Rowden House is a care home which is registered to provide care and accommodation to up to 39 older people. At this inspection there were 32 people living at the home. Some of them had dementia so were unable to share their views with us. The home has a number of people who wish to live a more independent lifestyle within the safety and security of the care home.

The main building is a period building and has three floors with communal spaces such as lounges and a dining room on the ground floor. At this inspection everyone had their own individual bedroom. The provider has some people attending the home during the day and completing periods of respite.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good

Improvements had been sustained to ensure people remained safe at the home. There were adequate numbers of suitable staff to meet people’s needs and to spend time socialising with them. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. The provider and registered manager promoted positive risk enablement to ensure people’s wishes were respected. People received their medicines safely. People were protected from abuse because staff understood how to keep them safe.

The home continued to ensure people received effective care. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People who required special diets had their needs met and meal times were treated as a social opportunity. Staff had the skills and knowledge required to effectively support people. People told us their healthcare needs were met and staff supported them to attend appointments.

The home continued to provide a caring service to people. People told us, and we observed that staff were kind and patient. People’s privacy and dignity was respected by staff and their cultural or religious needs were valued. People, or their representatives, were involved in decisions about the care and support they received. People who had specific end of life wishes had their preferences facilitated by staff to help provide a dignified death.

The service remained responsive to people’s individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. A programme of activities was being developed providing a range of opportunities. This considered people’s hobbies and interests and was becoming as personalised as possible. Complaints were fully investigated and responded to in a timely manner.

The service continued to be well led. People told us the registered manager was excellent and had made positive improvements to make the home a happier place. The registered manager and provider continually monitored the quality of the service and made improvements in accordance with people’s changing needs. Staff and the management were increasing links with the local community to provide wider opportunities for people.

Further information is in the detailed findings below

This inspection was unannounced and took place on 16 March 2015.

Rowden House is registered to provide personal care and accommodation for up to 39 people. The home specialises in the care of older people.

There is 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.

During the inspection there was a relaxed and cheerful atmosphere; staff and people living in the home were happy and at ease when they spoke with us. We observed friendly but professional banter with staff discussing local news and topics of interest. One person said, “It’s quite a cheerful place, they always have a smile and there is never a cross word.” A visitor said, “I am always welcomed, it’s more like visiting a family than a care home.”

Prior to this inspection we received concerns that care was not being carried out properly due to a shortage of staff. The registered manager confirmed they had been short of staff but all staff had worked well as a team ensuring people received the care they required. One staff member said, “Yes we have had a time when we were short of staff but we worked together and covered the shifts. We are better now, some people have left and we have new staff. It has really improved.” Records showed there were adequate staffing levels on each shift. The manager confirmed staffing levels could be flexible to meet the care needs of people and to support other staff with activities such as parties and trips out.

The manager’s vision for the home was to ensure all people received person centred care, recognising people’s freedom of choice and control over their life. Staff all demonstrated their awareness of the manager’s vision and could tell us how they helped people to maintain choice and provide support in a dignified and respectful manner. One staff, member said, “We are always mindful that it is their home, that care is specific to them and that they make the choices for the day not us.”

All care staff had received training in identifying and reporting abuse. All staff spoken with were able to explain to us the signs of abuse and how they would report any concerns they had. They all stated they were confident any concerns brought to the manager would be dealt with appropriately. People told us they felt safe in the home and they all knew who to talk to if they wanted to raise a concern or complaint.

People said they felt safe living at the home and with the staff who supported them. One person said, “Everybody is very kind, I don’t think I have seen anybody grumpy when they are with us.” A visitor said, “I am confident my friend is safe and well looked after.” There was a robust recruitment procedure in place which minimised the risks of abuse to people.

People’s health care needs were fully assessed and care and support was provided on an individual basis. One staff member told us, “We have very clear care plans but we also know everybody individually, there is very good communication so we know immediately if there is any changes.” This meant people’s individual changing needs were considered and catered for in consultation with them or a family member if necessary. Care plans and care practices were monitored to ensure people’s preferences were being followed and improvements were made when needed.

People saw healthcare professionals such as the GP, district nurse, chiropodist and dentist. Staff supported people to attend appointments with specialist healthcare professionals in hospitals and clinics. Staff made sure when there were changes to people’s physical well- being, such as changes in weight or mobility, effective measures were put in place to address any issues. One visiting healthcare professional said they found the staff to be proactive, going to the community team for advice if they needed extra input to people’s care.

Everybody spoken with told us they enjoyed the food, they all said the food was good. People were offered choices and the food was nutritious and well presented. People who needed assistance with eating were supported in a dignified and unhurried manner. Some people chose to eat in their room.

People told us there had been plenty of options for organised activities; however the activities organiser was now a care worker. The manager confirmed they were recruiting a new activities organiser. We saw people had been involved with the Frome College Arts Project. People shared their life histories with students. They planned to create a memory quilt for the Frome Festival. A local school also visited people for their community and history projects. People had been involved in a living eggs programme when they had incubated eggs and hatched chicks. People were supported to maintain links with the local community; the manager had links with local groups and schools.

There were systems in place to monitor the care provided and people’s experiences. An external audit was carried out by the manager of another home in the organisation as well as the regular audits carried out by the registered manager. Action plans were the put in place to address any issues found. A regular survey was carried out asking people and their relatives about the service provided by the home. Suggestions for change were listened to and actions taken to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.

This inspection was unannounced and took place on 16 March 2015.

Rowden House is registered to provide personal care and accommodation for up to 39 people. The home specialises in the care of older people.

There is 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.

During the inspection there was a relaxed and cheerful atmosphere; staff and people living in the home were happy and at ease when they spoke with us. We observed friendly but professional banter with staff discussing local news and topics of interest. One person said, “It’s quite a cheerful place, they always have a smile and there is never a cross word.” A visitor said, “I am always welcomed, it’s more like visiting a family than a care home.”

Prior to this inspection we received concerns that care was not being carried out properly due to a shortage of staff. The registered manager confirmed they had been short of staff but all staff had worked well as a team ensuring people received the care they required. One staff member said, “Yes we have had a time when we were short of staff but we worked together and covered the shifts. We are better now, some people have left and we have new staff. It has really improved.” Records showed there were adequate staffing levels on each shift. The manager confirmed staffing levels could be flexible to meet the care needs of people and to support other staff with activities such as parties and trips out.

The manager’s vision for the home was to ensure all people received person centred care, recognising people’s freedom of choice and control over their life. Staff all demonstrated their awareness of the manager’s vision and could tell us how they helped people to maintain choice and provide support in a dignified and respectful manner. One staff, member said, “We are always mindful that it is their home, that care is specific to them and that they make the choices for the day not us.”

All care staff had received training in identifying and reporting abuse. All staff spoken with were able to explain to us the signs of abuse and how they would report any concerns they had. They all stated they were confident any concerns brought to the manager would be dealt with appropriately. People told us they felt safe in the home and they all knew who to talk to if they wanted to raise a concern or complaint.

People said they felt safe living at the home and with the staff who supported them. One person said, “Everybody is very kind, I don’t think I have seen anybody grumpy when they are with us.” A visitor said, “I am confident my friend is safe and well looked after.” There was a robust recruitment procedure in place which minimised the risks of abuse to people.

People’s health care needs were fully assessed and care and support was provided on an individual basis. One staff member told us, “We have very clear care plans but we also know everybody individually, there is very good communication so we know immediately if there is any changes.” This meant people’s individual changing needs were considered and catered for in consultation with them or a family member if necessary. Care plans and care practices were monitored to ensure people’s preferences were being followed and improvements were made when needed.

People saw healthcare professionals such as the GP, district nurse, chiropodist and dentist. Staff supported people to attend appointments with specialist healthcare professionals in hospitals and clinics. Staff made sure when there were changes to people’s physical well- being, such as changes in weight or mobility, effective measures were put in place to address any issues. One visiting healthcare professional said they found the staff to be proactive, going to the community team for advice if they needed extra input to people’s care.

Everybody spoken with told us they enjoyed the food, they all said the food was good. People were offered choices and the food was nutritious and well presented. People who needed assistance with eating were supported in a dignified and unhurried manner. Some people chose to eat in their room.

People told us there had been plenty of options for organised activities; however the activities organiser was now a care worker. The manager confirmed they were recruiting a new activities organiser. We saw people had been involved with the Frome College Arts Project. People shared their life histories with students. They planned to create a memory quilt for the Frome Festival. A local school also visited people for their community and history projects. People had been involved in a living eggs programme when they had incubated eggs and hatched chicks. People were supported to maintain links with the local community; the manager had links with local groups and schools.

There were systems in place to monitor the care provided and people’s experiences. An external audit was carried out by the manager of another home in the organisation as well as the regular audits carried out by the registered manager. Action plans were the put in place to address any issues found. A regular survey was carried out asking people and their relatives about the service provided by the home. Suggestions for change were listened to and actions taken to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.

The people we asked told us they consented to their care and treatment and made the following comments. One person said “I make my own decisions, what to wear and what to eat and I decided to have the flu vaccine.” Another person said “I make my own decisions, about my money, to see my GP and I can refuse to rise” and a third person said “I discuss most things with my family.” One relative told us their family member living at the home was able to consent to their care and treatment.

The six people we asked said the staff were good and although sometimes they had to wait, their care was delivered in a timely manner. One person said “I have to wait sometimes but the staff do their best,” and another person whose choice was to stay in their bedroom said “I rarely wait for attention but I avoid using the call bells during busy times.” A social care professional said “staff are respectful towards people. They are busy but keen to support people and they are good at addressing the issues we raise.”

We were told the food was good, there were choices at each mealtime and alternatives were provided if they did not like the choices. One person said “I am having a boiled egg because I didn’t want what is for tea today.”

People told us the staff were responsible for the management of their medicines. One person said “I have no particular need to do them.”

People knew who to approach with complaints. One person said “ I’ve never made a complaint but I would tell the staff or the manager if I had one,” another person said “I would find who the boss was and tell me,” the third person we asked said “I have no cause to complain, nice kind staff and a lovely view from my room.” A relative visiting their family member said they would approach the manager and a social care professional told us the staff dealt with complaints appropriately.

We asked four people and one visitor about their experiences of the care provided by the staff. Three people and the visitor agreed to give us feedback and they made positive comments about the staff.

The visitor told us they were always greeted in a friendly manner by the staff and were always offered refreshments.

People told us the food served was good, there was always a choice and if people did not like the choices an alternative was provided. They told us their rights were respected and we were given examples on how their dignity and privacy was respected. We were told staff asked them how they wanted to be cared for and they made day to day living decisions.

People told us they felt safe with the staff and they knew who to approach with complaints. They said there was enough staff and when there was shortages, bank and agency staff were used. We were told staff were prompt to answer call bells.