About the service: Rowlandson house is a residential care home that was providing personal and nursing care to 17 people, two of whom were in hospital at the time of our inspection.

People’s experience of using this service

At the time of our inspection, people were experiencing significant change as the provider had decided to close the home.

Staff were supporting the reassessments of people to enable them to move to other homes which could meet their needs.

Nutrition plans were provided to Care Quality Commission (CQC) to meet the requirements imposed on the service following the last inspection. The plans indicated people were at risk of health conditions due to having a low body mass index (BMI). The operations manager told us this information was being passed as a priority to staff in other care homes and the advice of dieticians had been sought.

Since the last inspection improvements had been made in the administration of people’s medicines. The local clinical commissioning group and a pharmacy had worked with staff at the home to improve oversight of the medicines. This had assisted staff to more closely monitor people’s stock of medicine.

The home required cleaning to reduce the risks of cross infection.

Additional hoists had been provided to negate the need for staff transporting a hoist between floors.

Fire evacuation equipment was in place.

We passed on our concerns to local authority representatives to ensure people’s needs could be met in their new care homes.

Rating at last inspection: At the last inspection carried out in September and November 2018 we rated this service as inadequate. (Report published 11 December 2018).

Why we inspected: This inspection was planned to check improvements to the service were underway. However, we learned on 11 January 2019 of the impending closure of the home and we carried out this inspection to check people were safe.

Follow up: The service was due to close on 18 January 2019. We will speak to the local authority to confirm everyone who used the service has moved out.

This inspection took place on 25 September, 4 and 9 October 2018. The inspection was unannounced.

At our last inspection in June 2018 we rated each key question of safe, effective, caring, responsive and well led as requires improvement. We found breaches of regulations 11, 12 and 17. These breaches concerned issues of consent, safe care and treatment and good governance. We asked the provider to send us an action plan. They told us they would have completed all the required actions by 16 August 2018. We also met with the provider to discuss with them how they intended to improve each key question to a rating of at least ‘good’.

Following receipt of concerning information we undertook an unannounced focused inspection on 25 September 2018 and 4 October 2018 to look at the key questions of safe and well-led. This inspection was also done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection in June 2018 inspection had been made. Due to the concerns identified during our focussed inspection we returned to the service on 9 October 2018 to complete a comprehensive inspection and look at the additional key questions of effective, caring and responsive. We found continued breaches of regulations 11, 12 and 17 and further regulatory breaches of regulations 13, 14 and 19.

Rowlandson House 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 home provided accommodation across three floors for up to 27 people who require assistance with their personal care. The home does not provide nursing care. The registered manager told us 21 people were using the service at the time of our inspection. Most people using the service were living with dementia.

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 service had a registered manager in post. Due to staff shortages the registered manager had supported people as a member of the staff team. This took her away from her management duties.

People were at risk of the maladministration of medicines as there were no stock checks carried out in the service. This resulted in inspectors finding people’s medicines missing. Clear guidance to support staff in their application of topical medicines was not in place.

Records required updating and contradictions in people’s records needed to be addressed to give staff clear information about people’s care needs.

The service had failed to follow the requirements of the Mental Capacity Act 2005 and the Mental Capacity Act Code of Practice. This put people at risk of not being involved in decisions which affected them.

Fire evacuation procedures and equipment needed to be reviewed to enable staff to support people to evacuate people at their nearest exit.

The risks of cross infection were not reduced. The laundry was in a dirty state. Arrangements were put in place during our inspection to secure radiator covers to the wall to reduce the risk to people of accidental burning.

The small lift and the number of hoists available to staff made the movement and handling of people challenging. The operations manager told us they were planning to invest in the home.

Personal emergency evacuation plans were in place. However, we found the plans required support from more staff than was on duty to support people to evacuate. The registered manager showed us their dependency tool and they were providing more hours than required. We made a recommendation about this.

Improvements were required to ensure staff were meeting

This inspection took place on 19 June 2018 and was unannounced. This meant the provider did not know we would be visiting. A second day of inspection took place on 21 June 2018 and was announced.

Rowlandson House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Rowlandson House provides residential care and support for up to 27 people, some of whom are living with dementia. At the time of our inspection 18 people were living at the home. This is Rowlandson House’s first inspection.

A registered manager was in place. A registered manager is a person who has registered with the CQC 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.

Following this inspection, we met with the provider to confirm what they would do and by when to improve the key questions of safe, effective, safe, responsive and well led to at least good. We found the service had breached a number of regulations.

Fire exits were obstructed, staff did not know how to use the evacuation equipment and the home did not carry out fire drills.

The provider failed to identify, assess and manage risks to the health and safety of people of using the service. Care plans lacked detail and were not written from the perspective of the person.

The home did not follow protocols when administering medicines covertly to people and best interests decisions had not been obtained in line with legislation and guidance, including the Mental Capacity Act 2005.

The provider offered limited activities for people living with dementia. Outside areas were inaccessible to people and the risks had not been assessed. We recommended the provider reviews current guidance on meaningful activities for people living with a dementia.

Quality assurance systems were not effective as we identified a number of issues which the processes failed to recognise. For example, lack of best interest decisions, inaccurate information in care plans and the failings in monitoring training.

A robust recruitment process was in place, with staff being fully checked before starting working with people. The home had systems to monitor people’s DoLS ensuring people were not being deprived of their liberty without the appropriate authorisation.

People had maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Processes were in place to investigate safeguarding concerns and accident and incidents but no analysis was carried out to determine trends and patterns. People told us they knew how to make a complaint.

Staff told us they enjoyed working at the home. People were happy with the care and support they received and spoke positively about the staff. Staff and people told us the registered manager was approachable.

The home worked in partnership with external health care professionals ensuring people received care in a timely manner.

The provider had failed to advise us of a change to their statement of purpose which is a regulatory requirement.