This unannounced inspection took place on 6 and 7 August 2018. At our previous inspection in May 2017 we had found three continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the service was not safe, effective, caring, responsive and well led. At this inspection we found some improvement in areas however there were still two continued breaches and the home remains rated as requires improvement, overall. You can see what action we asked the provider to take at the back of the full version of this report.

Rowan Court Care Home 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. Rowan Court Care Home is registered to provide personal care and accommodate up to 76 people, based in one building. There were four ‘units’. There were 68 people using the service at the time of our inspection.

There was a registered manager 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.

Quality assurance systems in place to monitor the service were not always effective at identifying concerns and prompt action was not always taken to ensure people’s care improved.

Medicines were not always managed safely and we could not be sure people were always getting them as prescribed. Risks were not always assessed and managed appropriately as some plans were not always being followed. However, people felt safe and we saw that action was taken if there was a suspicion that someone was being abused. Staff understood their responsibilities and were safely recruited to help keep people safe. There were also sufficient amounts of staff to support people. We saw people were supported to move safely and people were protected from possible infection by measures in place. The building was also appropriately maintained and emergency plans were in place as a precaution.

People had access to a range of health professionals. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible. We have made a recommendation about ensuring decisions made in people’s best interests are documented. Appropriate Deprivation of Liberty Safeguarding (DoLS) referrals had been made. Staff received training and were supported in their role to care for people. People had access to sufficient amounts of food and drinks of their choice and were assisted when necessary. The building was suitably adapted for the people living there.

People found that staff were kind and caring and they were encouraged to be independent and to be involved in decisions about their care and support. People could personalise their bedrooms and there were no restrictions on visiting times for relatives.

People had their preferences catered for and people’s diverse needs were considered. If someone was nearing the end of their life, plans were put in place and we were told people were supported to have a dignified death. People were supported to partake in a wide range of activities and trips and to engage with staff. People could complain if they needed to and these were recorded, investigated and action taken to improve people’s experience of care.

People, relatives and staff were all positive about the registered manager. They were encouraged to offer feedback and staff felt supported. Notifications were submitted as required and the previous CQC rating was being appropriately displayed.

This unannounced inspection took place on 16 May 2017. At our previous inspection in October 2016 we had found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the service was not safe, effective, caring, responsive and well led. The service had been rated as Inadequate and placed into special measures. At this inspection we found some improvement in all areas of care. The service was no longer inadequate and will be removed from special measures. However during this inspection we identified further improvements were required and the provider remained in breach of three regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Rowan Court provides care and support, including nursing care, for up to 76 people, some of whom were living with dementia. At the time of the inspection there were 51 people living in the home.

There was a new manager in post who was in the process of registering with us. 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.

Risks of harm to people were not always assessed, managed and minimised. Staff did not always have the information they needed to be able to care for people safely.

People were not always safeguarded from harm or abuse as incidents of potential abuse were not always referred for further investigation. Some people were at risk of abuse as decisions were being made in isolation by staff at the service and the principles of The Mental Capacity Act 2005 were not always being followed.

People were not always receiving care that met their individual needs and preferences. Care records were regularly reviewed, however they were not always up dated promptly to ensure staff had the correct information to be able to care for people safely.

People's right to privacy was not always upheld. However, people told us they were cared for by staff who treated them with dignity and respect.

People received health care advice and support if their physical needs changed, however there was a delay in people receiving support for mental health care issues.

People were offered a choice of food and drink and if people lost weight or experienced difficulties in eating or drinking, referrals were made for advice.

People's medicines were stored and managed safely. People had their medicines at the required times.

There were sufficient numbers of suitably trained staff to meet the needs of people who used the service. New staff had been recruited through safe recruitment procedures to ensure they were of good character. Staff felt supported and received training to be effective in their roles.

The provider had a complaints procedure and action was taken when people raised concerns. There was a range of hobbies and activities available to people if they chose to join in.

The provider and manager had implemented new systems to drive improvement, however not all of the systems had proved effective in identifying the required improvements. .

This inspection took place on 25 October 2016 and was unannounced. At our previous inspection in November 2015 we had concerns that care being delivered was not safe and there were insufficient staff to meet people's needs in a timely manner. We found two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in Regulation 12 (Safe Care and Treatment) and Regulation 18 (Staffing). At this inspection we found that there had been some improvement, however the provider continued to be in breach of these Regulations. We also found further concerns and three further breaches of regulations in safeguarding people from abuse, people consenting to their care and the overall governance of the service. The overall rating for this service is Inadequate which means it will be placed into special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Rowan Court provides care and support, including nursing care, for up to 76 people, some of whom may require dementia care. At the time of the inspection there were 67 people living in the home.

The home was divided into three separate units. These were the Nursing Unit which accommodated up to 42 people requiring nursing care. The Memory Unit which accommodated up to 19 people requiring dementia care and the Residential Unit which accommodated up to 15people requiring personal care. We visited all three units and found some areas of concern in all three units.

There were still insufficient suitably trained staff to safely meet the needs of people in a timely manner throughout the service. People did not always feel safe with the availability of staff.

Care being delivered was not always safe. Risks of harm to people had not been minimised through the effective use of risk assessments. Action was not always taken to keep people safe.

Staff we spoke with all knew what constituted abuse and told us they would report it if they suspected abuse had taken place. However allegations of neglect were not always investigated.

People's medicines were not always managed safely. People were at risk of not receiving their prescribed topical creams.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA is designed to protect people who can't make decisions for themselves or lack the mental capacity to do so and the DoLS ensures that people are not unlawfully res

The inspection took place on 11 November 2015 and was unannounced.

Rowan Court provides care and support, including nursing care, for up to 76 people, some of whom may require dementia care. At the time of the inspection there were 74 people living in the home.

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.

The home was divided into three separate units. These were the Nursing Unit which accommodated up to 42 people requiring nursing care. The Memory Unit which accommodated up to 19 people requiring dementia care and the Residential Unit which accommodated up to 15 people requiring personal care. We visited all three units and found some areas of concern in the Nursing Unit and the Memory Unit.

Staff did not always adhere to relevant risk assessments and people were sometimes placed at risk of harm. People who used the service did not always receive their medicines as prescribed and sometimes action was not taken to address this when people refused their medication.

People did not always receive the care and support they required in a timely way.

Staff were trained to carry out their role and the provider had plans in place for updates and refresher training.Staff thought that the training had improved at the home.

The provider had safe recruitment procedures that ensured people were supported by suitable staff.

The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. People who required this had a mental capacity assessment in place ensuring that consent was obtained. Staff had a good understanding of why people may be considered to be deprived of their liberty. People and/or their representatives had consented to their care.

People’s health needs were monitored and referrals to health care professionals had been made where required. People were supported to access health care professionals and to attend clinics and outpatient appointments.

People had enough to eat and drink and were supported with their nutritional needs.

People told us that staff were kind and caring but that sometimes their dignity was not upheld. People did not always receive the care and support they wanted in a timely way.

There was an activities and entertainment programme in place which was overseen by two activity coordinators but not all people felt they had opportunities to be involved in hobbies and interests that were important to them.

People felt that the registered manager was “excellent”and always approachable. Staff felt supported by the registered manager and there was management support for staff on all three units in the home.

The provider had a complaints procedure available for people who used theservice. People and families thought that complaints were appropriately managed. Staff also felt able to raise concerns about poor practice knowing that they would be supported to do so and felt supported by the registered manager.

The registered manager had systems in place to monitor and improve the service. However these had not picked up on the need for improvements with medication management, manual handling techniques and the lack of dignity afforded to some people.

Appropriate records had been maintained in respect of care plans, daily care charts, staff recruitment and information about menus. Appropriate records had also been maintained in respect of maintenance of the building.