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Howlish Hall Residential Care Home Good

Reports


Review carried out on 4 November 2021

During a monthly review of our data

We carried out a review of the data available to us about Howlish Hall Residential Care Home on 4 November 2021. 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 Howlish Hall Residential Care Home, you can give feedback on this service.

Inspection carried out on 8 June 2021

During an inspection looking at part of the service

About the service

Howlish Hall Residential Care Home is a care home providing accommodation and personal care to up to 40 people. On the day of our visit, there were 28 people using the service, some of whom were living with a dementia type illness.

People’s experience of using this service and what we found

The home had effective infection prevention and control procedures in place. Staff wore appropriate PPE and were regularly tested for COVID-19 in line with government guidance. The home was clean and tidy. One person told us, “The home is beautifully clean.”

Staff treated people in a kind, respectful and compassionate manner. Staff were knowledgeable about people’s individual needs, wishes and preferences. People were involved in decisions about their care, offered choice, and encouraged to give feedback.

People received person-centred care and care plans in place were up to date to reflect people’s current needs. People were given information in a way which they could understand and people were supported to communicate effectively. People were encouraged to take part in activities which were relevant to them. Complaints were dealt with appropriately.

There was a positive culture throughout the home and staff morale was good. Staff felt supported by the registered manager. Effective quality assurance systems were in place. Management engaged and involved people who used the service, staff and relatives, and encouraged open and honest feedback. Action plans were in place to support continuous improvement.

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 requires improvement (published 21 October 2020).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 26 March 2019. At that inspection we found improvements were needed in the key questions of caring and responsive.

We undertook this focused inspection to check whether the provider had made the necessary improvements to improve the rating of those key questions and improve the overall rating of the service to good. This report only covers our findings in relation to the key questions caring, responsive and well-led.

We carried out an unannounced focused inspection of this service on 27 August 2020 where we looked at the key questions safe and effective. The ratings from that inspection for those key questions 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 from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection and our last focused inspection, by selecting the ‘all reports’ link for Howlish Hall Residential Care Home 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.

Inspection carried out on 27 August 2020

During an inspection looking at part of the service

About the service

Howlish Hall Residential Care Home is a residential care home providing personal care to 27 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

People’s experience of using this service and what we found

People told us they were safe living at Howlish Hall Residential Care Home. Staff understood the procedures to keep people safe and knew how to report concerns. Previous safeguarding concerns had been referred to the local authority and investigated.

People and staff gave positive feedback about staffing levels. The home was clean when we visited. Health and safety checks and risk assessments were completed to maintain a safe environment. Incidents and accidents had been investigated and action taken.

Staff confirmed they received good support and had access to the training they needed. People gave positive feedback about the meals they received. Staff supported people to access healthcare services when needed.

Staff gave very positive feedback about the new manager. The provider had a structured approach to quality assurance. A range of checks were completed and these were effective in identifying areas for improvement. People and staff had opportunities to share their views about the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update: The last rating for this service was requires improvement (published 26 March 2019) and there were multiple 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

We carried out an unannounced comprehensive inspection of this service on 26 March 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and effective which contain those requirements, in addition to the well-led key question.

As part of CQC’s response to the coronavirus pandemic we are also conducting a thematic review of infection control and prevention measures in care homes. The Safe domain also therefore contains information around assurances we gained from the registered manager regarding infection control and prevention.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains 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 Howlish Hall Residential Care Home 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.

Inspection carried out on 27 August 2019

During an inspection looking at part of the service

About the service

Howlish Hall is a residential care home providing accommodation and personal care for up to 40 people aged 65 and over. There were 28 people living here at the time of our inspection.

People’s experience of using this service and what we found

The provider and the manager had taken steps to improve the service and ensured people received safer care. An action plan to address the warning notice carried out by CQC had been implemented. All the requirements of the warning notice had been met.

Staff supported people to access chairs which were suitable for their height and enabled them to better stand up. People’s care records had been updated to include nutritional information and the use of bed rails. Actions had been taken to reduce the risk of people becoming trapped in the bed rails.

Audits to measure the effectiveness of the service had been improved. They now included checks on bedrails, emergency pull cords and topical medicines.

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 and systems in the service supported this practice.

Rating at last inspection and update:

The last rating for this service was requires improvement (published 29 June 2019) when there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Following our last inspection, we served a warning notice on the provider and the registered manager. We required them to be compliant with Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 31 July 2019.

Why we inspected

This was a targeted inspection based on the warning notice we served on the provider and the registered manager following our last inspection. CQC are conducting trials of targeted inspections to measure their effectiveness in services where we served a warning notice. The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance of the service.

We undertook this targeted inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the governance of the service. The overall rating for the service has not changed following this targeted inspection and remains requires improvement. This is because we have not assessed all areas of the key questions.

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.

Inspection carried out on 26 March 2019

During a routine inspection

About the service: Howlish Hall is a residential care home that was providing personal care to 27 people aged 65 and over at the time of the inspection. The service can accommodate up to 40 people.

People’s experience of using this service: During our inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to ensuring the safe care of people, staffing and effective governance arrangements.

The service had recently used agency staff but had not reassured themselves that the agency staff were suitable to work in the home. Pre-employment checks were carried out on permanent staff before they began working in the service. Staff were supported through induction and training, although they did not receive supervision in line with the provider’s policy.

Further work was required in the service to ensure people were safe. This included making emergency pull cords accessible and ensuring seating for people in the lounge was appropriate.

Checks on the service to monitor its effectiveness and quality failed to identify the deficits we found during the inspection. Some improvements such as fire safety and the updating of policies had taken place. However, this is the third successive CQC report when the service has required improvement.

Staff told us they felt supported by the registered manager who was working on shifts as a senior carer. This reduced their capacity to manage the service and implement improvements.

Improvements were required in people’s meal time experiences. The approach of staff in supporting people to eat was variable and not always dignified.

Staff were trained and assessed as competent to administer people’s medicines. Oral medicines were safely administered. There were gaps in the records held by the service on people’s topical medicines.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were given choices and their decisions were respected. However, we found the documentation used to assess people’s capacity was not in line with Department of Health guidance.

A new electronic system was being introduced by the provider to record people's care needs. Information had yet to be transferred and updated from the paper records to the electronic records. Further work was required to ensure these records provided clear guidance to staff on how to meet people’s care needs.

Accidents and incidents were documented by staff and reviews of the information was carried out by the registered manager who checked to see if they could have been avoided.

The service employed an activities coordinator who ran daily activities. Staff supported the activities by helping people join in the games.

Risks of cross infection were reduced as regular cleaning took place. Staff used gloves and aprons to avoid the spread of any infections.

People were protected by staff who were trained in safeguarding. Staff described to us scenarios where they had made alerts to the local authority when they had concerns about people’s welfare.

People were complimentary about the care they received from staff. They told us staff protected their privacy and promoted their independence.

People who used the service and their relatives were invited to participate in the service through quarterly meetings. Relatives had contributed raffle prizes to the service. Their views had been sought using a questionnaire. They had suggested improvements were required in the décor and the gardens.

Staff had asked people about their end of life wishes. These were documented in people’s files together with decisions on whether to be resuscitated.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: The overall rating was Requires Improvement (Published 20 December 2018.)

Why we inspected: Following the last inspection the provider sent us an action plans outlining how they intended to improve the service. We carried out this inspection to monitor the improvements and address concerns raised with us by the local authority.

Enforcement: During our inspection we found a repeated breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the lack of effective governance in the service. We took enforcement action and served the provider and the registered manager with a warning notice.

Follow up: We will continue to monitor the service through the information we receive and discussions with partner agencies. We will be speaking to the provider about their next steps to improve the service to an overall rating of Good.

Inspection carried out on 13 November 2018

During a routine inspection

This inspection took place on 13 and 16 November 2018 and was unannounced. The provider knew we would be returning for a second day but not when.

Howlish Hall 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 service is registered for 40 people and at the time of inspection there were 31 people living at the service.

A registered manager was in post at the time of the inspection visit, although they were absent on both days. They were registered with the Care Quality Commission in July 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.

The last inspection of the service was carried out in November 2017 and was rated requires improvement. We found that the service was not meeting all the requirements of Health and Social Care Act 2008 and associated Regulations. We found concerns relating to their emergency policies and procedures not always being followed, records were not effective at monitoring and recording staff training and the provider’s systems for assessing, monitoring and improving standards at the service were ineffective. Following this inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good.

At this inspection we found that the provider had made some improvements however we found further improvements were required to become fully compliant with the Fundamental Standards of Quality and Safety. This is the second time the service has been rated requires improvement.

We found concerns with the safe administration of medicines, fire drills did not support staff to keep people safe and the personal emergency evacuation plans (PEEPs) were not in place for two people and were in place for one person who had left the service. The purpose of a PEEP is to provide staff and emergency workers with the necessary information to evacuate people who cannot safely get themselves out of a building unaided during an emergency. Following the inspection the fire service completed an inspection of the service and provided an urgent action plan for the provider to follow.

Audits were taking place; however, they were not robust enough to highlight the issues we found during our visit. Records, were difficult to locate and once found in no order. It was highlighted at the last inspection that the provider did not complete any quality assurance checks at the service and the registered manager did not record their daily walk around. We asked to see them at this inspection and we were told there were no records kept of daily walk arounds and the provider does not complete any records to evidence checks of the service.

Risks assessments arising from people’s health and support needs needed to include more information to minimise the risk, be more person centred and to be updated or new risk assessment put in place when people’s needs changed.

Risks arising from the premises were not always assessed. Doors leading to stairwells were not locked on opening but were locked on closing. Meaning if a person opened the door on the bottom floor they could climb upstairs but be greeted by a locked door and have to go back down, a person opening the door on the top floor would not be able to get back in once the door shut and would have to navigate the stairs.

People who lived at the service were safeguarded from abuse. People told us that they felt safe at the service and that they trusted staff. Staff were booked in for refresher training in the safeguarding of vulnerable adults and said they would not hesitate to report concerns.

The registered manager understood their responsibilities in relation to the Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems in the service supported this practice. Records relating to who had DoLS in place were not updated in a timely manner, therefore staff were not fully aware of who had a DoLS in place. We did not see evidence of consent being recorded in all the files we looked at or evidence to show consent had been provided verbally.

Some areas of the service needed a deep clean and updating. The provider had a refurbishment plan stating all works would be completed by December 2019.

Accidents and incidents were recorded and monitored for trends and patterns.

Staff training was up to date. Supervisions were up to date and appraisals were in the process of taking place and booked in.

We found there was sufficient staff employed to support people with their assessed needs on the day of the inspection. However, an extra member of staff had been brought in and the activity coordinator was being used to support care staff, taking them away from their own role.

Appropriate recruitment checks were carried out before staff were employed to ensure they were suitable to work with vulnerable adults.

Feedback on the quality of the service had been sought.

People enjoyed the food provided.

People were supported to continue with their preferred religious needs.

Staff demonstrated a person-centred approach to care and they knew people well. Care plans had very limited information of people’s wishes, preferences and life histories, but staff we spoke with had a good knowledge of this

We saw evidence of activities taking place and people we spoke with enjoyed them.

The service had a complaints policy that was applied when issues arose. People and their relatives knew how to raise any issues they had. The service had received four complaints since the last inspection.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

Following the inspection the provider assured CQC that they have arranged for urgent works to be completed immediately. They had followed the fire services action plan and arranged a full independent review of the service.

This service has received a rating of 'Inadequate' in one or more domains 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.

Inspection carried out on 1 November 2017

During a routine inspection

This inspection took place on 1 November 2017 was unannounced. This meant the registered provider and staff did not know we would be visiting. This service was last inspected in November 2015 and was rated Good.

Howlish Hall Nursing and Residential Home 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. The service accommodates 40 people across two floors. At the time of our inspection 38 people were using the service.

The service 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 2008 and associated Regulations about how the service is run.

The provider had policies and procedures in place to support people in emergency situations. However, these were not always consistently applied or carried out. Staff received the training they needed to support people effectively but that training records were not effective at monitoring and recording staff training. The provider’s systems for assessing monitoring and improving standards at the service were ineffective.

Risks arising out of people’s support needs were assessed and plans put in place to reduce the chances of them occurring. The premises were clean and tidy and staff understood the principles of infection control. People’s medicines were managed safely. Policies and procedures were in place to safeguard people from abuse. The provider’s recruitment process minimised the risk of unsuitable staff being employed. Staff also gave us mixed feedback on staffing levels.

We made a recommendation that the registered manager uses a recognised staffing tool to monitor and plan staffing levels.

Staff were supported through regular supervisions and appraisals. 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. People were supported to maintain a healthy diet and to access external professionals involved in their healthcare. The premises had been adapted to meet the needs of people living there.

People spoke positively about the care they received at Howlish Hall, and described staff as kind and caring. Relatives also spoke positively about the caring nature of staff and they support they delivered to people. Staff had close but professional relationships with people living at the service. People and their relatives told us staff helped them to maintain their independence but were always available to provide support when needed. Throughout the inspection we saw lots of examples of kind and caring support and of warm and friendly interactions between people and staff. People were supported to access advocacy services where needed.

People received personalised care that was responsive to their needs and preferences. Care plans were regularly reviewed to ensure they reflected people’s current support needs and preferences. People told us they were supported to take part in activities they enjoyed. Policies and procedures were in place to investigate and respond to complaints. Policies and procedures were in place to arrange end of life care where appropriate.

Staff spoke positively about the culture and values of the service. One member of staff said, “It’s a beautiful home. People and their relatives also spoke positively about the ethos of the service. Staff said they were supported in their roles by the registered manager. Feedback was sought from people, relatives and staff and was acted on. The service had links with local organisations that were used to enhance the wellbeing of people using the service. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken. The rating awarded at our inspection of November 2015 was displayed at the premises as required by our regulations.

We found two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014, in relation emergency policies and procedures, training records and quality assurance systems. You can see what action we took at the back of the full version of this report.

Inspection carried out on 9, 10 and 11 September 2015

During a routine inspection

The inspection took place on 9, 10 and 11 September 2015 and was unannounced. This meant the registered provider or staff did not know about our inspection visit.

We previously inspected Howlish Hall Nursing and Residential Home on 8 August 2013, at which time the service was compliant with all regulatory standards.

Howlish Hall Nursing and Residential Home is a home in Bishop Auckland providing accommodation and nursing care for up to 40 older people who require personal care. 34 people were living in the home at the time of our inspection, 15 of whom were living with dementia.

The service had a registered manager in place. 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.

We began the inspection on the evening of 9 September 2015 in response to concerns raised with the CQC about levels of staffing overnight. We found that there were sufficient numbers of staff on duty in order to meet the needs of people using the service. All staff were trained or had training scheduled in core areas such as safeguarding, moving and handling, infection control and first aid. The service had a dedicated member of staff who organised training. We found that staff had an adequate knowledge of people’s preferences, needs, likes and dislikes.

We observed discreet and thoughtful interactions during our inspection and saw evidence in recorded documentation of the promotion of people’s right to dignified care. Relatives and external stakeholders told us that people were treated well and mostly agreed that the service was welcoming and effective.

There were effective pre-employment checks of staff in place and effective staff supervision and appraisal processes.

The service was mostly clean throughout and had acted on the majority of recommendations by the infection control team, although we did observe one requirement had not been acted on. During our inspection we also found a room used for storage and a sluice room left unlocked, which presented hazards to people using the service; these were rectified immediately.

Person-centred care plans were in place for all people using the service and the registered provider sought consent from people for the care provided. We saw that the registered provider was in the process of revising care planning and handover processes. We saw that there had been a number of failures to record aspects of care given, such as hourly positional checks and fluid intake records. The registered provider was able to show us that they had identified failings in the handover system used and had started the process of reviewing how all care plans and handovers were recorded.

The registered provider ensured relatives and healthcare professionals were involved in ensuring people’s medical, personal, social and nutritional needs were met.

The service had a robust set of policies and procedures to deal with a range of eventualities. Most people using the service we spoke with, relatives, staff and external professionals were complimentary about the management and ethos of the service.

The CQC monitors the operation of the Deprivation of Liberty Safeguards [DoLS], which applies to care homes. DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The registered manager was knowledgeable on the subject of DoLS and had provided appropriate paperwork to the local authority to deprive people of their liberty, where it was in their best interests.

Inspection carried out on 8 August 2013

During a routine inspection

In this report the name of the registered manager appears who was not in post and not managing this location at the time of this inspection. Their name appears because they were still a registered manager on our register at that time.

People told us they were happy with the care they received and staff checked they were in agreement with it. We saw staff consulted people before they provided care and support.

We found people's needs were assessed and care was planned in line with their needs. One person said, "They really look after me, they discuss how I want things all the time, it's brilliant."

Records were available to show that the manager monitored the administration records of medication. This meant that people's medicines were checked regularly by the manager to see that staff were administering, ordering and disposing of them properly.

Appropriate checks were undertaken before staff began work.

There was an effective complaints system available and a clear way of identifying complaints. We found that comments and complaints people made were documented and responded to appropriately.

Inspection carried out on 7 December 2012

During an inspection in response to concerns

People who used the service were happy with the care they received. One person told us "They (the care staff ) are lovely." Another person told us "They're angels." One of the staff we spoke with told us "I love working here."

We found people were generally happy with their surroundings although there were limited activities and some people said they were bored. Some people were concerned that if they wanted to participate in activities they had to go to the day centre within the home.

We saw staff at the home were respectful and courteous to people who lived there. Staff encouraged people to be independent and were knowledgeable about people's requirements.

We saw the home was clean and had a regular cleaning schedule in place.

We saw people's records were detailed and held relevant information, like visits from dentists, chiropodists and opticians.

Inspection carried out on 16 December 2011

During a routine inspection

Several service users spoke with us during this visit. Their comments were very positive about the service they received. One person said, �We�re very well looked after. All the nurses are lovely.�

Another said, �I love it here.�

Another person said, �I receive very good support, nothing is too much for them. I am respected here and they listen to what I have to say.�

One person said, �I would know what to do if I wanted to make a complaint.�

Another person said, �I have nothing to complain about, this is a wonderful place.�

One person said, �I love my bedroom because there are wonderful views of the gardens and countryside. I think the facilities here are excellent.�

Another person said, �It is always lovely and clean, I have no complaints at all.�

One person said, �I think they all do a very good job, I receive good support from them.�

Another person said, �All the nurses here are wonderful, they always have time for me, they work hard and do a very good job.�

A relative said, �I have no concerns at all, this place is exceptional.�

A visitor told us, �it�s fantastic - I can�t praise them enough for what they have done for my mother she has made a remarkable recovery since coming here. The care here is exceptional.�

A relative said, �It�s a very good service. I don�t know what we would do without it. I visit daily to see my wife and I have lunch and tea with her everyday. The staff team are a great support to my wife and me.�

Reports under our old system of regulation (including those from before CQC was created)