Archived: Howard Lodge Residential Home

The provider sent us an action plan after both inspections to show how they would become compliant with the regulations. We carried out this inspection to check that the action plan had been completed. We also looked at two other standards as we had received information of concern since the last inspection.

On the day of the inspection there were only six people using the service. People told us that they were happy with the care provided. They thought that there had been improvements to the home although the work currently being carried out could be noisy. One person said 'The place is a lot cleaner but the noise of scraping is a bit annoying at times.' Another said 'You can really notice the change but it's not always as peaceful as I would like. Still I am looking forward to being able to get in the garden in the warmer weather.' We observed interactions with staff and the care provided. Staff we spoke with knew people's needs well. We saw people were treated with respect and that staff were responsive to people's needs although we noticed on the day of the inspection that there was less staff interaction with people who used the service in the morning than there was in the afternoon.

At this inspection we found that the provider had invited in some interim managers and had taken advice from consultants on how to improve the service. They had also had support and training from the local authority Care Support Team. People were involved in decisions about their care and their needs were reviewed regularly. There were systems to protect people from the risk of infection and the standard of cleanliness had improved. There were appropriate systems in place to manage and administer medication. Improvements were being made to the safety and decor of the premises and suitable equipment had been purchased and was regularly maintained.

There were sufficient staff to meet people's needs and a programme of refresher training for staff was under way. Further training sessions had been identified and booked. Quality assurance systems had improved and an action plan was being drawn up to target areas for improvement. Records had been updated and were securely kept, but they were not always well organised and dates and signatures were sometimes not available where this was appropriate.

Following the inspection in July the provider sent us an action plan to tell us how it was going to become compliant with the other regulations identified. Due to the timescale involved these will be considered at a subsequent inspection.

We carried out this inspection to check that the provider had taken appropriate steps to comply with the warning notice. A number of improvements had been made at the premises and we saw evidence of maintenance planning and health and safety risk assessments. We spoke with some people who used the service who were generally happy with their care. They told us some improvements had been made to the building.

However there were areas where the provider was not compliant with the regulations, including aspects of fire safety, plumbing maintenance, security of harmful cleaning substances and waste. During the inspection we identified concerns in the storing, recording, dispensing and disposal of medication. We also identified concerns abut the storage of food which we have referred to the Environmental health department.

We found that the provider and deputy manager had taken action to address the previous compliance actions. Safeguarding training had been updated and we had been sent the relevant notification that provided details of the arrangements during the absence of the registered manager. At this inspection, however, we found that the provider was failing to comply with seven other essential standards.

We spoke with people who used the service. Most people felt their views were taken into account and said they were happy with the care provided. Comments included, 'the staff are great,' 'they look after us quite well,' and 'I could not fault my care.' Some people were not able to express their views and so we observed the care given. We also spoke with two family members of people who used the service and we spoke with four members of staff.

We looked at four care plans and noted from the records that people who were unable to mobilise were transferred using unsafe techniques. We observed that the environment was not sufficiently clean in some areas and arrangements were not in place to minimise the risk of infection. We were concerned about the condition of parts of the premises and the lack of a maintenance and refurbishment plan. People were not always protected from possible risks.

We found that records of people's care and support needs were not being regularly reviewed and monitored. There were limited systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

There were also insufficient arrangements to ensure that staff were appropriately trained and supervised to carry out their role.

As not all of the people using the service were able to speak with us, we carried out some observations during our inspection. We noticed that there was good communication between the staff and people at the service and the staff knew people's needs and preferences very well.

We inspected the premises and although some redecoration would be beneficial in places there were no concerns. However the service provider was on long term leave at the time of our inspection and they had failed to notify us of this, which they are required to do. Although there were no safeguarding issues we had concerns about staff training and awareness of procedures for raising a safeguarding alert if needed. We have referred this to the local authority.