Howlish Hall Residential Care Home

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect. At our last inspection we rated this key question good. At this inspection the rating has changed to requires improvement: This meant people did not always feel well-supported, cared for or treated with dignity and respect.

The service was in breach of legal regulation in relation to:

Regulation 12, Safe care and treatment

This service scored 40 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Due to the concerns identified during the inspection, we could not be assured people received a high quality, compassionate and caring service. While staff demonstrated concern for people’s wellbeing in a caring manner, their interactions were largely task focused. During our observations, staff did not engage socially with people in communal areas, such as sitting and chatting with them in the lounge. This limited the opportunity for meaningful engagement and relationship-building.

People and their representatives spoke positively about staff and the care provided. Comment’s included, “They are lovely, very helpful” and “Couldn’t be looked after better, staff are very kind and respectful.”

However, one relative told us they worried about visiting their loved one and finding them wet due to staff not doing regular checks. They said staff sometimes walked past the person’s room and waved but didn’t come in and ask if they needed anything. They told us “Sometimes [person]’s personal hygiene is not attended to, I have visited, and they smelled, their hair was not washed. This is not kind or respectful, not dignified for [person].”

Staff did not always treat people as individuals or make sure people’s care, support and treatment met their needs and preferences.

We observed inconsistent staff responses to one individual who was repeatedly calling out. Some staff responded appropriately by offering reassurance, while others responded differently. We raised this with a staff member, who explained that staff should be offering reassurance and checking if the person was alright in such situations. When asked where this guidance was documented, the staff member stated it should be included in the person's behaviour support care plan. However, upon reviewing the behaviour support plan, we found no guidance in place to direct staff on how to respond consistently to this behaviour. This lack of clear guidance risks inconsistent care and may cause confusion or distress for the individual.

People were not consistently supported to take part in meaningful activities or maintain their independence and access the community. We observed an activity taking part in the lounge. Not everyone in the lounge was able to take part in the activity; some people were asleep, while others were watching television. The activity was not suitable to meet people needs, ability or interest.

An effective system was not fully in place to ensure that people’s independence, choice and control was promoted.

Care plans did not include details about individuals' hobbies or personal interests. People did not have access to community-based activities, and for younger people using the service, no links had been made to local support groups or age-appropriate opportunities. Activities were not planned in a way that reflected the differing ages, capabilities, or interests of the people living at the service. One person told us they "would like to do more."

Activities took place in the large lounge, which was also used by people for socialising and watching television. This meant those not wishing to participate in activities experienced disruption to their chosen routines. The activity coordinator informed us there were plans to use a smaller lounge for group activities in the future, allowing people more choice and reducing disruption.

Access to external outings, such as trips to the seaside, was limited. We were told the service would need to hire a suitable vehicle and arrange additional staffing for such trips. However, these activities were not funded by the provider, meaning staff would need to volunteer in their own time, which limited the ability to organise and deliver meaningful outings.

There were no restrictions on visiting which was in line with government guidance. People could see their friends and family when they wished.

People’s needs, views and wishes were not always understood or listened to. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

During our observations, we saw one person in the lounge attempting to move their chair by shuffling and pulling on a nearby table and shouting help. There were no staff present to assist, and no call bell was available within reach, leaving the individual without a way to summon help. When a staff member entered the lounge, the person called out for help and pointed toward a chair positioned in front of the television. The staff member responded by saying, “You are sitting there,” and instructed the person to “sit still,” without exploring the individual's request further.

On another occasion a staff member entered the lounge, and a service user called out to them. The staff member said “Just a minute [person’s name]” but then never came back.

One member of staff expressed concerns about staffing levels, stating that they felt more staff were needed to provide safe and effective care. They commented “Staffing was good for a while but not now.”

The provider did not support or promote the wellbeing of their staff. They did not enable staff to support people with person-centred care.

The provider failed to ensure staff received appropriate support, training, professional development, supervision and appraisal as necessary to enable them to carry out their role and support their wellbeing.

Staff told us that when they first joined the service, they did not receive a robust induction to help them understand their roles and responsibilities. Morale was described as low, and when asked about teamwork, one staff member said, “It’s pretty poor, I don’t think the manager is aware of this.”

The service had recently experienced a period of change and uncertainty due to a change in management. Staff shared mixed feedback about their wellbeing at work. While some felt supported, others reported that more support was needed.

Staff spoke positively about the support provided by the newly appointed manager. However, this manager left during the inspection, leaving the service without a manager in place to provide leadership, direction, and support for staff wellbeing.