Archived: Rowena Court

Rowena Court is a care home which is registered to provide personal care for up to six people with mental health needs. There were six people being supported at the time of our inspection.

People’s experience of using this service and what we found

Although people told us they felt safe using the service, we found people were not protected from the risk of harm and abuse. The provider failed to appropriately escalate allegations of abuse, including where current staff were named as alleged perpetrators. Staff were not trained and equipped to respond appropriately to suspicions of abuse. This was a breach of the regulations.

We identified a second breach of the regulations due to the inadequate management of people’s risks, including poor learning from incidents at the home. Medicines management systems failed to ensure people would always be safely supported.

The provider started to improve recruitment processes after our inspection and staff felt staffing levels were safe. The home was clean and further improvements were underway, prompted by the local authority, to ensure good infection control.

We identified a third breach of the regulations because staff did not have adequate training and guidance to carry out their roles effectively, and staff deployment was not appropriately managed. We identified a number of shortfalls in how people’s needs were assessed in addition to a lack of training for staff. People were supported to access healthcare support, but this guidance was not used to appropriately inform people’s care. This all prevented adequate, effective support being provided to always meet people’s needs.

Although areas of the service were homely, the design and décor of the service failed to show regard for all people’s needs.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Although we saw some positive interactions with people from staff and people spoke positively about staff, established routines at the home, and the provider’s poor oversight such as their response to incidents, failed to ensure people were always well supported. We found concerns that compromised people’s dignity, respect and positive experiences. People did not have routine and planned opportunities to discuss and review their care to ensure this always met their needs.

We identified a fourth breach of the regulations as established routines at the home failed to ensure people’s individual needs and wishes were always taken into account. Furthermore, care planning processes failed to identify all people’s needs were appropriately identified and met including communication needs and end of life support.

People had been advised how to complain but no formal complaints had been submitted. People were supported to maintain community links and were encouraged to do some group activities at the home.

We identified a fifth breach of the regulations due to the provider’s poor governance systems which failed to adequately assess, monitor and improve the service. We found widespread concerns which had not been identified and addressed and which the provider had failed to notify relevant partner agencies as required. We identified a sixth breach of the regulations because the provider did not meet their legal requirement to notify CQC of specific incidents and events. Despite our urgent prompts during inspection and enforcement activity, the provider failed to act on the serious concerns we brought to their attention which placed people at ongoing risk of harm and failed to protect staff.

Rating at last inspection

The last rating for this service was Good (published March 2018).

Why we inspected

The inspection was prompted in part due to concerns about the provider’s governance systems and oversight of the quality and safety of care provided, identified through our inspection activity at another two services registered with the provider. We decided to inspect and examine those risks.

We identified serious concerns and breaches of the regulations at this inspection. We found evidence that people were at risk of harm as a result. Despite our urgent prompts and enforcement activity, the provider did not take enough action to mitigate those risks. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

At this inspection, we identified six breaches of the regulations. This was because the provider failed to protect people from abuse and ensure any allegations of abuse were immediately investigated. The provider failed to adequately assess and mitigate risks to people’s health and safety. The provider failed to ensure there were sufficient numbers of suitably skilled and competent persons deployed to safely meet people’s needs, including that staff received appropriate support and training. The provider failed to ensure people received person-centred care and treatment that met people’s needs and personal preferences. The provider failed to notify CQC of all events and incidents as required and failed to operate effective systems and processes to assess, monitor and improve the quality and safety of the service.

After our inspection, we took urgent enforcement action to require the provider to immediately address significant concerns that placed people at immediate risk of harm. We informed relevant partner agencies of our serious concerns. The provider failed to take enough action to ensure people’s safety which continued to place people at immediate risk of harm. We continued to liaise closely with the local authorities and other relevant partners.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

During and after our inspection processes, we requested information from the provider about what action they were taking to address our serious concerns. We also worked alongside the relevant local authorities in light of the immediate and urgent concerns we identified. We carried out urgent enforcement action in relation to this service. During our enforcement processes, we continued to monitor the service for any further concerning information to help inform our inspection activity.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post when we inspected the home. 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 were at ease around care staff that understood how to keep people safe and had received training. Staff understood people’s individual circumstances. Staff understood who to report concerns to as well as the risks to people’s health. Staff understood people’s health needs and the risks to their health. Recruitment processes for staff included background checks. People accessed support from staff when needed. People’s support with medicines was reviewed and checked to ensure people received their medicines in line with guidance for that person.

Staff were supported through training and supervision. Staff supporting people understood the importance of obtaining their consent. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff supported people to maintain a healthy diet and encouraged to make healthy choices in the food they chose. People were also supported to attend appointments with healthcare professionals and could seek additional help if needed.

People knew and liked the staff supporting them and had known them for some time. Staff understood people’s individual care needs, preferences and understood people’s cultural backgrounds. Staff involved people in their care by explaining choices and supporting people to make decisions about their care. People were supported by staff who understood what it meant to support people with dignity and respect.

Staff understood people’s needs and how to support them. People’s that were new to the home were supported so that staff could gradually get to know them and provide the support they needed. People understood they could speak with staff and the registered manager about their care if they had any concerns.

People knew and liked the registered manager. Staff spoke positively about working at the home and felt part of a team that was well supported. Staff felt able to seek help and guidance if they required it. Regular reviews of people’s care and quality audits ensured people’s care planning was timely and up to date. The registered manager worked with other stakeholders to ensure people received the care they needed.

Further information is in the detailed findings below

Rowena Court is registered to provide accommodation for persons who require nursing or personal care for up to 6 adults aged over 60 who experience a long term mental health condition. At the time of our inspection there were 5 people using the service.

The manager was registered with us as is required by law. 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 found that safe medicines storage, staff competency checks and guidance for staff in relation to ‘as required medicines’ were lacking. Staff were provided with training and were knowledgeable about how to protect people from harm. The service had a suitable amount of staff on duty with the skills, experience and training required in order to meet people’s needs. Recruitment systems ensured that the staff who were recruited had the right skills and experience to support people safely.

Staff were well trained, received a comprehensive induction and were provided with on-going supervision for their development. People were supported to access the nutrition they needed and were monitored for any changes in their dietary needs. The service ensured that people had access to a wide of range of healthcare professionals to maintain their health and well-being.

We observed staff interacting with people in a positive and respectful manner. People spoke to us about how genuinely caring and kind staff were towards them. People told us they were encouraged to remain as independent as possible by staff. We observed staff ensured people’s privacy and dignity was maintained.

People were consulted about all aspects of the planning of their care and in relation to the daily activities they were involved in. Activities available within the service were centred on people’s individual abilities, preferences and interests. The provider regularly sought feedback and the opinion of people using the service using a variety of methods. People knew how they could make a complaint and the provider’s complaints process was clearly displayed for people to refer to.

All of the people and staff we spoke were very complimentary about the quality of leadership within the service. The registered manager and deputy manager undertook regular audits to reduce any risks to people and ensure that standards were maintained. Feedback was actively sought and acted upon from people.

We saw that people were involved in making choices about what they wanted to do and what they ate and drank.

We found that people's needs were appropriately assessed and planned to ensure that care received was safe and appropriate. However, we found that the fire exit at the rear of the home was not sufficiently cleared to allow easy access in case of an emergency evacuation.

The service took steps to prevent abuse by ensuring that staff recognised the signs of abuse, understood safeguarding processes and whistle blowing procedures.

We found that staff received appropriate training and supervision to develop their skills and competency in meeting the needs of the people they supported.

The home monitored the quality of service that people received through regular reviews. It improved the service by taking account of comments and complaints and regularly assessing service through audits.

We saw that people were involved in making choices about what they wanted to do and where they wanted to go. Pone person we spoke with said, 'I bough my Christmas presents, staff came with me to see if I was okay'.

We found that people's needs were appropriately assessed and planned to ensure that care received was safe and appropriate. People told us they were happy with the care they received. One person told us, "We're looked after excellent, staff are brilliant'.

Staff knew how to safeguard people from harm and felt confident that if they had to report any abuse, action would be taken to protect people.

We saw that people's health and welfare needs were met by competent staff that had appropriate supervision and training.

There was a system to monitor the quality of service people received through regular reviews and audits.