The Rowans

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed 8 quality statements in the safe key question and found areas of good practice and minor areas of concern. These concerns had not impacted people’s health and safety. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. People were provided with safe care and support. Safeguarding concerns were investigated and acted on. Relevant agencies were notified when an incident had occurred. We did note two incidents had not been reported to the CQC. Action was taken to address this. Staff assessed and reviewed safety risks to people and made sure people, and those important to them participated in making decisions about how they wished to be supported to stay safe. There was an occasion where guidance provided from a health professional had not been updated in the person’s care records. Staff received relevant training to meet the range of people’s needs at the service. Staff received support through supervision and appraisal to support their continuous learning and improve their working practice. Managers checked the suitability of staff to ensure they were suitable and fit to provide care. People’s medicines were managed well, although we did have concerns that controlled drugs were not recorded appropriately. The home was clean and tidy. We found minor infection control concerns. Staff understood how to reduce the risk of the spread of infection.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not raise any concerns in relation to this area of the assessment.

Staff told us that they had regular reflective supervision sessions to review what was working well, and what could be improved at the service. A staff member said, “I get regular reviews of my work, I can discuss any issues that I have, and I am confident they would be addressed.” The manager explained how they and their staff team learned from incidents, with reflective sessions talking place to ensure appropriate action was taken For example, they told us when an incident occurred that involved some form of restraint this was always reviewed with the staff member to gain their views on the actions taken.

There were processes to review incidents and then make improvements. Staff were provided with the opportunity to reflect after incidents, to ensure learning and improvement could occur. This was particularly important when restraint had been used. Records showed staff were fully involved with a debrief of the incident and discussions were held to identify any areas for improvements, or, whether things could be dealt with differently. Staff meetings allowed staff to reflect on what was working well, and what could be improved at the service. There was a policy on the duty of candour. This guided staff to tell the person (or, where appropriate their advocate) when something has gone wrong. We reviewed complaints that had been made and saw this policy had been followed.

People did not raise any concerns with us relating to their ability to access other health and social services.

Staff had good knowledge of which health and social care professionals supported which people. Staff were able to explain when these professionals visited, and what type of support they offered. Staff knew how to monitor people’s health conditions, to ensure timely referrals were made to other services. The manager told us they were confident that people had access to the health and social care services they required to lead healthy and fulfilling lives.

Partners have no specific feedback on this area

Staff kept clear summary documentation on people’s holistic needs. If the person required a hospital admission, health professionals were provided with sufficient information to enable them to provide the care and treatment required. Where people required external health and social care support, documentation showed that suitable referrals had been made. For example, we saw a referral had been made to dieticians when a person needed support with their diet. We did note that the person’s care records had not been updated with the guidance provided. However, staff spoken with did understand how to support the person safely with their diet.

People told us they felt safe with staff. People told us that there were no unlawful restrictions imposed on them. They were free to complete their own routines and live their lives as they wished. Some people would be at risk if they did not have continuous supervision and control, where this was the case, we saw staff had applied the suitable Deprivation of Liberty Safeguards. These safeguards ensure people who cannot consent to their care arrangements in a care home or hospital are protected if those arrangements deprive them of their liberty.

Staff understood how to respond to allegations of abuse. Staff told us that they had no concerns, but if they did, they were confident the management team would act appropriately. Staff were confident in using whistleblowing processes if they felt concerns were not being responded to. The manager understood how to respond to allegations of abuse. They had a clear process of how to investigate and keep people safe. Staff knew where to find the safeguarding policy. They were aware of the policy guidance and knew how to follow it to keep people safe from potential abuse.

We saw people and staff had positive, respectful relationships. There was an open culture of communication and we saw no evidence that people were at risk or fearful of the staff team.

If an allegation of abuse was made, there were appropriate policies in place to guide the staff team. Records showed that incidents were quickly investigated and referred to the local authority safeguarding team if needed. We did note two incidents had not been referred to the CQC as required. Action was taken to address this immediately. During the inspection we noted the management team took quick and appropriate action when a safeguarding concern was raised with them. We were assured the action taken would keep people safe. People were kept safe when they went into the community. The appropriate number of staff were assigned to keep each person, protecting them from potential harm and without placing unnecessary restrictions on people.

People told us they were involved with care planning and were aware of the risks relating to their care.

Staff told us the care records provided them with sufficient information to provide people with the care they needed. They were aware that the care and support needs had been discussed with people (and relatives where appropriate) and risks to their health and safety had been identified, assessed and plans put in place. The manager told us they were confident that all people received care and support in accordance with their preferences.

Our observations raised no concerns regarding Involving people to manage risks at this service.

Care plans contained essential information for staff to be able to provide safe care and support. Risks to people’s health and safety in areas such as personal care, moving and handling and medicines had been assessed and any actions needed by staff to reduce the risk had been recorded. Reviews of care took place with people and their relatives (where appropriate) to ensure the current care provision continued to meet their needs. Agreements on how to make a person safe in an emergency had been agreed and recorded. This helped to keep the person safe. Staff had received training on how to support people’s individual needs. Some people at the service could become distressed due to their mental health diagnosis. Staff had received training on how to support people when they became agitated. People’s communication needs were clearly recorded. This allowed staff to understand people’s needs/wishes and support them to stay safe.

People felt the home environment was safe and they were supported to maintain their bedrooms and communal areas.

No concerns were raised by staff about the safety of the home environment. The maintenance person told us they had the time to complete all tasks to ensure people received care in a safe environment. The registered manager told they had worked with maintenance staff and all other staff to ensure that any risks to the home environment were reported immediately.

The home was free of clutter, rooms used to store potentially harmful materials such as cleaning products were locked. Equipment used to support people was stored safely. This helped to keep people safe. We noted a wardrobe was not fixed to the wall in one bedroom and a ground floor bedroom did not have a window restrictor in place. Immediate action was taken to address this to ensure people remained safe. Handrails were in place to support people with moving around the home independently. Access was available to a safe and secure garden area. Access was restricted to parts of the home that could cause people harm. This included the laundry, kitchen, and sluice. People were cared for in a safe environment.

There were effective arrangements to monitor the safety and upkeep of the premises and to ensure facilities and equipment were well-maintained. When equipment required a service the dates were recorded, and action taken. A recent visit by the Fire Service has highlighted a small number of issues that needed to be addressed to ensure the safety of the people and staff at the home. Action had been taken to address these points. Corridors were clear of any blockages, allowing people to follow easy to read escape routes. Staff had access to firefighting equipment throughout the home and fire alarms were throughout the building.

People did not raise any concerns with us in relation to the staffing team. People told us when they wanted to go out and do things, staff were always available for them.

Staff spoke highly of the training provided to them. They explained how it had supported them to be more effective in their roles. A staff member said, “I feel well trained, there is a wide range of training opportunities and I take all the training I can get.” Staff told us they had regular opportunities to meet their manager on a one to one basis for supervision. These meetings gave them the opportunity to feedback about their experiences and request further guidance/training if needed.

We saw there were enough staff to provide support to people safely. Staff were deployed effectively around the building, to provide timely support to people. This included staff who were providing continuous supervision for people. This type of supervision is provided when people may be at risk of harm to themselves or to others. We saw staff were suitably trained to complete their roles. Staff used their training to respond effectively to people’s needs. When people needed staff support, they were there for them. They were not intrusive and when people wished to be alone, their wishes were respected.

There were clear processes to ensure there were enough staff. The provider had used a calculation tool to assess how many staff were needed to meet people’s needs. The rota’s suggested these staffing levels had then been arranged according to this calculation. Staff had received suitable training to do their role. The management team ensured there was always suitably skilled staff working. There were some gaps in staff training, and this was being addressed by the provider. Once staff were trained, there were clear ongoing processes to assess their competency. If needed, further support and training was then given to improve staff skills. If staff were not providing the expected level of care, there were clear processes to monitor and improve their performance. Safe recruitment processes were followed. For example, previous employers were contacted to give references on the staff member. Staff had also had regular Disclosure and Barring Service (DBS) checks. These check the police database for convictions or warnings that may impact the staff members safety to work with people.

People did not raise any concerns with us about the cleanliness of the home.

Staff knew what personal protective equipment they should wear and when. Staff knew how to put on and remove this equipment, in a safe way. This protected people from the spread of infection. The manager was confident that the home met all required infection control regulations and procedures. They told us they had sufficient staff to ensure the home was clean and tidy and as a result any risk of the spread of infection was reduced.

The home was, overall, clean, and hygienic. On entering the home there was information on how to reduce the risk of the spread of infection, including COVID displayed in the entrance area. There was hand sanitiser and personal protective equipment (PPE) also available. We did note some minor issues which were raised with manager. This included in the ‘Wet Room’ a cream specific to a person left in there and not put away safely, no plastic sheath on the pull chord in shower area and the extractor fan was dusty. We also noted the legs on a shower chair were dirty, a clinical waste bin was not pedal operation and a person’s toothbrush holder was rusty. Action was taken to address this. We saw that staff had access to personal protective equipment (like gloves) throughout the home. This allowed them to support people in a hygienic way. We saw any dirt or spillages in the home were quickly resolved.

There were processes and policies in place, to ensure the environment was kept clean and hygienic. This protected people from the spread of infection. If an infection outbreak occurred (for example diarrhoea and vomiting), there were clear processes in place to reduce the risk of this spreading to other people at the service. Staff had received training in infection control, how to put on protective equipment and how to keep people safe in the event of an infection outbreak.

People did not raise concerns with us about how their medicines were managed.

Staff were able to explain how they supported people to take their medicines safely. One staff member said, “I can administer medications off site if its needed, I can administer medications offsite and I have had medications training.” Staff knew who to report medicine concerns to. For example, if they felt a person’s medicine was no longer effective they understood where to document this, and which health professionals to contact.

Medicines were stored in a locked area, to prevent people accessing them unsafely. Some people at the service were prescribed controlled drugs. These are subject to enhanced restrictions due to the addictive nature of these medicines. When these had been administered this has been recorded. However, we found two people who had controlled drugs to help manage escalations in their behaviour, did not have these medicines recorded in a controlled drugs register as per national legal requirements. This is important to ensure the safe management and administration of these medicines. Action was taken to address this. The controlled drugs were stored safely and securely and separate from other medicines as per national legal requirements. Staff had received training on the safe administration of medicines. Staff received assessments of their competency to do so safely. However, we noted some medicines were administered to people when they were outside of the home. The competency assessment did not include a review of this staff practice. This is needed to ensure staff are aware of the process to follow when away from home to maintain people’s safety. There were protocols in place for the safe administration of ‘as needed’ medicines. These are medicines that administered when needed, such as to and not as part of a regular administration routine. We did note some staff were unaware where these protocols were stored. This is important to ensure the consistent administration of these medicines.