The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Rowan Close is a ‘care home’. People in care homes receive accommodation, nursing and/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. Rowan Close provides accommodation and personal care for up to six people living with a learning disability, physical disability and autism. The home is positioned at the end of a cul-de-sac within walking distance of local shops and amenities. The accommodation is in a single storey bungalow and comprises two lounges, both overlooking the garden and one with sensory facilities. There are two kitchen/diners, one with accessible work surfaces for people using a wheelchair. People’s bedrooms are accessed by a central corridor.
At the time of our inspection six people were living at the home.
The inspection was unannounced and was carried out on 31 January & 2 and 9 February 2018 by one inspector.
We identified a number of serious concerns during our inspection and made several safeguarding referrals to the local authority following our inspection. The Head of Operations visited the home on the third day of our inspection and told us they would put an action plan in place. This was sent to us following our inspection. The provider had also employed a consultant to help support the registered manager and a senior manager to identify areas for improvement.
There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, we found people living at Rowan Close were not always offered choices or supported to experience inclusion.
The culture within the home was not open, transparent or supportive. The home was not well led and the provider had lacked oversight of the culture that had developed within the home. Concerns raised by staff had not been listened to, investigated and responded to effectively. Staff did not feel respected, valued or listened to and no longer felt able to raise concerns and issues for fear of recriminations.
Medicines were not managed safely. There were numerous issues with the stockpiling and unsafe storage of medicines, and large quantities of unused medicines were found in boxes, cupboards and drawers with no audit trail. The provider could not be assured people had received their medicines as prescribed.
Risks were not always safely managed. Unsafe and unsuitable foods were prepared in a way which increased people’s choking risks. Risk assessments had not always taken place before community activity as required in people’s support plans. Equipment checks had not taken place or were ineffective leading to the use of unsafe and potentially unsafe equipment.
Not all staff had completed the required training to ensure they could meet people’s needs effectively. Staff were not trained appropriately or in a timely way to manage a new resident’s specialist feeding equipment. Staff supervision had not taken place for all staff and no staff had received an appropriate appraisal.
Staffing was not sufficient or appropriately deployed to meet people’s needs. Staff worked in a way that was task focussed. They did not have time to sit and chat with people or meet their social/emotional/recreational needs.
The provider could not be assured that all incidents, accidents or near misses had been reported or acted upon. Incidents and near misses that we observed or were told about during our inspection had not been recorded.
Assessments were not always carried out effectively and information was not always communicated to staff in a timely way to ensure they knew how to provide care and support for people when they moved in to the home.
The provider could not be assured healthcare recommendations were always followed. There was evidence of some health referrals and input from GPs, dentists and district nurses. However, follow up actions were not always recorded and staff were unable to say if these had taken place.
People were not supported to follow a balanced diet and the quality of food offered to people was poor. Support plans did not contain information about people’s food likes and dislikes. There was some evidence that this had started to be addressed by end of our inspection.
People’s rights had not always been protected because the registered manager had not always followed the principles of the MCA 2005. MCA assessments and best interest decisions had not been recorded for most significant decisions or restrictions such as bedrails and lap belts.
People were not always supported to access their community to reduce isolation. They did not always receive care that was responsive to their needs and were often not supported to follow their support plans, interests and community activities due to lack of staffing. One person had not been supported to maintain relationships with people that were important to them leading to isolation from their community. Their communication needs had not been addressed as English was not their first language.
There were no recorded complaints and the Head of Operations was not aware of any although they could not be assured there had not been any complaints or that they had not been reported.
Staff did not feel involved in developing the service. They told us the registered manager did not delegate anything, was not responsive to feedback and did not empower the staff to share ideas. Senior staff had stood down as they were not enabled or allowed to carry out their senior roles.
Systems to monitor and assess the safety and quality of the service were in place, however they were not always effective. Many of the issues we found during our inspection had not yet been identified by the provider. The Head of Operations told us they had introduced a consultant and senior staff member into the home to help support the manager. They later told us they had also started to identify some concerns and shared these with us throughout the inspection. However, systems and processes required significant improvement to detect warning signs sooner in order to prevent such a decline in service.
People’s records were often out of date and inaccurate. There was no audit trail for medicines that were unused. The registered manager filled in gaps in witness charts retrospectively and we could not be assured all staff could remember what they had witnessed three weeks earlier. Support plans and other records were cut and pasted, and did not always reflect individual people’s needs. Management record keeping was disorganised and not accessible. The registered manager was not always able to provide information about the running of the home when requested.
Staff were kind and caring in their interactions with people. Staff knew people very well and understood their behaviour and body language to help support their communication. Staff understood where people wanted private time and respected this.
Relatives felt welcome and could visit any time. People and their families were involved in making decisions about their care, as much as they could be.
The environment was all on one level, purpose built and fully wheelchair accessible for the people who lived there.