Rowanweald Residential and Nursing Home

We found the following examples of good practice.

The home had taken steps to ensure people and staff were protected from preventable risks of infection. Visitors to the home were carefully screened so that they do not present a risk to people in the home. On arrival at the home visitors were required to complete a screening questionnaire, have their temperatures taken and show evidence of a negative lateral flow test (LFT) taken on the day of the visit. Arrangements were in place to enable visitors to take a LFT at the home and a safe place was provided for them whilst they were awaiting results.

The home followed current government guidance in relation to COVID-19 vaccination and testing for staff and people living at the home. Staff were required to demonstrate negative LFTs and have their temperatures taken before starting each working shift. At the time of this inspection, the interior of the building was being refurbished. The contractors carrying out the works had been required to show evidence of COVID-19 vaccinations and to demonstrate a negative LFT before commencing work each day.

At the time of this inspection, three people were isolating following positive COVID-19 tests. Information in relation to isolation requirements was placed on their bedroom doors and staff were observed to follow this. Where people were unable to receive visitors in their rooms due to the requirement to isolate, staff supported them to maintain contact with friends and family by telephone and the internet.

Staff had a good understanding of infection prevention and control measures. The home had sufficient and appropriate stocks of personal protective equipment (PPE). Supplies of PPE were provided for visitors and staff at the entrance to the home. PPE changing stations were available on each floor. Hand sanitisers were provided throughout the home and each PPE station, and people’s rooms, had suitable foot operated bins for the disposal of PPE and sanitary items. home had an area for staff to remove or put on PPEs. It had a poster and guidance showing staff how to remove PPEs correctly, hand washing facilities with sanitizer, and paper towels and foot operated large pedal bins lined with infected/clinical waste bags for the safe disposal of used PPE.

People and staff were ‘cohorted’ which meant they always stayed and worked in the same units at the home. Activities were repeated in each unit so that small groups of people could participate with their regular staff members in a socially distanced way.

Furniture in communal areas had been arranged to ensure people were able to socially distanced. Areas of the home that were being refurbished were closed off to people and staff wherever possible to reduce contact with visiting contractors.

We found the following examples of good practice.

• The service had been diligent in their efforts to protect their staff and people who used the service. They had ensured that visitors to the home were carefully screened so that they do not present a risk to people in the home. Visitors had to complete a questionnaire providing information about their health condition and any potential risks they may have related to the corona virus infection. Their temperatures were then checked at the door. Personal protective equipment (PPE) including face masks, disposable gloves and aprons were then provided for visitors to wear before entering the home. This was aimed at preventing and controlling the spread of infection. To further minimise the risks, the home had allocated a room where visitors could meet with people they were visiting.

• The home had a caring approach regarding ensuring that people had contact with their friends and relatives. Contact was maintained via the telephone and internet. Effort had been taken by the home to ensure that numerous people can be visited by their relatives. Regular visits had been arranged each day where people can have face to face contact with their relatives.

• Staff had a good understanding of infection prevention and control measures. The home had sufficient and appropriate PPEs. The home had an area for staff to remove or put on PPEs. It had a poster and guidance showing staff how to remove PPEs correctly, hand washing facilities with sanitizer, and paper towels and foot operated large pedal bins lined with infected/clinical waste bags for the safe disposal of used PPE. There was also guidance for cleaning re-useable PPEs. The home also provided further support for staff by providing snacks and drinks for them and allowing their personal grocery shopping to be delivered to the home for them. The registered manager had also written to each staff member to express appreciation for their work.

• People were encouraged to continue participating in activities in small groups. Social distancing was observed with seating being spread out.

• To reduce exposure to infection resulting from admission or transfer to hospital, the home made effective use of the services of the local rapid response team and their GP. As a result, there was minimal use of the ambulance service and hospital admissions had been reduced.

•Throughout the pandemic, senior managers of the company were in constant contact with the home to receive updates and support the registered manager and his staff. This had sustained the morale of staff and it had also maintained good communication among staff. The registered manager had also been involved in organising the local monthly corona virus peer support meetings attended by managers of other care services. Such meetings enabled other care services' managers to be updated on how to improve care for people during the pandemic.

Further information is in the detailed findings below.

The last comprehensive inspection we carried out in October 2017 found a breach of Regulation 18 HSCA RA Regulations 2014 Staffing. The service did not have adequate staffing levels and adequate deployment of staff. This placed people’s welfare and safety at risk. During this inspection in December 2018, we found that the service had taken action to comply with the requirement and the care needs of people had been attended to. The staffing system had built-in safeguards to ensure that the staffing levels were adequate.

Our last comprehensive inspection of 2017 also found a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Person centred care. During this inspection in December 2018, we found that the service had taken action to comply with the requirement. The service had ensured that care provided was person centred and met the needs of people. Feedback from people and relatives indicated that improvements had been made and the care needs of people had been attended to.

At the last comprehensive inspection we found that the service did not have sufficiently effective quality assurance systems for fully assessing, monitoring and promptly improving the quality of care provided for people. We recommended that the service regularly audit progress and action taken to ensure that deficiencies are promptly identified and rectified. During this inspection in December 2018, we found that the service had taken action to address the deficiencies identified. The service had a system of checks to ensure people received the care they needed. Regular audits had been carried out since the last inspection. Following these audits, the service had taken action to improve areas identified.

The service had also been subject to inspections by the local authority’s commissioning and quality monitoring department. They reported that improvements had been made in the running of the home. This was also reiterated by people and relatives we spoke with. Further effort had been made to engage with relatives and people's representatives by moving the manager's office to a room next to the front entrance of the home. This was aimed at improving communication with people and their visitors.

People who used the service and their representatives informed us that people had been treated with respect and dignity. The service had arrangements to protect people from harm and abuse. Care workers were knowledgeable regarding types of abuse and were aware of the procedure to follow when reporting abuse.

Risks assessments had been carried out and risk management plans were in place to ensure the safety of people. The service followed safe recruitment practices and sufficient staff were deployed to ensure people’s needs were met. There were suitable arrangements for the administration of medicines and medicines administration record charts (MAR) had been properly completed.

There was a record of essential maintenance and inspections by specialist contractors. Fire safety arrangements were in place. These included weekly alarm checks, a fire risk assessment, drills and training. Personal emergency and evacuation plans (PEEPs) were prepared for people to ensure their safety in an emergency.

The home had an infection control policy and all areas of the home we visited had been kept clean.

The service worked well with healthcare professionals and ensured that people’s healthcare needs were met. The dietary needs of people had been assessed and arrangements were in place to ensure that people received adequate nutrition.

We noted that the home had suitable arrangements in place to comply with the Mental Capacity Act 2005 and DoLS.

Care workers had received a comprehensive induction and training programme. There were arrangements for staff support, supervision and appraisals.

Care workers prepared appropriate and up to date care plans which involved people and their representatives. The service had made effort to engage people in various social and therapeutic activities within the home and in the local community.

There were opportunities for people to express their views and experiences regarding the care and management of the home. The service had a policy on ensuring equality and valuing diversity and protecting the human rights of people. There were arrangements to ensure that people’s religious and cultural needs were met. People were supported with their religious and cultural observances.

Complaints made had been recorded and promptly responded to. A satisfaction survey and been carried out and the results indicated that people were mostly satisfied with the care provided.

At our last comprehensive inspection on 19 October 2015 the service met the regulations we inspected and was rated Good. At this inspection we found areas where improvement was needed and have rated the home as Requires Improvement.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

The service had arrangements to protect people from harm and abuse. Care workers were knowledgeable regarding types of abuse and were aware of the procedure to follow when reporting abuse. Risks assessments had been carried out and risk management plans were in place to ensure the safety of people. The service followed safe recruitment practices and records contained the required documentation. The staffing levels had been regularly reviewed. However, some people, relatives and three social and healthcare professionals told us that there were times when there was insufficient care workers available to attend to people's needs.

The arrangements for the administration of medicines were satisfactory and medicines administration record charts (MAR) and the controlled drugs register had been properly completed.

The premises were kept clean and tidy. Infection control measures were in place. There was a record of essential maintenance of inspections by specialist contractors. There were fire safety arrangements. These included weekly alarm checks, a fire risk assessment, drills and training. Personal emergency and evacuation plans (PEEP) were prepared for people to ensure their safety in an emergency.

The service worked with healthcare professionals and ensured that people’s healthcare needs were met. The service had experienced problems ensuring that the healthcare needs were met. However, improvements had been made and this was confirmed by three healthcare professionals. The dietary needs of people had been assessed and arrangements were in place to ensure that people’s dietary preferences were responded to. People informed us that the provision of meals had improved since the arrival of the new chef.

We noted from comments from some people, some relatives, two social and healthcare professionals and our observations that some people had not received all the required care. We also noted that the care of some people had not been subject to regular reviews with them or their representatives. This is needed to ensure people received the care they needed and in accordance with their preferences.

The home employed two activities organisers. There was a varied activities programme to ensure that people received social and therapeutic stimulation. People were satisfied with the activities provided.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. We noted that the home had suitable arrangements in place to comply with the Mental Capacity Act 2005 and DoLS.

Care workers told us they worked well as a team and there was effective communication among them. They had received a comprehensive induction and training programme. There were arrangements for support, supervision and appraisals of care workers.

There were opportunities for people to express their views and experiences regarding the care and management of the home. Regular residents’ and relatives' meetings had been held. Complaints made had been carefully recorded and promptly responded to.

Checks and audits of the service had been carried out by the registered manager and regional manager. An annual audit was carried out by the quality assurance department of the company. We however, noted that checks on the care provided for people were not sufficiently robust to ensure that deficiencies were identified and promptly responded to. The registered manager explained that the service had experienced a lot of changes recently. Some care workers were on maternity leave and the previous deputy manager had left recently after serving the required weeks’ notice period. We were also informed by her that the regional manager who left a few months ago was not replaced until mid-August 2017. A new regional manager is now in place and they had already started to implement their action plan to closely monitor care provided. Professionals who provided feedback said there had been improvements in the service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.

Overall, people who used the service were satisfied with the care provided and said that they were treated respectfully. One person told us that they were happy and felt 'part of a family' at the home. Another person told us that the staff were 'friendly and helpful'.

We looked at five care records and these indicated that the individual needs of people had been attended to. The care records contained appropriate assessments, care plans and details of reviews. There was documented evidence that the healthcare needs of people had been attended to and there were records of appointments with healthcare professionals.

We observed that the home was clean and welcoming. There was a communal garden which was well maintained and was popular amongst people who used the service.

Staff we spoke with told us that they felt supported by management. During our inspection members of staff, one relative and people who used the service told us that the home would benefit from another member of staff during busy times.

Staff demonstrated that they were aware of what action to take when responding to allegations or incidents of abuse and had received training in safeguarding people.

People told us the staff cared for them well and met their needs. The care plans identified people's needs and how these were to be met. Changes in needs were recorded to keep staff informed so they could care for people effectively. People described the care they received as ranging from 'fair' to 'brilliant'. One visitor said they 'would highly recommend this home'.

Medications were being managed in the home. Two people confirmed they received their medications from the registered nurses and said their medication had been discussed with them so they knew what they were taking and why.

The home was being appropriately staffed and staff had relevant training and experience to care for people effectively. Staffing levels were monitored in line with people's dependencies.

Systems were in place for monitoring the quality of service people received. People said they were encouraged to express their views and raise any concerns and that they were listened to, with action being taken promptly to address any issues they raised.

We spoke with nine people using the service, seven visitors and six staff.