We carried out a comprehensive inspection of this service on the 13 April 2016, and a number of breaches to the legal requirements were found. After the inspection the provider told us what action they would take. We undertook a further inspection on the 31 May 2017 and found that the provider had made improvements and the legal requirements were now being met.

Rowan House provides support and accommodation for up to six people who may have a learning disability or mental health support needs. At the time of our inspection there were six people using the service.

The registered manager was 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.

We found that the outside area to the front of the building was not easily accessible for wheelchair users and that the back garden had uneven surfaces. This meant that not everyone could access this space freely. People’s relatives told us they did not always feel involved in the care planning process and the provider did not look at ways people could be involved in day to day tasks. Systems for monitoring the quality and safety of the service were in place but there was an inconsistent approach to driving improvement forward.

At this inspection we found that improvement had been made in all areas.

The outside areas to the building had been changed to enable wheelchair access and work had been done to the back garden area so that people could access outdoor space safely.

People and their relatives told us they were involved in the care planning process.

A robust quality assurance system was in place and the registered manager looked at ways they could continuously improve the service people received.

Staff had access to a range of training to provide them with the level of skills and knowledge to deliver care efficiently and had been provided with a robust induction.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service support this practice.

People’s information included guidance for staff so they could follow a structured approach to recognising and managing certain health conditions and behaviours.

People were given nutritious meals and were encouraged to be involved with choosing what foods they wanted to eat and preparing their meals.

We inspected this home on 13 April 2016. This was an unannounced Inspection. The home is registered to provide personal care and accommodation for up to six people who may have a learning disability or mental health support needs. At the time of our inspection six people were living at the home.

The registered manager was 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.

At this inspection we found the service to be in breach of regulations 15 and 17 of the Health and Social care Act 2008 (Regulated activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

The outside areas to the building were not always clean and properly maintained to ensure that people could access outdoor space safely. Whilst this had been identified as an area for improvement no action had been taken.

People were involved in their care planning although relatives did not always feel involved. A complaints policy in place along with an easy read version. All of the people we spoke with were happy to make a complaint should the need arise.

Systems for monitoring the quality and safety of the service were in place but there was an inconsistent approach to driving forward improvements within the service.

People we spoke with told us they felt safe. Staff understood their responsibilities to protect people from harm and abuse. Risks had been assessed and on the day of our inspection we found that the management of medicines was consistent and safe.

Staff had access to a range of training to provide them with the level of skills and knowledge to deliver care efficiently to meet people’s individual needs. Staff were inducted and prepared for their roles.

Staff had a good understanding of the requirements of the Mental Capacity Act 2005. Systems were effective in demonstrating people’s level of mental capacity. Applications to apply for Deprivation of Liberty Safeguards (DoLS) to protect the rights of people had been submitted to the local supervisory body for authorisation.

On the day of our inspection we found that people could access food and drink. Information was stored within the person's care plan and contained guidance about the person’s nutritional needs.

Family members we spoke with told us that people were involved in maintaining their health and well-being.

Staff maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible. Activities were provided to meet the interests of individual people. We saw people could be encouraged more to develop day to day living skills and that this was not happening. We found that the service had put plans in place develop peoples day to day living skills.

We were unable to communicate with people using the service to gather information as a result of their limited verbal communication. We spent time listening to and observing everyday life in the home to help us to understand what it was like for people living there. This indicated that people were relaxed and comfortable and found their experience at the home to be positive.

After our visit to the home we spoke to two relatives by telephone to ask their views of the service experienced by the people living at the home. They told us that people using the service were treated with respect and were well cared for. One person said, “They treat [X] with respect and dignity, and as a person, not just someone with a disability.”

Relatives told us they felt that people were safe at the home and they had had no concerns. They felt that staff were well trained and able to meet people’s needs effectively. One person said, “Staff are capable and have plenty of training and do and say all the right things.” Relatives also spoke highly of the Registered Manager’s commitment, and of their ability to manage the service and to lead the team in providing good quality care.

People who use this service were, because of their disabilities, unable to engage in two way conversation with us. Therefore people could not tell us if they are included in day to day decision making within the home, but comments from relatives and visitors indicated that they are satisfied with the way the home is run and with staff attitudes towards people who live there. They also told us that they thought people enjoyed the food and that the home is kept clean and tidy.

We looked at the care records of three people who used the service. We found that people made choices about their daily lifestyle where they were able to.

Care records showed that people were provided with appropriate support in a safe way in line with their plan of care. Equipment was in place to promote people’s comfort and safety. People were provided with a good choice of food and drink in a way that both encouraged and promoted a healthy balanced diet.

Relatives spoke positively about the care provided at Rowan House. One person said, “They do what is necessary to help him. Treble stars for the care here, ten out of ten. The best sign is when he is here and he is wanting them to come get him to go back ‘home’. It is very reassuring, wonderful for us when thinking of the future.”

People were cared for by staff who had had appropriate checks undertaken before they began work. The provider had systems in place to give new staff the training and support they needed for their role.

The provider had an effective complaints procedure available. Relatives confirmed that they would feel able to voice any concerns and felt sure they would be listened to.