This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Rowan Close provides accommodation and personal care for up to six people with a learning disability, physical disability and/or autism. The home is set at the end of a small cul de sac close to local amenities. The home comprises a large bungalow with two lounges, two kitchen/diners, a sensory room and a choice of bathrooms and showers. The home has its own private garden which has sensory mobiles and chimes.

Rowan Close 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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was no registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The current manager was in the process of applying for their criminal records check at the time of our inspection.

Quality assurance and auditing systems were in place. However, these needed to be fully embedded to ensure they were implemented consistently. Safety of equipment and infection control checks were not always effective in identifying issues.

The management of medicines had improved significantly although improvements to the quality of information when changes were made to people’s MARs was still required. People received their medicines as prescribed from staff who had been trained and were competent to do so.

Staff received guidance in how to keep people safe from harm and abuse and understood how to report any concerns.

Risks associated with people’s health, safety and welfare had been identified and assessed. Emergency evacuation procedures were in place and known to staff.

There were sufficient staff deployed on all shifts with the right skills to meet people’s needs and keep them safe. Recruitment procedures were in place to ensure only suitable staff were employed.

Improvements had been made to ensure staff received training, supervision and appraisal to provide them with the required skills, knowledge and competencies for their roles.

People’s rights were protected because staff understood the principles of the Mental Capacity Act (MCA) 2005) and asked for their consent before providing any support. Deprivation of liberty safeguards had been submitted to the local authority for authorisation when required.

People were offered a choice of fresh, home cooked food and a choice of drinks that met their preferences and dietary needs. People were supported by staff to maintain their health and wellbeing and had access to a range of healthcare services when required.

Staff were kind and caring and treated people with dignity and respect. People were encouraged to make choices and retain their independence and maintain relationships with people who were important to them. Family and friends cou

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Rowan Close is a ‘care home’. People in care homes receive accommodation, nursing and/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. Rowan Close provides accommodation and personal care for up to six people living with a learning disability, physical disability and autism. The home is positioned at the end of a cul-de-sac within walking distance of local shops and amenities. The accommodation is in a single storey bungalow and comprises two lounges, both overlooking the garden and one with sensory facilities. There are two kitchen/diners, one with accessible work surfaces for people using a wheelchair. People’s bedrooms are accessed by a central corridor.

At the time of our inspection six people were living at the home.

The inspection was unannounced and was carried out on 31 January & 2 and 9 February 2018 by one inspector.

We identified a number of serious concerns during our inspection and made several safeguarding referrals to the local authority following our inspection. The Head of Operations visited the home on the third day of our inspection and told us they would put an action plan in place. This was sent to us following our inspection. The provider had also employed a consultant to help support the registered manager and a senior manager to identify areas for improvement.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, we found people living at Rowan Close were not always offered choices or supported to experience inclusion.

The culture within the home was not open, transparent or supportive. The home was not well led an

People who lived at Rowan Close had significant care needs and were unable to verbally communicate their views and satisfaction with the care they received. We made observations and talked to staff about how they provided care to people and met their individual needs.

People who lived at the home were able to communicate using different forms of communication. Staff told us that Makaton signs – used for people with learning disabilities – were used for some people whilst others it was non-verbal communication such as touch and smell. When we visited Rowan Close we met three of the people living at the home and observed how they were cared for and treated. We observed two senior support workers and activities co-ordinator engaged with people in a positive way.

People were asked for their consent for some day to day care needs in an appropriate way. They received nutritious meals and had a choice of what and where they ate. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The service has appropriate recruitment and selection procedures in place and there was an effective complaints system available.

People who lived at the home were able to communicate using different forms of communication. Staff told us that Makaton signs – used for people with learning disabilities – was used for some people whilst others it was non verbal communication such as touch and smell. When we visited Rowan Close we met four of the people living at the home and observed how they were cared for and treated. We observed two senior support workers and activities co-ordinator engaged with people.

The atmosphere within the home was calm and relaxed with two people finishing their breakfast at the time of our visit. One person was in bed and did not wish to be disturbed and the staff respected their wishes.

We were introduced to people and observed staff use different communication methods with each person that ensured they knew we were there and visiting their home.

This inspection was carried out by an inspector on 5 and 6 October 2015.

Rowan Close provides accommodation for up to six people who require personal care. They provide support for people who may have a severe learning disability, complex physical needs, sensory impairments and epilepsy. The home has its own adapted vehicle. The service can offer a variety of activities in the local community and can also support holidays and trips away.

The home had a registered manager. 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 and associated Regulations about how the service is run.

Staff showed a good understanding of the needs of the people they supported. People were offered a choice of food and drinks which were sufficient for their needs and that met their dietary requirements. People’s hobbies and interests were documented and staff accurately described people’s preferred routines. Staff supported people to take part in activities both within the home and in the community.

There was a strong, visible person centred culture within the home. Staff identified creative and innovative solutions to delivering care that supported people to maintain their independence and to provide re-assurance when needed.

People, their families and their advocates were involved in planning and review of their care. Care plans were personalised and support was tailored to their individual needs. People’s risk assessments and care plans had been reviewed regularly to take account of their changing needs. Staff were knowledgeable about people’s health conditions and made referrals to health care professionals quickly when people became unwell or if they had concerns.

Relatives told us they were happy with the care people received. Staff treated people with kindness and compassion and respected people’s privacy and dignity. People’s end of life wishes were discussed, recorded and enabled and relatives told us their feelings were acknowledged and respected at these difficult times.

There were sufficient numbers of staff on duty to support people safely and meet their assessed needs. The provider had appropriate systems in place to recruit staff and appropriate checks were carried out before they commenced employment to ensure they were suitable for the role. Staff received an induction before they started work and were appropriately trained and skilled to deliver safe care. Staff undertook reflective practice which helped them improve the way they supported and interacted with people.

Safeguarding people was understood by staff who knew about their responsibilities to report any concerns of possible abuse. Individual and environmental risk assessments had been carried out and measures put in place to mitigate risks to people. There were robust systems in place to effectively manage the ordering, storage and administration of medicines.

Staff understood the requirements of the Mental Capacity Act 2005 and best interest decisions were made, where appropriate, and recorded in line with the Act.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm. We observed people’s freedoms were not unlawfully restricted and staff were knowledgeable about DoLS. Applications for DoLS had been made to the local authority when appropriate.

There were systems in place to monitor the effectiveness and quality of the service provided. Incidents and accidents were recorded and analysed, and lessons learnt were communicated to staff to reduce the risk of these happening again. Complaints procedures were in place although the home had not received any complaints.

There was an open and transparent culture within the home and staff and relatives said the manager was approachable. Staff understood the vision and values of the service and were actively involved in the development and improvement of the service. The provider understood their responsibility to inform the commission of important events and incidents that occurred within the service, such as safeguarding concerns and DoLS authorisations.