager organised the rotas to ensure that staffing levels were sufficient to meet people�s identified needs. There was a member of senior staff available on-call at all times in case emergencies arose.

Is the service effective?

People's care and welfare needs were assessed. It was clear from our observations and from speaking with care staff that they had a good understanding of the people's care and support needs. Care plans reflected people�s current individual needs, preferences and choices.

People told us that staff asked for consent before offering support and that they were listened to. People told us they felt involved in planning their support and were given choice.

People were involved in assessing their needs. They met each month with care staff where they were able to discuss their current care and support needs.

The service had made links with the community to enable people to take part in volunteering or work placement opportunities. People who used the service were encouraged and enabled to be an active part of their community, accessing local facilities.

Is the service caring?

One person we spoke with said �It�s lovely living here, I have the best staff.�

We saw that staff showed concern for people�s well-being. We observed staff seeking people�s permission before undertaking any care or support.

People were treated with dignity and staff respected people�s privacy. We saw that staff knocked on people�s bedroom doors before entering. Staff called people by their preferred name.

People were supported to be as independent as they wanted to be. During our inspection we saw several people accessed the community independently. Care plans we reviewed reflected people�s needs, preferences and diversity.

Is the service responsive?

People were encouraged to make their views known about the services they received. People in each bungalow met every Sunday to discuss any suggestions or concerns they had about the service they were receiving.

People living at Rowde had information on how to make a complaint available in an accessible format. We looked at how the service dealt with complaints. The service had not received any complaints since our last inspection.

The service worked well with other agencies, health professionals and family members to make sure people received consistency of care. Records contained details of appointments with health professionals and any outcomes. We saw that referrals were made to the appropriate health services when people�s needs changed.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care settings. While no applications had been submitted, appropriate policies and procedures were in place. Staff had received training in the Mental Capacity Act 2005 and the application of DoLS. We saw that practices were monitored to ensure the least restrictive measures were in place.

Is the service well-led?

The service had a �Fusion� model of support which was a statement of their intent. This ensured there was a clear set of values which included choice, specialist skills, person centred active support, health safety and well-being and involvement of families and other partnerships.

Care staff were motivated and caring and said they felt supported by management. They received regular supervision and appraisals were they could discuss personal development and learning opportunities.

Care staff were clear about their roles and responsibilities and the needs of the people they were supporting. This helped to ensure that people received a good quality service.

People who used the service received care and support from staff who were competent to carry out their roles. All staff received a comprehensive induction when they started their job. Further learning and development of staff was identified based on the needs of the people they were supporting.

The service had quality assurance systems in place which took into account feedback from people using the service or others acting on their behalf, observations of staff and complaints. Records we reviewed showed that where issues had been identified actions had been taken to resolve them.

There were arrangements in place to continually review safeguarding concerns, accidents and incidents. This ensured there were opportunities for learning or improvement.