Rowthorne Care Home provides accommodation, care and support for up to 40 older people. At the time of our inspection there were 38 people using the service.

At the last inspection on 9 May 2016 the service was rated as Requires Improvement and we found one breach of the regulations. After this inspection the provider wrote to us to say what they would do to meet legal requirements in relation to a breach in Good governance. We rated the safe and effective domains as requiring improvement. At this inspection we found the required improvements had been made and the service was rated Good overall.

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.

People continued to feel safe. Staff understood their roles and responsibilities to safeguard people from the risk of harm. Risks to people were assessed and monitored regularly. The premises were maintained to support people to stay safe.

Staffing levels ensured that people's care and support needs were met. Safe recruitment processes were in place. Medicines were managed in line with the prescriber’s instructions. The processes in place ensured the administration and handling of medicines was suitable for the people who used the service.

Systems were in place to ensure the premises were kept clean and hygienic so people were protected by the prevention and control of infection. There were arrangements in place to make sure action was taken and lessons learned when things went wrong, to improve safety across the service

People’s needs and choices were assessed and their care provided in line with up to date guidance and best practice. They received care from staff who had received training and support to carry out their roles.

People were supported to maintain their health and well-being. Staff supported people to attend appointments with healthcare professionals. People were encouraged to eat healthily and staff made sure people had enough to eat and drink.

People’s diverse needs were met by the adaptation, design and decoration of premises and they were involved in decisions about the environment. Staff demonstrated their understanding of the Mental Capacity Act 2005 and they gained people's consent before providing personal care.

Staff were caring and compassionate. People were treated with dignity and respect and staff ensured their privacy was maintained. People were encouraged to make decisions about how their care was provided. Staff had a good understanding of people's needs and preferences.

People were listened to; their views were acknowledged and acted upon. Care plans were focused on the person and their wishes and preferences. People and their relatives were involved in the assessment process and reviews of their care. People were asked about their wishes at the end of their life.

People were supported to take part in activities which they wanted to do, and encouraged to participate in events within the local community. There was a complaints procedure in place to enable people to raise complaints about the service.

The service had a positive ethos and open culture and people were involved in decisions about changes. People, their relatives and staff felt confident to approach the registered manager and felt they would be listened to. Quality assurance systems were in place to monitor and review the quality of the service which was provided to drive continuous improvement.

This inspection took place on 9 May 2016 and was unannounced.

There is a requirement for Rowthorne Care Home to have a registered manager and a registered manager was in place in place at the time of this 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.

The service is registered to provide residential care for up to 40 older people. At the time of our inspection 24 people were using the service. This was because sections of the building were closed for refurbishment.

Systems and processes were not always operated effectively to ensure the quality and safety of services were assessed, monitored and improved. In addition, systems and processes did not always reduce risks to people. Although people had been asked for their views, there was no regular review of people’s views on the quality of care provided, including those views of other professionals and families.

Medicines were not always given to people as prescribed and medicines management and administration did not always follow guidelines for the safe use of medicines. The way staff were organised and deployed, had on occasion, left people waiting for their care and support. As such people did not always receive personalised or responsive care. Staff recruitment processes ensured staff were checked prior to working at the service to ensure they were suitable to do so.

People were supported by staff who were kind and thoughtful about people’s care. People’s choices and decisions were respected by staff. On most occasions, but not all, staff were mindful of respecting people’s dignity and supporting their privacy.

The provider had taken steps to reduce the risk of abuse to people through staff training and awareness in safeguarding people and whistle blowing procedures. Other risks to people’s health were identified and care plans were in place to ensure any risks were reduced. People who required assistance to mobilise were assisted safely by staff who had been trained.

People were asked for their consent to their care and support. For people who lacked capacity to consent to their care and support the provider had procedures in place that followed the principles of the Mental Capacity Act (MCA) 2005. The provider also had procedures in place to apply for assessment and approval of any restraint on a person’s freedom in line with the Deprivation of Liberty Safeguards (DoLS). Staff understood the principles of the MCA and DoLS and staff training in other areas relevant to people’s care needs was well managed to ensure staff retained up to date skills and knowledge.

Staff received supervision and demonstrated knowledge of people’s needs. People were supported to access other health care services as required. In addition, people had expressed their choices and preferences over meals and drinks and received sufficient food and drink that met their nutritional needs.

People, and where appropriate families, were involved in planning people’s care and support. People could share their views in a variety of ways, including meetings with staff. People were able to maintain relationships with those who were important to them. People received support to engage in games and entertainment.

The registered manager was viewed as being approachable and open in their leadership of the service. The registered manager had made improvements to the service and the systems in operation at the service and staff found these improvements helpful. The registered manager was aiming for consistent standards of good quality care and support, however changes to the staff team due to reorganisation and change meant the support to the registered manager was not always consistent.

Records

There were 40 people using the service at the time of this inspection. The purpose of our visit was to check the action taken by the provider to ensure they were meeting essential standards. We found that improvements had been made to the premises to ensure that people were cared for in a clean and hygienic environment. A number of practices had changed to prevent and control infection and the service's policies and practices fully supported these improvements.

We found that systems, designed to reduce the risk of infection at the service, had been updated and were in use. The majority of staff had received training in preventing and controlling infection.

The two people we spoke with told us that the environment was kept clean and tidy. One of them said, “Everything is spotless...the cleaners do a good job.”

There were 34 people using the service at the time of this inspection. The purpose of our visit was to check the action taken by the provider to ensure they were meeting essential standards. We found that improvements had been made to the premises to ensure that people were cared for in a clean and hygienic environment. A number of practices had changed to prevent and control infection. However, not all the service’s policies and practices fully supported these improvements.

We found that some systems, designed to reduce the risk of infection at the service, were still being developed or updated. Not all staff had received training in preventing and controlling infection.

One person using the service told us that staff followed hygienic practices by washing out their commode twice a day. They also told us that the premises were kept clean, which we confirmed on our visit.

There were thirty eight people living at the home at the time of our inspection.

During our inspection we spoke to eight people who lived at the home. We also spoke with the relatives of two people, one visiting professional and two members of care staff and one member of the cleaning staff.

One person living at the home told us, ''I am very well looked after here. The food is all right and there are plenty of things for me to do if I want to.'' Another person told us, ''On the whole I am well looked after. Sometimes I have to wait a short while for assistance to get into bed. The food is good and we have meetings to discuss any problems but I can go to the office any time in between. We have crafts on Mondays, we also play cards and bingo and have tea and cake social afternoons.''

The visiting professional told us, ''The care is good here and they always contacts us quickly if they have a problem. However, the handwashing facilities are poor. I carry alcohol gel with me as there is none available at this home.''

All of the comments we received from people living at the home and from the relatives we spoke to were very favourable about the home’s operation and the comforts and facility provided through living there.

People gave us very positive reports about the caring qualities of the staff and that they usually had enough staff to support and meet their needs. They did tell us about recent problems with staff sickness affecting their care on some days, but emphasised that their needs were always met. The home's manager and staff confirmed the pressures produced by sickness, but also that systems had been put in place to limit the impact and about how things would be improving with a timely return to work. A family member, who was involved in helping her relative decide about her future at the home described how helpful everybody had been and told us that they were confident that their relative was well cared for.

We observed that a lot of people still retained high levels of independence and they told us were encouraged by staff to continue doing things for themselves where it was safe. They also expressed strong views about being involved in choosing to live at the home and a continued ability to speak out and express themselves.

People that we spoke to expressed satisfaction with the physical standards of the home and that it was always warm, well lit and comfortable to live in. They also commented on the recent redecoration and refurnishing of the communal areas, which they felt had been done to a good standard and with a lot of care to match colours and fabrics.

People living at the home said that they were confident that if they had any problems they knew who how to get something done and were confident that they would be listened to; nobody had made any formal expressions of complaint and described a very open style of management that was there to help them as much as possible.