Howlish Hall Residential Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last inspection we rated this key question good. At this inspection the rating has changed to inadequate: This meant services were not planned or delivered in ways that met people’s needs.

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

Regulation 12, Safe care and treatment

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not consistently placed at the centre of their care and treatment planning. Staff did not routinely work in partnership with individuals to adapt care in response to changing needs.

Care plans did not always reflect people's preferences for how they wished to receive support. For example, one person who sometimes experienced periods of distress had a care plan that included general guidance on minimising known triggers, such as loud noises or large crowds. Staff were encouraged to support the individual using self-soothing strategies such as music or sensory items; however, the plan did not specify what these strategies or items should be, making the guidance unclear and not effective.

Although the care plan stated that staff should prioritise safety and avoid physical intervention unless absolutely necessary, it did not outline what type of restraint could be used, if required. When we spoke with staff, they confirmed they had not received any training in restraint techniques. This training was also not included in future training plans.

It was unclear from the care plans whether people had been involved in planning how they wished to receive their care and support. The absence of documented capacity assessments meant it was not clear who had the capacity to consent to their care or whether they were able to sign their own care plans. In all the care plans we reviewed, signatures were from staff only.

One relative told us, “I would like to see their care plan. I’ve asked, but I’ve been waiting 18 months.”

Records did not always demonstrate that people’s care and treatment were delivered in line with their assessed needs.

Care plans did not consistently show that individuals’ needs had been assessed prior to starting with the service. Although the provider had introduced an electronic care planning system, it had not been used effectively. Some important care plan information remained in paper format and had not been uploaded to the electronic system, leading to gaps and inconsistencies in people’s care records.

Where required, referrals to other health and social care professionals had been made to seek advice and support. One visiting health professional confirmed that the service did make appropriate referrals and stated that staff knew people well and always had the relevant information available during visits.They explained that they primarily liaised with senior carers, all of whom were described as knowledgeable. The professional confirmed that staff followed the guidance provided and would ask questions or telephone for clarification when needed.

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Since 2016 all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard. The Accessible Information Standard tells organisations what they have to do to help ensure people with a disability or sensory loss, and in some circumstances, their carers, get information in a way they can understand it. It also says that people should get the support they need in relation to communication.

There was a lack of visual aids, such as picture menus, to support people in making informed choices about their meals. People living with dementia may benefit from tools such as picture menus or being shown plated meal options, which can promote autonomy and reduce confusion during mealtimes.

During our visit, we observed that none of these options were available. A chalkboard displaying the lunchtime menu was present in the dining room; however, this was not accessible.

A variety of activities are offered each week, with the schedule displayed on a noticeboard outside the dining room. However, this was not easy to see or identify. It lacked pictures, the print was light in colour, and there was no clear signage to indicate that this was the activity board. These factors reduced the accessibility of the information, potentially limiting people’s ability to engage with the activities on offer.

An effective system was not in place to demonstrate how the provider was listening to and involving people. Records did not always demonstrate how complaints and concerns were fully addressed and investigated.

Audits that were in place had not been completed consistently. For example, we found complaints had been audited by the previous manager up to April 2025; however, no audits had been completed after this date. The manager confirmed there were no other auditing or monitoring processes in place in relation to complaints to monitor for any trends or learning needs.

The activities coordinator had recently held a meeting to discuss activities. While the meeting notes recorded that nine people had attended, they did not identify who had participated. However, the notes did include some of the suggestions made by people for future activities, indicating a level of engagement, though not fully evidencing individual involvement or follow-up actions.

People had access to care and treatment. However, for individuals at risk of social isolation, there were no clear measures in place to reduce this risk. For example, one person’s care plan noted that staff should encourage them to join others in communal areas as a way to prevent social isolation. However, the care plan did not offer any alternative approaches should the person not want to access the communal areas.

We discussed with the manager what arrangements were in place to cover unplanned staff absences. They explained that cover relied heavily on the goodwill of existing staff, which could be difficult to secure. The manager informed us that the service would be short staffed over the coming weekend. As no cover was available and the provider does not permit the use of agency staff, the manager planned to cover the shift themselves. They explained that the service operates a two-week rolling rota, and staff are often reluctant to work on their scheduled weekends off, as this falls outside their agreed shift pattern. The manager identified this as a reflection of the current staff culture.

Health care professionals visited on a regular basis to review people’s needs and were contacted in between visits.

Staff and leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.

Policies and procedures intended to promote equity in people's experiences and outcomes were out of date. The policies we reviewed had been written in 2017. Although a sheet was present showing they had been signed as reviewed by previous managers, no amendments had been made. As a result, we could not be assured that the policies reflected current legislation, guidance, or best practice.

Only 8 out of 33 staff had completed training in equality and diversity. This indicates a significant gap in staff awareness and understanding, which may impact the service’s ability to promote inclusive and person-centred care.

Records relating to people’s end of life wishes were not always person centred. Care plans reviewed did not contain information on how people wished to be supported towards their end of life. Only 13 out of 33 staff had completed training in end of life care. This may affect the service’s capacity to ensure staff are confident and competent in delivering high-quality care and support to people approaching the end of their lives.

Care plans for younger people or those who were quite able, did not include goals or strategies to support the development of independence skills. As a result, opportunities to prepare individuals for more independent living were not being actively supported through care planning.