This unannounced comprehensive inspection took place on 22 October 2018. The inspection was to follow up to see whether improvements had been made from the previous inspection in November 2017.

Rowena House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Rowena House is a care home situated in Conisborough, Doncaster and is registered to accommodate up to 40 people. The service is provided by Runwood Homes Limited. Accommodation is provided on both the ground and first floor. The service had several communal and dining areas and easily accessible secure gardens. On the day of inspection 33 people were living at Rowena House.

At the last inspection, on 14 November 2017, the service was rated requires improvement overall and in safe, effective, responsive and well led, and good in caring. Breaches of regulations 12, safe care and treatment and 17, good governance were found. This was because risks associated with people's care were identified but not always managed and systems in place to monitor the service delivery were not always effective.

At this inspection we found the service had made sufficient improvements to satisfy the previous breaches, although further improvements are required which require embedding into everyday practice.

A registered manager was in post. 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.

Staff understood their responsibility to report any concerns and were aware of the action to take if they suspected abuse had occurred. People were supported to manage their risks by staff who were aware of the need to protect people from avoidable harm. There were sufficient numbers of staff available to meet people's care and support needs. The provider recruited staff safely.

Most people received their medicines as prescribed. Medicine stocks did not always tally with those determined by the medication administration record. The environment was maintained, generally clean but some areas were in need of redecoration. Systems were in place to monitor infection control.

There were enough staff to ensure people were safe and had their needs met in a timely way. Staff had the skills and knowledge to carry out their roles and were supported by a system of induction, relevant training, one-to-one supervision and appraisals.

Staff understood their responsibilities under MCA, people's capacity had been assessed and when required best interest's meetings had been held and recorded.

People told us that they enjoyed the food. People had a choice of meals and were supported to maintain a healthy diet in line with their choices, preferences and any healthcare needs. People's health was assessed and monitored. Staff took prompt action when they noticed any changes or decline in health. Staff worked closely with health professionals and followed guidance given to them to ensure people received safe and effective care.

People's dignity and privacy was maintained by staff. People told us staff were kind and caring. Staff maintained people's dignity and encouraged choice and independence. Staff supported people to maintain friendships and relationships. People's friends and family could visit when they wanted and without restriction.

There were some activities available for people to enjoy, although the home did not have a dedicated activities staff member. Care records were personalised and detailed how people wished to be supported. Most provided clear information to enable staff to provide appropriate and effec

The inspection took place on 14 November 2017 and was unannounced. The last comprehensive inspection took place in November 2016, when the service was rated requires improvement. We found that staff did not receive appropriate support to carry out their role effectively. The registered provider sent us an action plan indicating what action they would take to address this breach.

At this inspection we found the registered provider had taken appropriate actions to meet the requirements of the breach. However, we also found risks associated with people’s care were identified but not always managed appropriately and that systems in place to monitor the service delivery were not always effective. The service rating remained as ‘requires improvement.’

You can read the report from our last inspections, by selecting the 'all reports' link for ‘Rowena House’ on our website at www.cqc.org.uk.

Rowena House is a care home situated in Conisborough, Doncaster which is registered to accommodate up to 40 people. The service is provided by Runwood Homes Limited. Accommodation was provided on both the ground and first floor. The service had several communal and dining areas and easily accessible secure gardens.

At the time of our inspection there was a registered manager in post. 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. However, the registered manager was also registered at another service.

We completed a tour of the home with the registered manager and identified some issues in relation to infection control. Some areas required attention and staff practice was not always in line with infection control procedures and guidance.

We looked at systems in place to ensure people received their medicines in a safe way. We found staff who administered medicines were appropriately trained to do so. Medicines were stored appropriately in a locked room. However, we found some concerns with the recording of medicines administered.

Risks associated with people’s care had been identified but appropriate actions had not always been taken to ensure people were safe.

We observed staff interacting with people and found there were enough staff to meet people’s needs. However, we received comments from people who used the service and their relatives, which indicated there were times that staff were not available.

The service had a safe recruitment system in place. Staff received an induction when they commenced employment at the service. This included shadowing other staff so they could get to know the people who lived at the home.

People had been referred to healthcare professionals when required but their advice was not always followed.

People we spoke with were complimentary about the meals they received. However, they were not always offered a meal which was suitable to meet their assessed needs.

The service was meeting the requirements of the Mental Capacity Act 2005. Where people lacked capacity, best interest decisions had been made.

The registered manager had a supervision and appraisal schedule in place. Staff we spoke with told us they received supervision on a regular basis.

People who used the service and their relatives were satisfied with the home and felt it provided a safe and comfortable environment where their preferences and wishes were upheld.

We looked at care plans and found they reflected people’s needs, although they lacked a person centred approach. We spoke with the registered manager about this and they informed us that they were currently working on the care plans.

We saw staff interacting with people and providing social stimulation. People who used the service told us they were involved in activities.

The registered provide

The inspection took place on 28 and 29 November 2016 and was unannounced on the first day. The home was previously inspected in January 2016. It was overall rated good but had one breach of regulation. Regulation 12 Safe care and treatment.

The service has a registered manager who had been registered with the Care Quality Commission since September 2013. 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.

Rowena House is a care home situated in Conisborough, Doncaster which is registered to accommodate up to 36 people. The service is provided by Runwood Homes Limited. At the time of this inspection there were 35 people living at the home. Accommodation was provided on both the ground and first floor. The service had several communal and dining areas and easily accessible secure gardens. The home was close to local amenities of shops and healthcare facilities.

At the previous inspection we found medication was not always administered as required by the prescriber. Gaps in the medication records meant some medications may have been missed. Some medication protocols were inaccurate which meant people may not have received 'as and when required' (PRN) properly. At this inspection we found improvements had been made and the registered manager had introduced weekly medication audits and PRN protocols had been put in place to direct staff when ‘as required’ medication was to be given. However we found some recently admitted people still required protocols to be put in place. These were in place before the inspection was concluded.

The requirements of the Mental Capacity Act 2005 were in place to protect people who may not have the capacity to make decisions for themselves. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made.

There were sufficient staff with the right skills and competencies employed to meet the assessed needs of people living in the home. Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food and drink. People we spoke with told us they enjoyed the meals and there was always something on the menu they liked.

People had limited access to activities. Staff were expected to include activities as part of their working routines. We observed an outside entertainer performing songs that were age appropriate on the first day of the inspection and the hairdresser was on site on the second day of the inspection.

We found the service had a friendly relaxed atmosphere which felt homely. Staff approached people in a kind and caring way which encouraged people to express how and when they needed support. Everyone we spoke with told us that they felt that the staff knew them and their likes and dislikes. One person said, “I like it here the staff are kind and friendly.” Relatives also confirmed to us that they thought the staff supported people appropriately and encouraged people to be involved in their care.

Formal supervision’s were not taking place at the frequency required by the provider. This had been highlighted by the regional care director at a recent audit. The registered manager was aware of this and was looking at ways to improve frequency. Five staff that we spoke with told us they had not recently received supervision and they told us that th

The inspection took place on 26 and 27 January 2016 and was unannounced on the first day. This was the first inspection of the service following the Care Quality Commission registration in September 2015. The service was previously registered under another provider.

The service has a registered manager who has been registered with the Care Quality Commission since September 2013. 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.

Rowena House is a care home situated in Conisborough, Doncaster which is registered to accommodate up to 34 people. The service is provided by Runwood Homes Limited. At the time of this inspection there were 21 people living at the home. Accommodation is provided on both the ground and first floor. The service has several communal and dining areas and easily accessible secure gardens. The home is close to local amenities of shops and healthcare facilities.

Medication was not always administered as required by the prescriber. Gaps in the medication records meant some medications may have been missed. Some medication protocols were inaccurate which meant people may not have received ‘as and when required’ properly. Medication was stored correctly and returned to the chemist if they were no longer required. You can see what action we told the provider to take at the back of the full version of the report.

The requirements of the Mental Capacity Act 2005 were in place to protect people who may not have the capacity to make decisions for themselves. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made.

There was a recruitment system in place that helped the employer make safer recruitment decisions when employing new staff. We found staff had received a structured induction and essential training at the beginning of their employment. This had been followed by regular refresher training to update their knowledge and skills. Staff knew how to recognise and respond to abuse correctly. They had a clear understanding of the procedures in place to safeguard vulnerable people from abuse.

There were sufficient staff with the right skills and competencies to meet the assessed needs of people living in the home. Staff told us they felt supported by the manager and provider, formal supervisions were taking place and appraisals were planned for later in the year.

Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food and drink. People we spoke with told us they enjoyed the meals and there was always something on the menu they liked.

People were able to access some activities although there was no dedicated activity co-ordinator. People told us they had enjoyed baking and having entertainment from outside the home. They also liked involvement from the local community. Some people told us they would like more activities as sometimes there was not sufficient happening.

There was a strong and visible person centred culture in the service. (Person centred means that care is tailored to meet the needs and aspirations of each individual.) We found the service had a friendly relaxed atmosphere which felt homely. Staff approached people in a kind and caring way which encouraged people to express how and when they needed support. Everyone we spoke wi