The Rowans Care Home known as The 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.

The Rowans provides personal care and accommodation for up to 54 older people some of whom had dementia. On the day of our inspection there were 49 people living at the service.

We inspected on 12 September 2018 and the visit was unannounced. This meant the staff and the provider did not know we would be visiting.

At the last inspection in August and September 2016, the service was rated overall ‘Good’, with a ‘Requires Improvement’ rating in the Responsive domain. At this inspection, we found evidence to demonstrate and support the ongoing overall rating of ‘Good’.

The registered manager for the service had recently left their employment and the registered manager of one of The Rowans sister homes was managing the service. A registered manager is a person who has registered with the Care Quality Commission (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.

People told us they felt safe living at The Rowans. Their relatives agreed with what they told us. The staff team had received training in the safeguarding of adults and were aware of their responsibilities for keeping people safe from avoidable harm and abuse.

The risks associated with people’s care and support had been assessed and managed. People's care and support needs had been identified and plans of care had been developed. The staff team knew the needs of the people they were supporting well.

Appropriate checks had been carried out on new members of staff to make sure they were suitable to work at the service and relevant training had been provided. People did not feel there were always enough staff members on duty each day. This was recognised by the management team and actions were taken on the day of our visit to address this.

People were supported with their medicines in a safe way. Protocols were in place and followed with regards to medicines prescribed ‘as and when required’.

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 were provided with a clean and comfortable place to live and there were appropriate spaces to enable people to either spend time on their own, or with others. The staff team had received training on infection control and followed best practice guidance in preventing the spread of infection.

The staff team supported people to make decisions about their day to day care and support and always obtained people’s consent to their care. They were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) ensuring people's human rights were protected.

People were provided with a balanced diet and were supported to maintain good health. They had access to relevant healthcare services such as doctors and community nurses and they received on-going healthcare support.

People told us the staff team were kind and caring and treated them with respect. Observations made during our visit confirmed this.

Staff members felt supported by the manager and management team and told us there was always someone available to talk with should they need guidance or support.

A formal complaints process was in place and people knew who to talk to if they had a concern of any kind. People were confident that any concerns they had would be taken seriously and acted upon.

The manager was in the process of exploring people’s wishes and preferences at end of life and this was being included in people’s plans of care.

Relatives and friends

We carried out our inspection visit on 31 August and 1 September June 2016. The inspection was unannounced.

The service provided accommodation and personal care to 56 older people including people living with dementia and similar health conditions. At the time of our inspection there were 53 people using the service.

The service had a registered manager. 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 felt safe living at The Rowans Care Home. They felt safe because they trusted staff’s ability to look after them. Staff knew their responsibility to keep people safe from harm and abuse. They followed the provider’s guidelines to support people and report any concerns they had relating to people’s safety and wellbeing.

Risks associated with people’s care were assessed and managed to protect people from harm. The registered manager assessed people’s needs and used this to deploy sufficient numbers of staff to meet people’s needs.

Staff had access to a range of training which equipped them with the relevant skills they required to meet people’s needs. The provider completed relevant checks which ensured that staff had the right skills, experience and knew how to support people safely.

People were supported in accordance with the Mental Capacity Act (MCA) 2005. Staff sought their consent to their care and treatment.

People were supported with their nutritional and health needs. They had access to a variety of healthy meals that they told us they enjoyed. They also had prompt access to healthcare services when they needed. However, people’s records did not always show that they received the adequate level of support they required.

Staff were kind and compassionate to people. They were knowledgeable about the needs of the people they supported and treated them with dignity and respect. They provided the support that people needed to be involved in decisions about their care.

Care was centred on people’s individual needs. Their care plans reflected the support that they received. Staff provided people with opportunities to access a variety of social activities and support to follow their faith.

The provider listened to feedback from people using the service and their relatives. People told us that staff acted promptly on their feedback.

The provider had effective procedures for monitoring and assessing the service in a way that promoted continuous improvement. People and their relatives were satisfied with the service they received and they felt supported to contribute to the development of the service. Staff felt supported in their role which enabled them to deliver a good standard of care.

We carried out this inspection in response to information of concern that we received. As part of this inspection we spoke with four people who used the service, three care workers, the home manager and a quality assurance manager. At the time of our inspection there was no registered manager in post but the home manager was in the process of applying to CQC to become the registered manager.

We looked at a number of records including people’s personal records, staff records and records in relation to the management of the service. We also observed the care being provided.

People we spoke with complimentary about the home and the support they received from the staff team. We found that staff were knowledgeable about the needs of people they cared for and were caring and attentive in their approaches.

People’s needs had been comprehensively assessed and care plans were up to date and contained accurate information. We found that the service had assessed people’s individual risks and plans were in place to minimise these risks. This meant that care had been planned to ensure people’s safety.

However, care plans did not always contain sufficient information about how staff should meet people’s individual needs, particularly in relation to the support people may require with regard to communication or how staff should respond if people became anxious or distressed. Care plans we looked at and our observations showed that staff did not always consider people’s dementia care needs. This meant that people may have been at risk of receiving care that was inappropriate.

We found that one person was under a Deprivation of Liberty Safeguards (DoLS) but the conditions that must be met with this authorisation had not been met by the service. We asked the manager to take immediate action to rectify this.

There was a system in place to monitor the quality of service being received which included audits and checks. Wherever issues were identified we saw evidence that action had been taken to respond to this. There was an effective complaints system in place and the service took into account and acted on the views of people who used the service.

The inspection was carried out by a CQC inspector. We spoke with seven people who lived at the service and two visiting relatives. We gained information about the service from reviews of care records and discussions with staff. We spoke with the care home manager, a senior manager responsible for overseeing the work of the care home, a senior care worker, two care workers, an activities co-ordinator and a catering worker. We also spoke with three visiting health and social care professionals who were involved in assessing the needs of people living at the care home.

We used the evidence we collected during our inspection to answer five questions. Below is a summary of what we found.

Is the service safe?

People we spoke with told us they felt safe at the care home. They said they knew how to raise complaints with the home manager and outside organisations such as CQC. We saw the complaints policy was clearly displayed in the home and complaints were effectively managed by the service. We saw records that showed the service worked effectively with the local safeguarding authority to ensure people were safe.

We saw people were protected against inappropriate and overly restrictive care because managers understood and complied with legal requirements under the Mental Capacity Act (2005) and associated Deprivation of Liberties Safeguards.

We saw health and safety risk assessments were in place and were regularly audited and evaluated to ensure people were safe. We noted there were appropriate assessments of risk carried out for each person who received a service. These assessments ensured care was designed and delivered safely.

Is the service effective?

People told us they felt the care offered was helpful and effective. One person told us the care and support they received meant they could “Lift (their) head up and carry on.”

One relative told us about their satisfaction with diet and nutrition support their relative was receiving. They said their relative was, “Putting on weight and getting (their) old spirit back.”

Three visiting health and social care professionals told us the care offered by staff improved the wellbeing of people they had a role in supporting.

Five care records we looked at showed effective care and support was provided to address the needs of people who suffered falls and people at risk of suffering serious skin problems such as pressure ulcers.

Is the service caring?

People who received care, their relatives and health and social care professionals were asked to comment on the quality of the service in a survey carried out in January 2014. People who responded felt strongly that staff provided care with kindness, dignity and respect. One visiting relative told us they were always made to feel welcome at the care home. They said they found the attitudes of staff to their relative “Kind, gentle and respectful.” During our inspection we observed patience, care and warmth shown by staff towards people they were caring for.

Is the service responsive?

We saw records that showed the serviced sought the views of people who received care, their relatives, GP’s district nurses and social workers. We noted from care records and minutes of meetings that people’s ideas and concerns were noted and action was taken to address them. One person told us they were concerned about an aspect of a plan to improve the environment of the care home. We looked at minutes of a recent meeting and saw this person’s concerns were noted. The manager told us that the improvement plan had been amended to accommodate this person’s view and the views of other people who used the service.

We saw from reviews of peoples' care needs that plans of care were adapted to meet their changing needs and wishes.

Is the service well-led?

People we spoke with told us the service had benefitted from the work of the recently appointed care home manager. One person said “there has been a positive difference since the new manager came.” One relative said they no longer noticed an unpleasant odour that they had previously observed around the care home.

Care staff told us about recent improvements in the cleanliness of the environment and the consistent use of daily recording systems to confirm people had received all of the care they required.

The manager told us about new service initiatives including a gardening group. We saw records of group meetings that confirmed people’s ideas would be implemented with the help of a voluntary organisation.

We saw that ideas and information about the running of the service was effectively communicated on noticeboards, information posters, detailed records of meetings, performance audits and staff appraisals. We noted from discussions with managers and staff that they took a pride and satisfaction in providing effective and safe care.

People told us that mostly staff respect and involve them in their care and support. We saw that plans reflected people's needs and where possible they were involved in their care plans.

We were told that meals had improved in the service and that people were now receiving the nutrition they needed. We saw support plans detailing people's fluid intake and evidence that where people were losing weight referrals were being made to the relevant professional.

The building is currently being refurbished and we saw communal areas had been redecorated.

We looked at training records and these showed what training staff had undertaken and people spoken with felt that staff knew what they were doing and had the skills when working with people with a dementia.

We spoke with five people who use the service and two relatives. They told us that they experienced good care and that staff helped them when they needed it.

"I need two staff to help me and they are there when I need them."

"I am involved in my care and given choices."

"I like it here, the staff are kind and never shout."

"Things have improved since this manager took over."