This inspection took place on 20 and 21 September 2018 and was unannounced. Rowena House Limited 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 care home accommodates up to 22 people in one adapted building. There were 16 people living at the service at the time of our inspection.As a result of our last inspection in February 2018 we took enforcement action and served a warning notice on the provider and registered manager requiring them to make improvements in order to ensure the home environment was safe; that identified risks to people were safely managed and; to ensure people’s medicines were managed safely. At this inspection we found that whilst the provider had acted to address many of the issues we had previously identified, there remained some shortfalls amounting to a continued breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Risk assessment tools, including the Malnutrition Universal Screening Tool (MUST) had not always been used correctly when assessing risks to people. People’s care plans did not always include guidance for staff on how to manage identified risks safely. The provider had acted to improve fire safety at the service but further action was required to reduce the risk of legionella and to ensure the environment was safe.
Improvements had been made to the recording of the administration of people’s medicines and to the provider’s processes for receiving and disposing of medicines. However, we also found prescribed creams were not always securely stored and there continued to be a lack of guidance in place for staff on the support people required to take medicines which had been prescribed to be taken ‘as required’.
As a result of our last inspection in February 2018 we took further enforcement action and served a warning notice on the provider and registered manager requiring them to make improvements to their systems for monitoring the quality and safety of the service. At this inspection we found that whilst improvements had been made to address many of the issues we had previously identified, there remained further areas in need of action, amounting to a continued breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Checks on the safety of the environment had not always regularly been conducted and had not always identified issues in order to drive improvements. Staff had not carried out any audits of people’s care plans in the time since our last inspection which may have helped identify the issues we found with people’s risk assessments. The provider was unable to demonstrate that routine checks had been carried out to monitor for the risk of legionella. Whilst improvement had been made to the process used for auditing people’s medicines, medicines audits had not identified the issues we found in regard to the lack of guidance in place for staff on medicines prescribed to people to be taken ‘as required’.
At our last inspection in February 2018 we asked the provider to take action to make improvements in order to protect people from the risk of abuse because allegations of abuse had not always been reported to the local authority safeguarding team. This action had not been completed; we found details of further incidents which had not been reported to the local authority safeguarding team where required amounting to a continued breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At our last inspection in February 2018 we asked the provider to take action to make improvements to ensure they followed safe recruitment practices. This action had not been completed; one staff member had been working at the service without a criminal records check having been completed. This was a continued breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed the criminal records check following our inspection.
The service had 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.
At our last inspection we found improvement was required because the registered manager was not always aware of their legal responsibilities in managing a care home. At this inspection we found continued concerns in regard to the registered manager’s understanding of the responsibilities of their role. They had not acted to fully address four breaches of regulations which we had identified at our last inspection and lacked an understanding of the types of incidents which could be defined as being abuse which prevented them from fulfilling their responsibility to properly safeguard the people living at the home. This was a breach of regulation 7 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
You can see what action we told the provider to take at the back of the full version of the report.
At our last inspection in February 2018, we asked the provider to take action to make improvements because the home was not always clean and some furniture was in poor condition. This action has been completed. Improvements had been made to the cleanliness of the home and new furniture had been purchased which could be more easily cleaned in the event of a spillage.
At our last inspection in February 2018, we asked the provider to take action to make improvements to ensure staff were appropriately supported through a programme of training and supervision. This action has been completed; staff completed an induction when they started work at the service. They received training in areas considered mandatory by the provider and regular supervision to support them in their roles.
At this inspection we found that improvements were required to ensure the details of any accidents and incidents were regularly reviewed in order to look for trends and reduce the risk of repeat occurrence. We also found improvement was required to ensure people’s preferences about the support they wished to receive at the end of their lives had been consistently discussed with them and included in their care plans to help ensure they received the care they wanted at that time.
There were sufficient people deployed at the service to meet people’s needs. Staff wore protective clothing such as gloves and aprons when supporting people with personal care tasks to reduce the risk of infection. People’s needs had been assessed before they moved into the home. The provider used nationally recognised tools and guidance when assessing people’s needs.
People were supported to maintain a balanced diet and told us they enjoyed the meals on offer at the service. Staff supported people to access a range of healthcare services when needed. They worked to ensure people received effective joined up care when moving between different services. People told us that they liked the service’s living environment. The provider had plans in place to redecorate areas of the home and confirmed they would take people’s views into account when the work was carried out.
Staff sought people’s consent when offering them support. People were supported to have 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. Staff treated people with kindness and consideration. People were involved in decisions about their care and treatment. Staff respected people’s privacy and treated them with dignity.
People and their relatives had been involved in the planning of their care. Care plans reflected people’s needs and included information about their likes and dislikes, and preferences in the way they received support. People were supported to maintain the relationships that were important to them. The provider supported people to take part in a range of activities which met their need for social stimulation and engagement. People knew how to complain and expressed confidence that any issues they raised would be addressed.
The provider had recruited a new home manager who had day to day responsibility for the management of the service. They demonstrated an understanding of the Health and Social Care Act 2008 and their responsibilities in managing the service. Staff spoke positively about the support they received from the management team. People, staff and relatives told us the service was well managed and that the new home manager had made improvements since starting work at the home.
Staff told us there was a positive working culture at the service. They attended regular staff meetings and handover meetings between each shift in order to share information about any service developments and ensure they were aware of the responsibilities of their roles. The provider sought the views of people and their relatives, and acted to make service improvements based on their feedback. The management team worked openly with other agencies including local authority commissioners and quality assurance teams.
The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. This is because the service had been rated as 'Inadequate' in at least one key question over two consecutive comprehensive inspections.
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 i