We carried out a review of the data available to us about Ann Marie Howes Centre on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Ann Marie Howes Centre, you can give feedback on this service.
Ann Marie Howes Centre is a purpose-built care home registered to accommodate and deliver personal care to a maximum number of 32 people. At the time of this inspection there were 20 people living at the Ann Marie Howe Centre, receiving personal care, who were over 65 years of age and living with dementia and/or physical disability.
People’s experience of using this service and what we found
Staff had received training in safeguarding and knew how to keep people safe. There were recruitment processes in place and recruitment checks were carried out before staff were appointed.
Medication was administered safely and staff supported people following good infection control practices.
People were supported by kind and caring staff who knew people well.
The new manager was implementing changes to improve the quality of the service and had carried out audits to monitor the quality and safety of the service. Surveys were completed to gather information about people’s views. Spot checks were carried out to ensure the quality of the service was maintained.
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 29 July 2020) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations
Why we inspected
The inspection was prompted in part by notification of a specific incident whereby the person using the service made allegations of sexual abuse. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. There were further allegations of poor care. A decision was made for us to inspect and examine those risks and we undertook a focused inspection to review the key questions of safe, and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not plan to inspect them. However, during the inspection, following positive feedback we received about the service, we decided to inspect the key questions of caring and responsive. Ratings from previous comprehensive inspections for those key questions not inspected were used in calculating the overall rating at this inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
The overall rating for the service has changed. The service has improved from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ann Marie Howes Centre on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The Ann Marie Howe Centre is a purpose-built care home registered to accommodate and deliver personal care to a maximum number of 32 people. At the time of this inspection there were 25 people living at the Ann Marie Howe Centre, receiving personal care, who were over 65 years of age and living with dementia and/or physical disability.
People’s experience of using this service and what we found:
Inspectors found care and treatment was not always provided in a safe way. The registered manager had failed to take prompt action to update peoples risk assessments, exposing people to harm. People had personalised care plans, but these were not always updated following a review or change in circumstances. People did not have personalised activity plans and people were not effectively supported to avoid social isolation.
Systems and processes were not effective in assessing, monitoring and mitigating the risks relating to environmental health, safety and welfare of people. Audits had not taken place for over a year, exposing people to harm. People did not have complaints but knew how to make a complaint if they needed to. The registered manager understood their duty of candour but did not operate a lessons’ learned process.
Infection control was not effectively managed, people were not always protected from cross contamination as continence pads, stoma bags, and personal protective equipment was not safely stored.
People were not always supported to maintain a balanced diet. Specific dietary needs were not always met, and fluid monitoring was ineffective. People did not always receive a coordinated approach between the care home and external health services. People did not always attend planned health care appointments or receive planned health care tests. This led to people experiencing on going symptoms and remaining at risk of ill health.
People received medications as prescribed. Staff did not always record the reason for administering `as required` topical creams, or the outcome of using them, preventing effective reviews of outcomes, for people using this medication.
People received mixed outcomes regarding promoting independence and being treated with dignity and respect. Staff were kind and caring and respected confidentiality and people’s privacy.
Staff received induction and refresher training and either had a health and social care qualification or had completed the care certificate.
MCA
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies in the service supported this practice but the systems did not.
The registered manager did not have a process for identifying when Deprivation of Liberty, (DoLS), authorisations expired and DoLS authorisations had expired prior to new authorisations being applied for. Staff were not clear on how DoLS related to their daily practice in delivering care, or which people had a DoLS in place.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 11 July 2017).
Why we inspected
This was a planned inspection based on the previous rating.
We have found evidence that the provider needs to make significant improvements. Please see the all sections of this full report. The provider has taken some action to mitigate the risks identified at inspection. You can see what action we have asked the provider to take at the end of this full report.
The overall rating for the service has changed from good to Requires Improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Anne Marie Howes Centre on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to safe care and treatment and good governance, at this inspection.
Please see the action we have told the provider to take at the end of this 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.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
At the last inspection, the service was rated ‘Good’.
At this inspection we found the service remained ‘Good’.
People were kept safe because staff had a good knowledge of current, good safeguarding practices and how to apply this when supporting people. People received safe care because risks had been identified and were managed effectively. Although people living at the home, relatives and staff felt there insufficient numbers of staff available, this was not evidenced on the day of our visit and we found there were sufficient numbers of staff available to ensure people received support as they wanted. People were supported to receive their medicine safely.
People were assisted by suitably trained and supported staff that had the knowledge and skills they needed to do their job effectively. People felt staff had a good knowledge of their support needs.
People were supported to have 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. The provider had taken suitable action when they had identified people who did not have capacity to consent to their care or treatment. Applications had been made to authorise restrictions on people's liberty in their best interests.
People were complimentary about the quality of food and were supported in their choice of meal. Health care professionals were involved in supporting people to maintain peoples’ health and wellbeing.
People were supported by caring and kind staff who demonstrated a positive regard for the people they were supporting. People had been encouraged to be as independent as much as possible. Care was reviewed, where possible, with the person and their relatives to ensure the care provided continued to meet people’s needs.
People and their relatives were aware of how to raise concerns or make complaints and were happy with how the service was managed. There were systems in place to monitor the quality of the service to ensure people received a good quality service.
The inspection took place on 5 and 9 of March 2015 and was an unannounced inspection. We last inspected the service on 8 October 2013. At the last inspection the provider was meeting all regulations inspected.
The home is located within a care centre which has other facilities available for people who live in the home to access if they wish.
Ann Marie Howes Centre provides accommodation for 32 people. The service did not have a registered manager in post. An application had been submitted to us for the current acting manager to become registered. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
People felt safe with the staff that supported them because staff knew how to protect people from harm. Procedures were in place that ensured the service was safe and that people’s rights were protected.
There were sufficient numbers of suitably recruited staff available to support people. Staff had received training that ensured they had the skills and knowledge to care for people.
People were consulted about their care so their wishes, choices and preferences were known so they could receive care on an individualised basis.
People were supported to access health care services and timely referrals were made to ensure people remained healthy.
People were supported to undertake activities of their choice in the home and out in the community. Facilities were available for activities and included computers and an activity centre.
Systems were in place to monitor and check the quality of care provided and where changes for improvement were required we saw that action was taken. External reviews by the provider was completed regular to support the manager of the service which included gathering people views about the service provided.
We saw that people using the service were asked in a number of ways how they wanted their care to be delivered so they were able to influence how their care is provided. We saw that dignity and privacy was promoted and maintained. One person we spoke with said, 'I can have what I want for breakfast and at the time I want it'.
Effective, safe and appropriate care was received by people using the service, to meet their needs. One relative spoken to said, 'The staff were all very good and they were happy their relative was safe here'.
There are suitable arrangements in place to ensure that people are safeguarded against the risk of abuse. People living at the home feel safe, and are confident that staff will protect them.
There were systems and procedures in place so that medicine was administered, stored and disposed of safely.
Evidence we gathered indicated that staffing levels were adequate and that staff were supported through appropriate training, so that people's needs were met by appropriately trained staff. Some people using the service told us that there was enough staff to meet their needs. One member of staff told us they 'really liked working here'.
On the day of our visit there were a total of 31 people living at Ann Marie Howes centre which included two people who were in hospital due to ill health.
There were two units within the service each with a separate lounge and dining area. The manager explained people had a choice of the two units and people where able to sit and eat where they pleased.
Some people were unable to verbally share with us their views about the care they recieved due to their health conditions or complex needs. We were able to look at other areas for evidence to support their experience such as sampling a set of care records, speaking to relatives and staff. We also used a short observational framework for inspection (SOFI).This is a specific way of observing care to help us understand the experience of people who could not talk with us. We used SOFI with four people living at Ann Marie Howes Centre.
We observed that people were relaxed and appeared settled and happy with their care. People reported that staff were caring and approachable. One person commented about staff and said they were "Very caring'.
People told us there were activities they could participate in like games and singing sessions. People commented they did not have to take participate in activities that they did not enjoy.
People said they enjoyed their meals and they were offered choice, one person told us the food was "Brilliant". During lunch time staff ensured that people were comfortable and had an adequate meal. We saw there was choice on the menu and people enjoyed their meals.
The relatives we spoke with were happy with the care received by their family members. We saw staff attended to people in a caring, considerate manner and responded appropriately to their needs. Staff were knowledgable about the needs of the people they were caring for. Staff were able to identify people who needed extra support as reflected in their care records.
Staff we spoke with showed understanding in areas of privacy and dignity. Staff understood what constituted abuse and said that they would be able to recognise and report poor practice. Staff were aware of their role in respect of prevention of falls and of how to respond to any difficult to manage behaviour, areas relevant to the people they cared for. This demonstrated people were cared for by appropriately trained staff.
Staff told us they were happy working at Ann Marie Howes Centre Home. One staff member we spoke with said "We are a good team". Staff felt trained and supported to provide good care.
We found the service was improving as a result of findings from their own audits. For example a team system was introduced so where possible people were cared for by the same group of staff.