About the service: Rowena House is a care home that provides accommodation for up to 22 older people. At the time of the inspection 14 people were using the service.

Rating at last inspection: At our inspection on 6 February 2018 the home was rated inadequate overall and was placed into ‘Special Measures’. At our last inspection 20 and 21 September 2018 we noted that improvement had been made and the overall rating for home was ‘Requires improvement’. However, the home remained in 'special measures' because they had been rated as 'Inadequate' in at least one key question over two consecutive comprehensive inspections.

At our last inspection 20 and 21 September 2018 we found breaches of regulations because medicines were not always managed safely, risks to people were not always property assessed, appropriate recruitment checks had not always been carried out before staff started work and the provider’s quality assurance processes were not operating effectively. We also found a breach of regulations because the registered manager in post at that time lacked an understanding of their regulatory responsibilities. They had not identified safeguarding incidents at the service as being potential incidents of abuse, despite similar concerns having been raised with them at the previous inspection amounting to a breach of regulations. Improvement was also required because some people’s end of life support preferences had not been discussed with them or their relatives. At that inspection a new manager had been appointed to manage the home. They had made some improvements in the way the service was operating.

At this inspection we saw that the manager had addressed these breaches and were compliant with the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The manager told us they had applied to the CQC to become the registered manager for the home.

People’s experience of using this service: Risks to people using the service were assessed, reviewed and managed appropriately. People’s medicines were managed safely. There were safeguarding adult’s procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks were being carried out before staff started working at the home and there were enough staff to meet people’s needs. There were procedures in place to reduce the risk of the spread of infections.

People’s care and support needs were assessed before they moved into the home. Staff had received training and support relevant to people’s needs. People were supported to maintain a balanced diet. 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 support this practice.

Staff treated people in a caring and respectful manner. People’s wishes relating to their end of life care needs had been discussed with them or their relatives [where appropriate] and recorded in their care files. People and their relatives [where appropriate] had been consulted about their care and support needs. People were supported to participate in activities that met their needs. The home had a complaints procedure in place.

The manager had effective systems in place to assess and monitor the quality of the service. They had worked in partnership with health and social care providers to plan and deliver an effective service. The provider took people, their relatives, staff and health and social care professionals views into account through satisfaction surveys and meetings. Feedback from the surveys and meetings was used to improve on the service. Staff enjoyed working at the home and said they received good support from the manager. Management support was always available for staff when they needed it.

Why we inspected: This was a planned inspection based on previous rating.

As the provider has demonstrated improvements and the service is no long

This inspection took place on 20 and 21 September 2018 and was unannounced. Rowena House Limited 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 home accommodates up to 22 people in one adapted building. There were 16 people living at the service at the time of our inspection.

As a result of our last inspection in February 2018 we took enforcement action and served a warning notice on the provider and registered manager requiring them to make improvements in order to ensure the home environment was safe; that identified risks to people were safely managed and; to ensure people’s medicines were managed safely. At this inspection we found that whilst the provider had acted to address many of the issues we had previously identified, there remained some shortfalls amounting to a continued breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Risk assessment tools, including the Malnutrition Universal Screening Tool (MUST) had not always been used correctly when assessing risks to people. People’s care plans did not always include guidance for staff on how to manage identified risks safely. The provider had acted to improve fire safety at the service but further action was required to reduce the risk of legionella and to ensure the environment was safe.

Improvements had been made to the recording of the administration of people’s medicines and to the provider’s processes for receiving and disposing of medicines. However, we also found prescribed creams were not always securely stored and there continued to be a lack of guidance in place for staff on the support people required to take medicines which had been prescribed to be taken ‘as required’.

As a result of our last inspection in February 2018 we took further enforcement action and served a warning notice on the provider and registered manager requiring them to make improvements to their systems for monitoring the quality and safety of the service. At this inspection we found that whilst improvements had been made to address many of the issues we had previously identified, there remained further areas in need of action, amounting to a continued breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Checks on the safety of the environment had not always regularly been conducted and had not always identified issues in order to drive improvements. Staff had not carried out any audits of people’s care plans in the time since our last inspection which may have helped identify the issues we found with people’s risk assessments. The provider was unable to demonstrate that routine checks had been carried out to monitor for the risk of legionella. Whilst improvement had been made to the process used for auditing people’s medicines, medicines audits had not identified the issues we found in regard to the lack of guidance in place for staff on medicines prescribed to people to be taken ‘as required’.

At our last inspection in February 2018 we asked the provider to take action to make improvements in order to protect people from the risk of abuse because allegations of abuse had not always been reported to the local authority safeguarding team. This action had not been completed; we found details of further incidents which had not been reported to the local authority safeguarding team where required amounting to a continued breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our last inspection in February 2018 we asked the provider to take action to make improvements to ensure they followed safe recruitment practices. This action had not been completed; one staff member had been working at the service without a criminal records

This inspection took place on the 6 and 7 February 2018 and was unannounced. Rowena House Limited 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. Rowena House Limited accommodates up to 22 people in one adapted building. There were 20 people resident at the service at the time of our inspection.

At the last comprehensive inspection in January 2017 we found breaches of Regulations 9, 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 due to concerns with the lack of activities on offer at the service, the provider’s practice around managing the risk of people choking, and with the provider’s recruitment practices. Following that inspection the provider wrote to us to tell us the action they would take to address our concerns.

At this inspection, we found that whilst the provider had addressed the individual concerns identified at our last inspection, there remained concerns amounting to breaches of regulations because risks to people were not always managed safely and the provider could not always demonstrate that sufficient checks had been made on the suitability of the staff working at the service.

We also found further breaches of regulations because safeguarding allegations had not consistently been reported to the local authority safeguarding team, furniture in the premises was worn and in need of replacing, and medicines and the risk of infection were not safely managed. Staff were not always supported in their roles through training and supervision, people were not always lawfully deprived of their liberty and the provider’s systems for monitoring the quality and safety of the service were not effective in identifying issues or driving improvements.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The service had 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. The registered manager had submitted notifications about important events to CQC where required, but we found improvement was required to ensure they understood all of their responsibilities in order to meet legal requirements.

There were sufficient staff deployed to meet people’s needs, although improvement was required to increase the number of staff employed by the service in order to reduce the frequency at which agency staff were used to cover shifts. The provider reviewed records of accidents and incidents to determine whether any changes were needed to the way in which they were supported, but improvement was required to ensure accidents and incidents were consistently reported and recorded.

Staff sought consent from people when offering them support and understood the process to follow in supporting people to make decisions in their best interests where they lacked capacity to do so, in line with the requirements of the Mental Capacity Act 2005 (MCA). People’s needs were assessed and these assessments formed the basis on which their care plans were developed, although improvement was required to ensure care plans accurately reflected people’s individual needs and preferences.

People received support from staff to eat and drink and records confirmed dietary advice had been sought from healthcare professionals, where appropriate, but improvement was required to ensure kitchen st

Rowena House Limited is a care home that provides accommodation for up to 22 older people. There were 17 people using the service at the time of our inspection.

This inspection was prompted in part by a notification of an incident following which a person using the service sustained a serious injury. This incident is subject to a safeguarding investigation and as a result of this we did not examine the circumstances of the incident at this inspection. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of pressure sores. This inspection examined those risks.

We found that assessments had been carried out to assess the risk to people in relation to their skin integrity and pressure sores. Staff checked people daily during personal care for skin redness on pressure areas. Staff told us that any change to people’s skin integrity would be reported to the registered manager and the GP and district nurse would be called to attend the home. We saw that the district nurse had recently been made aware of the high risk to a person using the service developing pressure sores. The district nurse had advised the home to monitor the person skin daily and contact them directly should there be any problems.

At this inspection we found breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities), Regulations 2014 in relation to safe care and treatment, staffing and person centred care. We found that action had not been taken to support a person where risks to them had been identified in relation to eating and drinking. Appropriate recruitment checks did not always take place before staff started work. People using the service were not receiving person centred care that reflected their needs or their personal preferences. You can see what action we told the provider to take at the back of the full version of the report.

We found the provider had safeguarding adult’s procedures in place and staff had a clear understanding of these procedures. Staff had access to a whistle-blowing procedure and said they would use it if they needed to. There was enough staff on duty to meet people’s needs. People received their medicines as prescribed by health care professionals.

All staff had completed mandatory training in line with the provider’s policy; they were receiving regular formal supervision and, where appropriate, an annual appraisal of their work performance. The registered manager and staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and acted in accordance with this legislation. People were being supported to have a balanced diet and they had access to health care professionals when they needed them.

Staff knew people well and had developed positive caring relationships with them. People using the service and their relatives, where appropriate, had been consulted about their care and support needs. They were also provided with a brochure that included information about the home and the standard of care they should expect. People’s privacy and dignity were respected.

People’s care plans and risk assessments provided guidance for staff on how to support them with their needs. Where people’s needs had changed, their care records were being updated to reflect the changes. People and their relatives knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

The provider recognised the importance of regularly monitoring the quality of the service. However the registered manager was not aware of some of their responsibilities with regard to the Health and Social Care Act 2014. Some of the homes administration records had not been kept up to date. The provider took into account the views of people using the service and relatives through surveys. They carried out unannounced visits to the home to make sure people wh

At our last inspection of the service on the 22 April 2014 we found that people could be at risk as the appropriate recruitment checks were not always in place. There was a breach of Regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We asked the provider for an action plan to tell us how they would become compliant with this regulation. Prior to this inspection CQC received anonymous information about the service in which concerns about the condition of the premises and the staffing levels were raised.

We carried out this inspection to check that the provider had taken appropriate steps to comply with the compliance action and to follow up on the concerns that had been highlighted.

The inspection team who carried out this inspection consisted of one adult social care inspector. On the day of the inspection there were 18 people using the service. During the inspection, the inspector worked to answer one of our five key questions; Is the service safe?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with four of the care staff, the provider who was also the registered manager and a visiting health care professional. We did not talk with people at the service about the areas we inspected as most people were not able to communicate with us about these issues due to the level of dementia they experienced. We observed interactions between staff and people using the service in the communal areas throughout the day. We looked at records related to the service such as staff duty rosters, staff files and audits. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found inadequate systems were in place to identify risks to people from risks at the premises or risks from inadequate maintenance. Where maintenance was required it had not always been identified and where it had been identified risk assessments had not always been completed to manage and reduce risks to people who used the service.

Appropriate recruitment checks were now in place. We saw there were procedures in place to make all necessary recruitment checks on staff before they started work at the service.

There were sufficient levels of staff employed at the service. We found that the staffing levels matched the staff rota. People’s needs were responded to and met in a timely way. New permanent staff had recently been employed and regular agency staff were used where required.

We considered our inspection findings to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

People at the service were not able to express their views to us about this so we used the SOFI (Short Observational Frame work for Inspection) tool to observe the way staff interacted with people. We saw that people appeared relaxed and comfortable in the presence of staff and in the company of others. The atmosphere felt calm and convivial. There was no sign of any distress and interactions were warm and encouraging. People were asked for their consent, and verbal and non-verbal cues were checked for signs of consent or otherwise.

Records we looked at showed that staff regularly reviewed and checked potential risks to people's safety, health and welfare at the service. There was appropriate guidance for staff on how to manage these risks and keep people safe from harm when providing care and support. Staff were aware of safeguarding vulnerable adult procedures and what to do if they had concerns.

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, relevant staff understood when an application should be made and how to submit one.

Equipment at the service was maintained and checked regularly to make sure it was safe to use. External service contracts were in place as well as internal checks, most but not all internal checks had been regularly recorded. Issues had been identified with a supplementary boiler and we saw there was an action plan in place to address this. New equipment had been bought where the need was identified.

Staff on each shift were trained to deal with emergencies. The provider was available on call in case of emergencies and there was a contingency plan in place.

However recruitment practices were not always robust. While some checks e.g. right to work, identity and Disclosure and Barring Service clearance were made before staff started work, there were inadequate checks on staff character and employment history. Health declarations were not completed by staff prior to commencing work.

Is the service caring?

Two people we spoke with at the service were able to express their views about the care they received. One person told us “I am being well looked after.” Another person said “It is ok here. The staff are nice.” We spoke with a relative of someone who uses the service they told us they were happy with the care provided and said "The staff are lovely, very helpful. Everyone is very caring. I cannot fault it there at all. They have always provided good care and X has been very happy there. We are kept up to date with any changes and invited to reviews."

During our inspection we observed that staff supported and interacted with people displaying patience, respect and warmth. People’s consent was sought as much as possible before providing care. People who used the service were appropriately dressed and had been supported with their personal care and choices regarding their meals and activities for the day. We observed that there were enough staff to meet their needs, people were not rushed or seen to be waiting for support. Activities were provided and we saw that staff encouraged people to interact during the day.

People’s interests, past history, health needs and their preferences for care and support had been documented and were regularly reviewed. This provided staff with a picture of people’s needs and enabled them to engage with people in an appropriate manner.

Is the service effective?

People’s care plans provided detailed information to staff about their needs. These were regularly reviewed to check they were appropriate. However, the latest care plan was only available electronically. The provider advised they would print out the plans as a matter of urgency so staff had access to an up to date copy.

The provider had a business plan that was aimed at improving the service. Work was being carried out to improve the flooring and fire safety in the home at the time of the inspection. There was a system of regular checks and audits across aspects of the service. These include health and safety checks and spot checks of night staff.

People who use the service, their representatives and staff were asked for their views about the care and treatment provided within the home, although it was not clear that there was an effective process in place to use all comments to inform any changes.

Is the service responsive?

The provider told us they tried to respond to people's needs as far as possible. For example a person who used the service helped with the trolley at meal times as they had been a chef and wanted to be involved. People’s preferences or wishes were responded to as far as possible.

We saw that people’s care plans and risk assessments were updated following a fall or other change in their situation. Families or people’s representatives were kept informed about any changes and health professionals were contacted if a need arose.

Where problems with equipment had been identified an action plan was in place which was being reviewed.

Is the service well led?

We observed staff undertaking tasks and providing care and support to people in a competent manner. People in the home interacted positively with staff. Most people were unable to express their views to us but our observations suggested that they were content with the care and support they received within the home.

Staff we spoke with were knowledgeable about policies and procedures at the service as well as people’s individual needs. They said they had received sufficient training to carry out their work and that they were well supported to do their job. They felt they could bring any issues to the staff meetings. Several commented that the provider was very approachable. One person said “You can go to them with anything and they will listen.”

People we spoke with said they were happy with the care they received. They said the staff were respectful and friendly. People said they felt staff supported them in they way they wanted and were caring and helpful.

The people we spoke with said that staff were kind and looked after their needs. They told us they were happy and satisfied with the service.

However, we found that people’s care plans did not reflect their changing needs and staff failed to undertake appropriate risk assessments. We also found a lack of assessment of the suitability of the care plans and other aspects of service delivery including safety of the premises.

People we spoke with told us they were happy and satisfied with the service. They told us they were kept well informed. One person said- "the service is excellent”; another said “never had any reason to complain".

The relatives we spoke with at the time of the visit were very happy with the way their relatives were cared for and looked after by the staff. They said that they always found the home clean and the staff welcoming. They said that they were kept informed and were involved in the care planning and were encouraged to bring in pictures, photographs and small items of furniture to personalise their relative’s room.

The inspection took place on 23 July 2015 and was unannounced. A further announced visit was made on 14 August 2015. .

Rowena House Limited is a care home located in Beckenham, Kent that provides accommodation for up to 22 older people. There were 19 people using the service at the time of our inspection.

We last inspected Rowena House Limited in September 2014. At that inspection we found that improvements were needed to make sure people were provided with a safe environment. Following that inspection the provider sent us an action plan to tell us the improvements they were going to make. At this inspection we found that the actions we required had been completed and this regulation was now met.

There was a registered manager in post at the time of our inspection. 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.

People felt safe living at Rowena House Limited and spoke positively about the care provided to them. Staff knew people well and treated people with kindness, dignity and respect. Relatives and friends were welcomed and people were supported to maintain relationships with those who matter to them. Visitors spoken with were positive about the service being provided and said they could visit at any time. They spoke about the relaxed and homely atmosphere and this was evident on both days we visited.

Staff had received training around safeguarding vulnerable people and knew what action to take if they had or received a concern. They were confident that any concerns raised would be taken seriously by senior staff and acted upon.

People were supported to take their medicines as prescribed and to access to healthcare services when they needed them.

Appropriate recruitment checks took place before staff started work. Staff received training and on-going support to help them perform their allocated job role.

The service understood and complied with the requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

There was a system in place for dealing with people’s concerns and complaints. The registered manager understood their role and responsibilities and positive feedback was received from people and staff about the senior staff team working at Rowena House Limited.

There were systems in place to help ensure the safety and quality of the service provided.