Archived: Rowley House Nursing Home

Rowley House Nursing Home is a residential care home providing personal and nursing care to people aged 65 and over. The service can support up to 35 people in one adapted building. At the time of our inspection there were 31 people using the service.

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

People were not supported in a safe way by enough skilled staff who understood their needs and risks. People were not supported by staff who understood safeguarding and had raised concerns with the local safeguarding team as required. Action was not taken in response to accidents and incidents to reduce the future risk of harm to people.

People were not supported by staff who understood infection control and COVID-19 government guidance and were adhering to this. People were not supported to receive their medicines safely. People did not have access to external professionals in a timely way.

The registered manager and provider had not ensured there were effective oversight at the service to identify where improvements were required and to implement these. People did not feel listened to and their feedback was not acted upon. The provider and registered manager had not notified CQC of all potential incidents and safeguarding concerns at the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 27 July 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection .

Why we inspected

The inspection was prompted in part due to concerns received about people’s safe care and treatment, medicines management, safeguarding, staffing and the oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

We have found evidence that the provider needs to make improvements.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to people’s safe care and treatment, safeguarding, staffing staff training and competency and the oversight of the home at this inspection. This is the home's fifth consecutive rating of less than good and fifth consecutive breach of regulations in relation to people's safe care and treatment and the oversight of the service.

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

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 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.

Rowley House Nursing Home is a residential care home providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service can support up to 35 people in one adapted building.

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

Although improvements had been made, we found they had not been fully embedded. People’s total fluid intake was not always recorded. Whilst we found no evidence of harm, systems for managing people’s medicine during a period of respite was not effective.

Sluice and laundry room doors were unlocked allowing people unsupervised access to COSHH products. This posed a risk to the people who lived at the home. A fire exit was blocked by wheelchairs, although they were removed by staff. Whilst most safeguarding issues were raised and acted on, we found one concern where the registered manager had not identified a potential safeguarding involving another agency.

Improvements had been made to the governance systems. Including regular audits being carried out, however they had not identified the errors or incidents we found.

Improvement had been made to people’s risk assessments, which were up to date and reflective of their current needs. Infection, prevention and control systems in place were effective. People were supported by enough staff who were trained to meet their needs. Lessons were learnt when things went wrong.

We found improvements to assessments of people’s capacity to consent to their care and treatment. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to eat and drink to maintain a healthy diet although records were not consistently updated. People’s needs were assessed, and care was delivered in line with their preferences and requirements. Staff worked with other health and social care professionals and people had access to healthcare services. The home was adapted to meet people’s needs.

People were supported and well treated and had input into their care and decisions made. Staff respected people’s dignity and privacy and promoted their independence. Improvements had been made to ensure people’s care plans were more person-centred. People’s communication needs were met, and they were supported to follow interests and maintain relationships. The provider acted on complaints to improve care. People’s end of life wishes were considered.

The registered manager had improved the culture in the home and staff and managers shared an open and honest and person-centred approach to care. The provider acted on their duty of candour. People, their relatives and staff were involved in the service and changes had been made to the home to improve the quality of care being delivered.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 January 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider had met previous enforcement actions and with a new registered manager in place there had been vast improvements. However, not enough improvement had been made and the provider was still in breach of regulation. The service remains rated requires improvement, it has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rowley House Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rowley House Nursing Home provides accommodation for people who require nursing or personal care and can accommodate up to 35 people across two floors. At the time of our inspection, there were 19 people living at the service.

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

Risks were not always managed in a safe way. Care plan documentation was not always kept up-to-date. Information to guide staff to safely support people was inconsistent placing people at risk of harm.

Medicines were not always stored safely, and some recording of medicine administration was incomplete.

Some of the governance processes were not robust or consistent enough to sustain and drive improvements.

There were sufficient numbers of staff to meet people’s needs. Staff were trained to keep people safe from the risk of abuse and/or harm.

The home was clean, and staff adhered to strict infection prevention control practices to mitigate the risk of the spread of infection. Staff had received specific training about how best to protect people from the Covid-19 virus.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager had implemented some practices which had led to some positive outcomes in the home. The people, staff and relatives we spoke with shared this view.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (Inspection date 17 February 2020, Published 25 November 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulation 12 (safe care and treatment) and regulation 17(Good governance).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We received concerns in relation to the risk management of people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rowley House Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to safe care and treatment and good governance.

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

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rowley House Nursing Home can accommodate up to 35 older people with nursing care needs. There were 23 people using the service at the time of our inspection. They can accommodate people over two floors. Some rooms are shared.

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

During our inspection we identified several concerns relating to the safety of the environment that could potentially impact on the health and welfare of the people who used the service. These had not been addressed by the provider prior to our visit. The provider took prompt action, during and immediately following the inspection to address these issues meaning that the environment was made safe.

At the time of our last inspection we had concerns that the quality and safety of the service provided for people was not being well monitored and evaluated meaning areas for improvement were not being identified or addressed. Although we saw that systems and process have now been implemented, the provider had not always identified shortfalls or acted to address them to ensure people’s safety.

Care plans did not always accurately reflect people’s needs and people were not consistently supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Staff were caring and respectful, promoting people’s privacy, dignity and independence.

People were happy living at the home. Relatives were positive about the support their family members received, especially over recent months. There was a complaints procedure in place should people wish to share a concern.

Overall there were enough staff at the home to meet people’s needs in a timely manner. Staff told us that they received training and support to help them be effective in their roles.

The quality of the food had improved, and activities were becoming more structured after the appointment of a member of staff whose responsibility it was to develop this area.

During the inspection the provider and the home manger were open, transparent and keen to make improvements at the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement. (published December 2019). During this inspection the service was found to be in breach of Regulation 17 HSCA RA Regulations 2014 Good governance and Regulation 12 HSCA RA Regulations 2014 Safe care and treatment. The provider sent us an action plan as to how improvements were to be made and we considered this at the time of this inspection.

Why we inspected

This was a planned, unannounced, inspection based on the previous rating.

Enforcement

At the inspection, we have identified breaches in relation to the safety of the environment, recording systems, the assessment and documentation of consent and the governance of the service.

The provider immediately started to address all of our concerns.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rowley House Nursing Home 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. Rowley House Nursing Home can accommodate up to 35 people, based in one building. There were 24 people using the service at the time of our inspection, with one other person also living there who was in hospital.

There was no registered manager in post, although there was a manager who was in the process of applying to register with us. 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.

Quality assurance systems in place to monitor the service were not always effective at identifying concerns and prompt action was not always taken to ensure people’s care improved. Feedback sought from people and relatives was not always acted upon promptly. Feedback from other professionals was also not always acted upon quickly enough, so concerns identified continued to be an issue.

Medicines were not always managed safely and we could not be sure people were always getting them as prescribed. Risks were not always assessed and reviewed sufficiently to ensure lessons were learned. However, people felt safe and staff understood their safeguarding responsibilities. Staff were safely recruited to help keep people safe.

There was mixed feedback about staffing levels and the skills mix of staff had not always been considered. People were protected from possible infection by measures in place and the building was appropriately maintained.

People were not always supported to have maximum choice and control of their lives as the principles of the Mental Capacity Act 2005 were not always being followed, although staff did offer choices. Decisions made in people’s best interest were not always recorded. We could not be sure that all necessary Deprivation of Liberty Safeguarding (DoLS) referrals had been made as capacity assessments were not always undertaken or reviewed.

People did not always find the choice of food sufficient and felt the food needed improving. Staff received training and were supported in their role to care for people. People had access to other health professionals to help keep them well. The building was suitably adapted for the people living there and improvements to the décor were ongoing.

People found that staff were kind and caring and they were encouraged to be independent and to be involved in decisions about their care and support. People could personalise their bedrooms and there were no restrictions on visiting times for relatives.

People were not always sufficiently supported to partake in enough activities as staff were not always available. People and relatives felt that staff knew their preferences well, although further consideration of people’s protected characteristics would be beneficial. People felt able to complain and thought their feedback would be dealt with. Consideration had been given to people nearing the end of their life and arrangements made to ensure medicines were available so they would be pain-free.

People, relatives and staff were positive about the manager and felt the manager was approachable. Staff felt supported.