The inspection took place on 7 and 13 November 2018 and was unannounced on the first day and announced on the second day. At the last inspection on 17 and 21 August 2017 the registered provider was not meeting the regulations related to safe care and treatment, receiving and acting on complaints and good governance. The service was rated requires improvement in the key questions of safe, effective, responsive and well led.

Following the last inspection, we met with the registered provider and they sent us an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well led to at least good. At this inspection we checked to see whether improvements had been made and found the registered provider was not meeting the regulatory requirements relating to good governance.

Rowan Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Rowan Court is part of Holly Bank Trust which is an organisation specialising in providing education, care and support for young people and adults with profound complex needs. It was registered with the Care Quality Commission to provide accommodation for people requiring nursing or personal care, for up to 15 people. At the time of our inspection it was providing this service to 15 young adults.

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. The service was delivered in line with these values.

A registered manager was not in place, as they had left the service in 2017 and not yet de-registered. 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. The service had been managed by a manager from another service run by the same provider, and they had applied to register with CQC. They had also left the service in October 2018 after a period of absence and the home was being managed temporarily by a second manager from another service.

Relatives told us they felt their family member was safe at Rowan Court.

Medicines management had improved and a safe system was now in place. Staff had training in safe administration of medicines and staff competency checks on the administration of medicines had been refreshed in the last year. Incidents related to medicines errors were analysed and action taken to prevent future risks to people.

Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse and safe recruitment and selection processes were in place.

Emergency procedures were in place and staff knew what to do in the event of a fire. Risk assessments were individual to people’s needs and minimised risk whilst promoting people’s independence.

Detailed individual behaviour support plans gave staff the direction they needed to provide safe care.

The required number of staff was provided to meet people’s assessed needs.

Staff told us they felt supported. Staff had received an induction and role specific training, which ensured they had the knowledge and skills to support the people who lived at the home.

People were supported to eat a balanced diet, and meals were planned around their tastes and preferences. They were supported with diets of different consistencies and nutritional intake was monitored.

People were supported to maintain

We inspected Rowan Court on 17 and 21 August 2017. Both days of inspection were unannounced; this meant the service did not know we were coming.

Rowan Court is provided by Hollybank Trust, an organisation specialising in education, care and support for young people and adults with complex needs. Staff at the home refer to people who use the service as ‘adults.’ The premises were purpose built and located in the grounds of Holme Valley Memorial Hospital, in Thongsbridge. The home provides care and accommodation for up to 15 people; at the time of this inspection 15 people were using the service. The building has three floors and five people live on each floor; all rooms are ensuite.

The home had 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in June 2016 we identified a breach of regulation relating to good governance, as risk assessments were not always reviewed by the stated review date, and the manager at the time lacked oversight of safety and quality at the home. A second breach of regulation we identified related to staffing and was the result of issues with training. The home had been rated as Requires Improvement in the key questions of Safe, Effective and Well-led, and Good in Caring and Responsive.

On the first day of inspection we identified concerns with the way medicines were managed and administered. We fed this back to the registered manager the same day. On the second day of inspection, four days later, we found no improvements had been made.

Accidents and incidents at the home were not always recorded on the provider’s electronic system. Those which were on the electronic system did not always contain information about how they had been investigated and what measures (if any) had been put in place to prevent reoccurrences.

The provider and registered manager lacked oversight of safety and quality at the home; this was a concern at the last inspection in June 2016. The system of audit at Rowan Court was not fit for purpose.

The registered manager did not fully record how complaints had been investigated and resolved.

People’s care files contained a range of person-centred risk assessments. All but one we saw had been updated according to the stated review date. This was an improvement from the last inspection. Risks to people posed by the building, equipment and utilities had been managed.

People’s relatives, staff at the home, and other healthcare professionals told us sufficient staff were deployed to meet people’s needs. Our observations supported this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, there was no consistent approach to mental capacity assessment at the home.

Staff had access to the training, supervision and support they needed to provide people with effective care. This was an improvement from the last inspection.

People liked the meals cooked by staff at the home; risk assessments and guidance was in place to ensure people were supported to eat and drink safely. We found one person’s food and fluids charts had not been completed fully.

The building had been purpose-built for people with complex physical needs. People had specialist equipment which they had been assessed for and staff had the guidance they needed to support people with this equipment safely.

Records showed people had access to a range of healthcare professionals to help them maintain their holistic health. Feedback we received from healthcare professionals about the home was positive.

People indicated staff were caring

This inspection took place on 21 June 2016 and was unannounced. This meant the registered provider did not know we would be visiting. The service was last inspected in July 2014 and was meeting the regulations we inspected at that time.

Rowan Court is part of Holly Bank Trust, which is an organisation specialising in providing education, care and support for young people and adults with profound and complex needs. It is based in purpose built premises on the grounds of Holme Valley Memorial Hospital, close to Huddersfield. It provides care and accommodation for up to 15 people. At the time of our inspection 15 people were using the service.

There was a manager in place but they were not 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 2008 and associated Regulations about how the service is run. The manager was leaving the service at the end of June 2016 and a new manager had been appointed.

Risks to people using the service were assessed and plans put in place to minimise the chances of them occurring. However, we saw that risk assessments were not always reviewed by their stated review date. Risks to people arising from the premises were regularly reviewed.

Emergency plans were in place to support people safely in emergency situations, though they were not easily accessible. There was a business continuity plan in place to help provide a continuity of care in situations where the service was disrupted.

Accidents and incidents were monitored by the manager and registered provider and steps taken to minimise the risk of them occurring.

There was a safeguarding policy in place and staff understood the types of abuse that can occur in care settings. The safeguarding policy contained guidance to staff on indicators of abuse and how they should report any concerns they had. Staff confirmed there was a whistleblowing policy in place and said they would use it if they had any concerns.

People’s medicines were managed safely. People’s medicine support needs were set out in a medicine care plan. Protocols were in place providing guidance to staff on people’s ‘as and when required’ medicines. Controlled drugs were securely stored and regularly monitored.

Procedures were in place to ensure safe staffing levels. During the inspection we saw that people were attended to quickly and staff were attentive to people in their own rooms and communal areas. Staff told there were enough staff employed to support people safely. Procedures were in place to minimise the risk of unsuitable staff being employed.

Staff received mandatory training in a number of areas, but was not always refreshed in line with the registered provider’s policy to ensure it reflected best practice.

Newly recruited staff completed an induction programme before they could support people without supervision. Staff we spoke with confirmed they had completed the induction programme before supporting people on their own.

Staff were supported through regular supervisions and appraisals. Staff also completed competency checks in areas such as moving and handling and medicines to see if further training was needed, and we saw records of these in staff files.

The service worked within the principles of the Mental Capacity Act 2005. Everyone using the service was subject to a DoLS authorisation. The manager kept a chart showing when these had been granted, when they expired and any conditions that applied. This helped ensure that any renewal applications were made in a timely manner. Where people lacked capacity to make some decisions they were still encouraged and supported to decide things they were capable of.

People were supported to maintain a healthy diet. Care plans also contained evidence of the involvement

At the time of our inspection the registered manager was taking a planned day off. During this inspection we spoke with the three people who were living at Rowan Court, the senior member of staff on duty, three care workers and two relatives.

We considered all the evidence we had gathered under the outcomes we inspected.

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans were well organised and the information was clear.

We saw that there were risk assessments in place for bathing, tissue viability and fire safety. Where someone was assessed as being at high risk, such as from a diminished swallowing reflex, then control measures had been recorded to state how the risk would be minimised.

We saw there were robust systems in place to assess and check appropriate and safe care was being delivered. These included daily and monthly internal audits. These audits included infection control and mattress quality and suitability.

The provider had appropriate security arrangements in place to protect people who lived at the service. We found that the entrance door was secure and visitors could only enter the building with the knowledge of the staff. People indicated to us they felt safe and secure in the home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We spoke with two relatives who told us of their experience of the service. They told us the service was 'fabulous' and perfectly met both the needs of their relative and themselves. They said they felt confident that everything they and their relative needed would be provided.

Staff we spoke with were clear about the needs of the people they supported and what they told us was reflected in people’s care plans.

We spoke with staff who told us they felt well supported by the manager who arranged access to regular training and development to ensure they were able to deliver appropriate care.

Is the service caring?

We saw all people at the home appeared at ease and relaxed in their environment. We saw that people responded positively to staff with smiles when they spoke with them. We observed that staff included people in conversations about what they wanted to do and explained any activity prior to it taking place. We noted staff understood people's non-verbal methods of communication and were able to respond appropriately.

We saw that people were dressed appropriately for their age and the time of year. We noted people had been supported to express their personality, for example by having their nails painted in a colour of their choice or their hair styled in a particular way.

Care staff on duty told us they were responsible for providing people with meaningful activities that they enjoyed. We saw each person had a weekly timetable of activities. A care worker told us that these were guides used by staff to encourage people to participate in activities they might find enjoyable. With the help of staff people told us of activities they had been involved with. These included going to football matches, the zoo and to the horse racing. Smiles and positive body language indicated to us that these activities were greatly appreciated.

Is the service responsive?

We reviewed three people's care records and found they all had complex health care needs and received services from a range of secondary health care providers.

Our discussions with the senior social care officer on duty demonstrated the provider was fully aware of each person's individual care needs. Care plans and risk assessments were in place to be able to respond to frequently changing health care needs.

All people had a health passport which would accompany them in an emergency to hospital. The health passport was a document containing all current relevant information about a person including allergies, communication difficulties, current medication and known diagnoses. This ensured other health care professionals had access to meaningful information to help them act safely in emergency situations.

All care plans contained a specific section on communication. Our observations and scrutiny of care plans demonstrated the provider had explored every avenue of care to ensure people with profound communication problems were not isolated through their inability to communicate by speech.

Is the service well led?

Decisions about care and treatment were made by the appropriate staff at the appropriate level. There was a clear staffing structure in place with clear lines of reporting and accountability.

The staff we met were well trained and competent to make most of the routine care decisions. They said they knew when and how to report any issues or concerns and they were confident management would provide any necessary advice or support.

There was evidence that learning from incidents and investigations took place and as a consequence appropriate changes were implemented.

Our inspection demonstrated the provider had good governance arrangements in place. The provider was recognising its accountability, was acting on lessons learned and was honest and open in seeking the best possible outcomes for people. The service was well led.

Due to the complex needs of people living at Rowan Court and our inability to communicate with them verbally, we were only able to talk with one person to obtain their views about the care they received. They told us they were happy and received good care.

We observed staff were attentive to people's needs and appeared to know them well. Although people did not have capacity to consent to complex care decisions, we observed staff involving people in decisions. For example, asking them what they wanted to eat and drink and what activities they wanted to participate in.

We reviewed people's care records and spoke with a relative of a person living at Rowan Court. The care records we looked at were person centred and provided an accurate and up to date picture of their care needs and how their care needs were to be met. The relative whom we spoke with was very complimentary about the quality of care. They told us, "I can't praise it highly enough".

The staff we spoke with told us they provided good care and received the necessary training and support to enable them to so.

Due to the complex needs of the people living at Rowan Court, we were unable to seek their views about the service they received. In order to gain an understanding of people's views about the service, we spent a significant proportion of our time observing care practice. We saw positive interaction between staff and people using the service and staff spoke to people in a positive and kind manner. We saw staff knocking on people’s room doors prior to entry, which showed respect.