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Howard Goble House Requires improvement


Inspection carried out on 25 June 2019

During a routine inspection

About the service

Howard Goble House provides care and support for older adults with profound and multiple

learning disabilities and some who live with dementia. It can accommodate up to 12 people over two floors. At the time of the inspection the home was providing care and support to 11 people.

The service has not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This meant that people who use the service did not live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. However, people using the service did not receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People's experience of using this service Medicines were not always safely managed. Medicine Administration Records (MAR) were not always completed in full and medicines handover sheets were not always signed. People were protected against the risk of infection. Assessments were carried out to ensure people's needs could be met. Risks were identified, and management plans were in place to manage these safely. Accidents and incidents were appropriately managed, however, learning from this was disseminated to staff.

Appropriate numbers of suitably skilled staff were not available to meet people's needs in a timely manner. Staff were supported through induction, training and supervisions. 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 practice.

Staff were not always kind and caring and people’s privacy and dignity was not always respected, and their independence was not always promoted. People were encouraged to eat a healthy and well-balanced diet. People had access to different healthcare professionals when required to maintain good health.

Information was available to people in a range of formats to meet their communication needs if required. There was a system in place to respond to complaints in timely manner.

There were systems in place to assess and monitor the quality of the service provided, however these were not effective. The service was not currently supporting people with end of life care needs, if they did this would be recorded in their care plans. The provider worked in partnership with key organisations to ensure people's needs were planned and met.

The outcomes for people using the service did not reflect the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support was not focused on them having as many opportunities as possible for them to gain new skills and become more independent.

For more details, please see the full report which is on the CQC website at

Rating at last inspection: The last rating of the service was good (published on 12 January 2017)

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: Enforcement: We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person-centred care, dignity and respect, safe care and treatment, good governance and staffing.

Please see the action we have told the provider to take at the end of this report.

Follow up: We will ask the provider to complete an action plan to show what they will do and by when to improve to at least good. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any

Inspection carried out on 8 December 2016

During a routine inspection

MCCH Ltd – Howard Globe House provides care and support for older adults with profound and multiple learning disabilities and some who live with dementia. It can accommodate up to 12 people. At the time of the inspection the home was providing care and support to 11 people.

This inspection took place on 8 and 9 November 2016 and was unannounced. Howard Globe House care home was registered with the Care Quality Commission on 10 December 2010. At the last inspection in 2013, the service was meeting the legal requirements in force at that time.

The service had a registered manager in post. 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.

People using the service could not always express their views so we observed the support offered and spoke with relatives and staff. Relatives told us that their family members were safe and well treated. During the inspection we saw that people appeared happy and content and their relatives felt confident they were not at risk of harm. Family members supported most of the people but those who weren’t had an independently appointed advocate who could express their views and help them to ensure their voice was heard.

Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work.

The service employed sufficient number of staff to support people. Staff were encouraged to raise issues as they occurred and said that there was an open environment and felt supported by the manager and provider. Staff had received training specific to the needs of people using the service, for example, mental health awareness and safeguarding adults. They received regular supervision and an annual appraisal of their work performance. The manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were being supported to have a healthy balanced diet. People’s medicines were managed safely and they received their medicines as prescribed by health care professionals.

People’s relatives and health care professionals had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people to meet their needs. Staff encouraged people to be as individual as possible and to do things they wanted to do. People’s relatives were aware of the complaints procedure and were confident their complaints would be fully investigated and action taken if necessary.

The manager recognised the importance of regularly monitoring the quality of the service provided to people. The provider sought the views of relatives of people using the service, staff and health care professionals through annual surveys and regular meetings. They used feedback from these events to make improvements at the home. Staff said they enjoyed working at the home and they received good support from the manager.

Inspection carried out on 18 November 2013

During a routine inspection

Howard Goble House provides accommodation for 12 older people with learning disabilities, including people with dementia care needs The home is divided into two units one on the ground floor and the other on the first floor with lift access. Six people live in each unit. People were supported in activities of daily living. We observed during our inspection that people were treated with care and respect. One person we spoke to told us; "I like living here" and another said "it's all right here."

We found that people had risk assessments and care plans. People had a staff member allocated as their key worker who would regularly review their care. Staff told us that people were supported to make their own decisions and that they would build in choices to the daily routine. Staff had access to a consent policy and received training on the mental health act.

The provider had a complaints policy and had made suitable arrangements to obtain people�s feedback on the service provided. Relatives we spoke with told us that they had no cause to complain and that they were very happy with the care. We found that staff had been trained on the control of infection and appropriate arrangements were in place for the cleaning of the home. We found that there were effective recruitment procedures in place and the relevant checks were carried out on staff before they started in post. Staff were suitably qualified and had access to appropriate training and development opportunities.

Inspection carried out on 5 February 2013

During a routine inspection

We spoke to three people using the service and five staff and observed the way people were supported at our inspection on 05 February 2013. People told us they were supported to be as independent as they wanted to be and they were consulted with about their care. We saw that care plans were mainly up to date and reflected guidance from other professionals. There was a programme in place to ensure staff were updated in safeguarding training and records were kept securely. People told us that there were not always sufficient staff to support people in the community on an ad hoc basis, but that planned activities and appointments were attended.

Inspection carried out on 20 March 2012

During a routine inspection

During our visit on 20 March 2012 people who used the service told us the staff were nice, that it was all right living at Howard Goble House, and also that the food was all right.

Overall we observed staff engaging with people in a warm and supportive way, enabling them to take part in activities of daily living, to pursue their own interests, and to participate in activities in the community. The atmosphere in the home was comfortable and relaxed. However, we also observed a few instances when people were treated in a way that undermined their dignity.

In response to the annual feedback questionnaire in 2011, relatives, family friends and an advocate said staff were respectful and provided a personalised approach to people�s care. They also said that people�s health care needs were met, and that they were made to feel welcome and were treated courteously whenever they visited or phoned the home. Their comments indicated that people using the service were happy, settled, comfortable and content. Also, that they were in good communication with staff, and any concerns they raised with staff would be addressed. Comments received were positive about the care provided by staff and the improvements seen in people�s well being.

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