Rowans Residential Home is a ‘care home’ that provides accommodation for a maximum of nine adults, of all ages, with a range of health care needs and physical disabilities. At the time of the inspection there were nine people living at the service. 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. Rowans provides accommodation over two floors. Some bedrooms are on the ground floor where communal areas are also present. The remaining bedrooms are on the first floor which is accessed by chair lifts. Staff continuously monitor people if they remain in their rooms to ensure people’s needs are met at all times. People are able to access garden area. The home is near to St Agnes which people visit regularly.
There was a registered manager in post who was responsible for the day-to-day running of the service. 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. Rowans have been owned by the provider for many years and it is a family run business.
We carried out this announced inspection on 24 February 2018. At the last inspection, in October 2015, the service was rated Good. At this inspection we found the service remained Good.
On the day of the inspection there was a calm, relaxed and friendly atmosphere in the service. We observed that staff interacted with people in a caring and compassionate manner. We spoke with all the people at the service to gain their views of the service. They all told us they were happy with the care they received and believed it was a safe environment. Comments from people included, “All the staff are wonderful”, “it’s lovely here”, “I feel very lucky to be here.”
Staff ensured people kept in touch with family and friends. Relatives we spoke with told us they were “delighted” with the care that their family members received. Comments included “It’s a lovely atmosphere; it’s a real family here.” Relatives told us they were always made welcome and were able to visit at any time.
Staff said they were proud to work at Rowans and told us “This is our extended family” and “We [staff] love working with the residents and relatives and we work well as a team.”
People were protected from abuse and harm because staff understood their safeguarding responsibilities and were able to assess and mitigate any individual risk to a person’s safety. People said they felt safe at Rowans, and relatives echoed this view.
The service was warm, comfortable and appeared clean with no unpleasant odours. The service was well maintained. People were pleased with their private bedrooms and had decorated them to reflect their preferences and tastes. People were treated with kindness, compassion and respect.
The service had suitable arrangements for the storage and disposal of medicines. Medicines were administered by staff who had been trained and assessed as competent to manage medicines. The manager had contacted the pharmacist as there had been difficulties with the service receiving some people’s prescribed medicines in a timely manner. The manager had liaised with the GP to ensure that medicines that were delayed in being sent to them were available to administer for people. Whilst there had been a difficulty with gaining some medicines it had not impacted on the health of people using the service.
People received care and support that was responsive to their needs because staff were aware of the needs of people who lived at Rowans. Staff were prompt at recognising if a person’s health needs had changed and sought appropriate medical advice promptly. One person told us “I have good and bad days. Yesterday was a bad day and I stayed in bed and staff looked after me.” Relatives told us the service always kept them informed of any changes to people’s health and when healthcare appointments had been made.
Care plans were well organised and contained personalised information about the individual person’s needs and wishes. Care planning was reviewed regularly and whenever people’s needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted. Risks in relation to people’s care and support were assessed and planned for to minimise the risk of harm.
People told us they were able to take part in a range of group and individual activities. Care records showed that people took part in a range of activities. We saw people undertaking individual activities such as reading books, socialising, listening to music and watching TV.
People told us the food was “Great.” Staff supported people to maintain a balanced diet in line with their dietary needs and preferences. Where people needed assistance with eating and drinking staff provided support appropriate to meet each individual person’s assessed needs.
Staff were recruited in a safe way. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes.
Staff were supported by a system of induction training, one-to-one supervision and appraisals. The induction and on-going training of staff ensured they were effective in their role. Staff knew how to ensure each person was supported as an individual in a way that did not discriminate against them. People’s legal rights were understood and upheld.
Management and some staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). They demonstrated their understanding of these principles in the way they cared for people. Staff believed that everyone at the service had the right to make their own decisions and respected them. The manager told us currently the people they supported had capacity to make decisions about their health and welfare and this was constantly reviewed. The manager knew the process to follow if a person’s level of capacity changed so that the service would act in accordance with legal requirements.
There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong leadership and led by example.
People and relatives all described the management of the service as open and approachable. People and their relatives told us if they had any concerns, or comments about the service that they could approach the provider, manager or staff “without hesitation.”
People were asked for their views on the service regularly. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.