Howlish Hall Residential Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last inspection we rated this key question good. At this inspection the rating has changed to inadequate: This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

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

Regulation 11, Need for consent

Regulation 14, Meeting nutritional and hydration needs

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

Care plans reviewed did not consistently demonstrate that people’s needs had been assessed prior to starting with the service. Assessments of people’s care and support were not recorded on the service’s electronic ‘Log my Care’ system. It was unclear whether assessments had been completed prior to people commencing at the service or considered when planning care. For example, one person’s care plan stated that they lacked capacity to make decisions about how their medicines were managed. However, there was no capacity assessment on file to support this conclusion. The absence of a formal assessment meant there was no documented evidence to guide how their care and support should be appropriately planned and delivered in line with the Mental Capacity Act.

People’s nutritional and hydration needs were not consistently met. People were not always supported to access a healthy balanced diet. We observed during the inspection that neither fresh nor frozen vegetables were available during main meals. The absence of vegetables with main meals does not meet recommended nutritional standards for a balanced diet, which is essential to support the health and wellbeing of service users.

Food was not always presented in an appetising way to encourage enjoyment specifically for people who required a modified diet. For example, we observed that where people required specialist diets, individual food items were all pureed together rather than separately, preventing people being able to taste the individual components of their meals. When senior staff were asked about this, they confirmed that meals were pureed due to limited meal choices. They also stated that individuals on pureed diets or softer foods often only had one mealtime option available to them.

During the inspection, we observed that mealtimes were not reasonably spaced out. This is not in line with good practice guidance for older people in residential care homes, which supports adequate nutritional intake, maintain energy levels and promote wellbeing.

The service worked with other teams and external services to support people. However, care plans did not consistently reflect input or advice from these professionals. For example, in cases where individuals required support with alcohol misuse, there was no evidence within care plans to show that the service had engaged with relevant external agencies to ensure appropriate care and support were in place.

For younger residents with mental health needs, there were no discharge plans in place to support their transition from the service, which primarily caters for older people. There was no evidence that the service was working proactively with health and social care professionals to identify or secure more appropriate, specialist accommodation. This limited individuals’ opportunities for recovery, independence, and progression to more suitable settings.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control.

While there was regular involvement with healthcare professionals, there was no evidence that people who were able to participate were involved in reviewing their health and wellbeing needs. For people with capacity, records did not document how they were supported to be involved in managing their wellbeing and making decisions about living healthier lives.

Daily records of care provided did not clearly demonstrate how people's health and wellbeing were monitored to identify any changes in their needs. For example, one person’s care plan noted that they received personal care at 10:34 hours, but there were no details about what this involved. The next entry was not until 19:10 hours, simply stating that the person was in the lounge. There was no information recorded to confirm whether any further personal care or wellbeing checks had been carried out during this period. This lack of detailed recording makes it difficult to ensure that people’s care needs are being consistently met and monitored.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The recording of people’s weights was not effective, and gaps were identified in the records. It was not always evident that staff were regularly calculating and recording Malnutrition Universal Screening Tool (MUST) scores. This increases the risk that changes in a person’s health or risk of malnutrition may go unnoticed.

The provider did not make sure effective systems were in place to ensure the service was working within the principles of The Mental Capacity Act 2005.

Where it was deemed people did not have the capacity to consent, robust assessments were not in place to determine if people had capacity to consent or not. Failure to implement appropriate capacity assessments puts individuals at risk of decisions being made without appropriate legal or ethical safeguards.

We discussed with the manager if they had processes in place to monitor Deprivation of Liberty Safeguards (DoLS). The manager confirmed there was no formal monitoring of DoLS applications. Due to ineffective records and monitoring we could not be assured people were not being unlawfully deprived of their liberty.

The provider’s failure to ensure records evidenced they were working within the principles of the Mental Capacity Act 2005 and service users’ consent was obtained and best interest decisions followed, placed service users at risk of not having their rights upheld and undue restrictions placed upon them without the correct processes being followed.

We reviewed staff training records. There was no evidence that staff had undertaken any training in DoLS. We could not be assured staff had the appropriate skills and knowledge in relation to the Mental Capacity Act 2005.