Archived: Rowan Tree Lodge

Updated 10 November 2018

We undertook an unannounced focused inspection of Rowan Tree Lodge on 19 and 23 October 2018.

This inspection was done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection on 24 April 2018 had been made. The team inspected the service against three of the five questions we ask about services: is the service well led, is the service responsive to people’s needs and is the service safe? This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

The inspection was undertaken by one adult social care inspector. During our inspection we spoke with the manager of the service, the area manager, two care staff members and one nurse employed by the service.

We spoke with four people using the service and one relative.

As part of our inspection we undertook general observations and walked around the service. We viewed the care plans belonging to four people, as well as different daily records and documents relating to people’s medicines. We viewed complaints, accidents and incidents and other records relating to the management of the service. This included different kinds of checks the manager, area manager and provider used regularly.

Before our inspection we reviewed the information we held about Rowan Tree Lodge. This included whether we had received any notifications from the provider. A notification is information about important events which the service is required to send to us by law.

We looked at this information to plan our inspection at Rowan Tree Lodge, as well as the provider’s previous action plans and information they gave us in their last Provider Information Return (PIR). A PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The provider had submitted this before our last comprehensive inspection.

We contacted the local authority for feedback regarding the service and they provided us with insight of their ongoing monitoring.

Updated 10 November 2018

This inspection of Rowan Tree Lodge took place on 19 and 23 October 2018 and was unannounced.

Rowan Tree Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection nine people were living at Rowan Tree Lodge. The care home is a large detached house converted into a nursing and care home for 16 older people.

At the time of the inspection there was a new manager in post, but they had not yet registered with CQC. We returned to Rowan Tree Lodge for a second day of inspection to meet the new manager who had started their role in August 2018.

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.

We carried out an unannounced comprehensive inspection of this service on 24 April 2018. Breaches of legal requirements were found regarding the governance of the service. This was because people's care plans lacked guidance around care and support. Governance arrangements were not always robust to ensure a safe, well managed service.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report covers our findings in relation to those requirements and additional concerns we found at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rowan Tree Lodge on our website at www.cqc.org.uk.

At this inspection we still found issues with the governance of Rowan Tree Lodge, which meant the service remained in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition, we found breaches of Regulation 12, regarding the safe care and treatment of people who lived at the home.

You can read what actions we told the provider to take at the end of this report.

Whilst we found that some improvements had been made to the safety of the service and to how it was led, we have not revised the rating for the service. We will check this during our next planned comprehensive inspection.

At this inspection we found that information in people’s care plans was still not always consistent. Record keeping processes had not always ensured that information was up to date and reliable for staff. Staff had not always taken timely action in line with care plans.

We found that although the service had addressed some cleanliness issues, we had concerns about other aspects of the service’s safety. This included the day-to-day management of fire risk and water hygiene.

We found that checks and monitoring processes did not always ensure robustly the safe care and treatment of people who lived at the home. This included checks to protect people from pressure sores.

The area manager had looked to improve protocols for people’s ‘as required’ medicines. They made further significant improvements between the two days of our visit. The area manager was also liaising with GPs to get clearer directions for people’s prescribed creams. The service managed other medicines safely.

There were enough staff to meet people’s needs. People who lived at the home, relatives and staff confirmed this. The area manager had carried out checks to recruit new staff, although some references needed clarification.

Staff were aware of their responsibilities to safeguard people from abuse and avoidable harm. Staff had confidence that managers would deal with any concerns.

People who lived at the home told us care staff were wonderful. However, we also found that the service needed to improve on how they listened to people’s needs and wishes.

Staff were knowledgeable about people’s needs, but some aspects of person-centred care needed to improve. The service was developing their activity offer.

We observed staff engaging with people and heard good examples of how the responsiveness of care to individual’s needs had made a big difference.

The area manager had developed their own and the service’s audit checks. These needed further improvement, as they had not picked up on significant issues we found.

The staff, manager and area manager at the service were warm and welcoming. They were helpful, engaging and acted on any concerns we had. The area manager worked hard between the two days of our visit to make further improvements.

As the manager was new, not everyone knew who they were. However, the manager and area manager held regular meetings with relatives to keep them up to date with changes. We heard positive feedback about the new manager.

There were regular team meetings and staff we spoke with felt well supported.

There had been no notifications to CQC since we last inspected the service, the area manager confirmed to us no notifiable events had occurred. The service had displayed ratings from our last inspection as required.