About the service: Rowans is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Rowans can accommodate up to eight people who may have a learning disability, in one adapted building. At the time of the inspection, there were seven people using the service.

People’s experience of using this service:

¿ Everyone we spoke with had nothing but praise. Comments made were, “[Name] has lived there for 25 years. I have to be honest, I couldn’t wish for a better place for [Name] to live. They understand [Name] down to a T.” And, “They are human being’s, and they are put at the centre. It's like a family environment and everyone is very, very happy.”

¿ Some improvements were needed to make the environment safer. We could access the electric cupboard and a cupboard with hot pipes. This posed a potential risk to people. We have made a recommendation about risk management.

¿ Some areas were cluttered, and the environment needed some improvements. The registered manager told us they were planning to improve the environment.

¿ The service applied 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.

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

¿ A range of activities was provided, which included involvement and use of local and wider community-based activities.

¿ People were cared for and supported by staff that understood their needs exceptionally well. Staff could understand people’s small gestures and noises and understood what they were saying.

¿ Staff treated people with dignity and respect and were sensitive to their needs. Staff worked with insight and could anticipate people’s needs in an individualised way.

¿ The service had systems in place to keep people safe, and staff followed these guidelines when they supported people. There were enough staff available to meet people’s care needs and people received their medication as prescribed and on time.

¿ A robust recruitment process in place. Staff had been recruited safely with the skills and knowledge to give care and support to people.

¿ People’s health and emotional needs were assessed, monitored and met in order for them to live well.

¿ The service worked closely with relevant health care professionals and people received the support they needed to have a healthy diet that met their individual needs and choices.

¿ Systems were in place to drive improvement and audits were carried out on a regular basis, which looked at the quality of the service people received. The registered manager had a clear oversight of the service.

¿ The needs of people were met by staff who had the right competencies, knowledge, skills, attitude, and behaviours, to carry out their role and responsibilities.

Rating at last inspection: This service was last rated Good. (9 September 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the service through the information we receive, and inspect the service, if risk is indicated.

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

Rowans is a residential care home registered to provide accommodation and personal care for up to eight people who have a learning disability. There were eight people living at the home on the day of our inspection.

The inspection took place on 9th September 2016 and was unannounced. The last inspection of this service took place in April 2014 and at that time the service was meeting all the required standards inspected.

At the time of 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 and associated Regulations about how the service is run.

The service was managed by a longstanding management team which comprised of the registered manager and the nominated individual both of whom were also the registered provider. They shared responsibility for running the service on a day to day basis.

People were safe at Rowans. Risks to people were managed safely and positively which ensured people received safe care that met their needs whilst at the same time allowing them to exercise choice and control.

People were protected against the risk of abuse by staff who understood their safeguarding responsibilities and knew who to report any concerns to.

Medicines were managed safely by staff who were trained and assessed as competent to give medicines safely.

Systems and processes were in place to ensure the safe recruitment of staff with sufficient numbers of staff employed to safely meet people’s needs.

People received support to take part in activities both inside and outside their home.

The service had a good understanding of the Mental Capacity Act and people were supported to make their own decisions. Appropriate assessments of mental capacity had been undertaken in accordance with current legislation and good practice.

Staff asked for consent before supporting people in ways they were comfortable with. People were supported to make choices about how they wanted to live their day to day lives including exploring interests and maintaining relationships that were important to them.

Staff felt well supported by the management team who were accessible and listened to them. Regular supervision, appraisals and competency checks meant that staff felt confident and competent in their roles. A regular programme of training was provided with opportunities for specialist training relevant to meeting the needs of the people who used the service.

People were supported to have enough to eat and drink which reflected their preferences and helped them maintain a healthy balanced diet.

People were supported to maintain their health and wellbeing. Staff worked with healthcare professionals and were pro-active in referring people for assessment or treatment. The provider maintained detailed health records and shared this information appropriately with the relevant health and social care professionals. This meant that people’s health was closely monitored to ensure they received any treatment they required in a timely fashion.

The care and support people received was personalised and met their individual needs and preferences. People, or their representatives, were involved in making decisions about how the support was delivered so they felt listened to and included.

Staff upheld the vision and values of the service which put people at the heart of everything that they did. Staff treated people with dignity and respect and promoted their independence.

The management team was held in high regard by relatives and staff who felt included in the running of the home. There were systems in place to ensure the quality and safety of the service and respond appropriately to complaints and feedback.

We looked at four people's care records. Other records viewed included staff training records, staff and resident meeting minutes and satisfaction questionnaires completed by relatives of people using the service and staff. We considered our inspection findings to answer 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?

When we arrived at the service the registered manager asked to see our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

Relatives of people living in the home told us that they were confident that their relatives were safe living in the service and had complete confidence in the provider and manager. We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

The service was safe. We saw records which showed that the health and safety in the service was regularly checked. This included regular fire safety checks, this meant that people were protected in the event of a fire.

Is the service effective?

Relatives of people people using the service told us that they felt that their relative was provided with a service that met their needs. One person said, " Having my relative cared for in Rowans gives me complete peace of mind." Another person said, "We can't fault Rowans." People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People using the service had complex needs and were therefore very limited in thier abilities to communicate with us, however their relatives had completed satisfaction questionnaires. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People using the service were provided with the opportunity to participate in activities which interested them. We saw that people's choices were taken in to account and listened to. People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

People told us that they had been given the opportunity to visit the service prior to admission. One relative told us: " I don`t think there could be a better place than Rowans, the staff are great. It is always clean and free from any offensive odours."

We saw that care plans and risk assessments were regularly reviewed with people who used the service or relatives if they were unable to fully participate.

During our inspection we saw that staff were knowledgeable about people’s needs and promoted their independence. During our discussions with staff we found that they had a good understanding and awareness of people’s care needs and preferences.

We saw that there were policies and procedures, records and monitoring systems in place for the protection of people who used the service from abuse. Staff told us that they had participated in regular training, which had enabled them to gain the skills and knowledge required to support people who used the service. The staff we spoke with told us they felt supported by their managers.

We saw that there were procedures in place to monitor the quality of the care and support, seeking the views of the relatives of the people who use the service. We saw that systems were in place to ensure that the building and equipment were maintained safely and repairs were addressed promptly, thereby ensuring people’s health and welfare.

People living at Rowans had complex needs and were unable to speak with us; we gathered evidence of people’s experiences of the service by observing how they spent their time and noting how they interacted with other people living in the home and with staff.

We saw that people had individual ways of communicating and were able to make members of staff aware of their needs and wishes. Staff showed a good understanding of people’s needs and preferences and we noted that staff treated people with respect.

We spoke with relatives of seven of the eight people living at Rowans and all were highly complimentary about the care their relatives received. Some of the areas highlighted by relatives included that they were always made welcome; there was a consistent team of skilled staff; communication was excellent and they were always kept informed of issues relating to their relative; people’s healthcare was well managed; the provider and the management team were “...marvellous” and “...couldn’t be more committed”.

A relative told us: “I would unreservedly give them top marks”. Another said: “It is a great comfort to know that [our relative] is well looked after. Standards are absolutely excellent”.

We found that staff received the training they needed to provide care and support safely and showed us that they understood the needs of the people using the service.

We saw that there was a lively atmosphere in the home and that people chose how they spent their time.

Due to people's complex needs they were unable to verbally tell us their views about living in the home. We, however, throughout our visit observed that people were happy, relaxed and at ease.

We saw that they were at ease in the company of those supporting them and saw that staff understood their needs well and knew how to respond to them.

Relatives spoke very highly of the service saying that 'Nothing was to much for them'. One person said that they often visited their relative and took them home, but that they were always happy to be back at Rowans'. All of the relatives with whom we spoke without exception were extremely happy with the care that their relatives were receiving, and all said that they would not wish or want them to be anywhere else.