Howson Care Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Requires Improvement. At this assessment the rating has changed to Good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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 mostly had a proactive and positive culture of safety, based on openness and honesty, but record keeping prevented effective incident analysis. Staff listened to concerns about safety, and lessons were learnt to continually identify and embed good practice.

Safety events were recorded and analysed to identify themes and drive improvement. For example, a falls analysis was completed to identify patterns and improve safety. However, some incident records were not always detailed enough to support a thorough review. For example, staff did not always record what safe holds were used or for how long following a physical intervention when a person was experiencing emotional distress. We raised these concerns with the provider and the registered manager who took prompt action to improve record keeping.

The service promoted a positive learning culture and welcomed feedback from people, staff and partner agencies. Staff described the service as open and said the registered manager listened when they had concerns. One person’s relative told us, “They’re always easy to speak to and I’ve no concerns.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Hospital passports were in place in the event people required medical treatment. These contained essential information about people’s health care needs and personal wishes. In the event of a fire or other emergency, grab bags were available that contained information about how to evacuate people safely.

When people move between services, information was shared appropriately between relevant professionals to support smooth transitions. Feedback from people and their relatives indicated the service supported safe transitions between services.

The provider mostly worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

There was a process in place for recording and reporting safeguarding concerns. However, we found 2 safeguarding incidents that had not been directly reported to the local authority safeguarding team or the care quality commission. Records indicated the provider had taken necessary action to review the incidents and ensure people’s safety, including the involvement of health care practitioners. We raised this with the provider, and they took the necessary action to ensure these incidents were reported.

Staff received safeguarding training and understood how to recognise and report signs and symptoms of abuse. People and their relatives told us they felt safe. One person told us, “I feel very safe as nice people look after me”, with another person describing the service as “safe as anywhere else.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that people who did not have the capacity to agree to their care and treatment had the appropriate legal safeguards in place and specific conditions were being met.. However, the use of restraint by staff was not fully reviewed to ensure least restrictive practices were maintained. This meant the provider could not be fully assured they were always working within the principles of the MCA.

The provider mostly worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks related to people’s care were mostly well-managed however, some care plans and people’s records required development to strengthen risk management systems. For example, a person’s falls risk assessment did not include the consumption of alcohol. This meant the risk analysis was not fully informed. For another person, their care plan did not contain accurate information about their repositioning routine for the safe management of pressure related injuries. Despite this, records indicated the care they received was effective as the person’s pressure injuries had improved.

Staff understood how to respond to risk and the registered manager was responsive when concerns were raised. People and their relative’s mostly felt risk was well managed and people were safe.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Fire equipment checks and periodic evacuation drills were completed to ensure people’s safety in the event of a fire or other emergency. Mobility equipment was in good condition and fit for use, however we did observe some people’s wheelchairs and other mobility aids were visibly dirty. One person told us, “I can walk if I use this rollator. I’ve got a mobility scooter too but am going to change it for a folding one so I can go on outings for longer.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Dependency assessments were used to ensure suitable numbers of staff were on shift and effectively deployed. We found staff were always available and responded to people’s needs. People mostly told us there were enough staff to meet their needs. However, feedback from some relatives indicated The Wing area of the service was sometimes left unsupervised.

Staff received training relevant to the needs of the people using the service. New staff completed an induction to ensure they were prepared for working at the service. Competency assessments were used for specific care tasks such as administering medicines, to ensure staff followed safe practice.

Recruitment checks were in place to ensure staff were safe to work with vulnerable adults and had the necessary skills and experience to fulfil their role.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service was kept clean and tidy and laundry was well managed to prevent the risk of infections spreading. One person told us, “My room is kept clean for me. We get our own clothes back from the laundry.”

Staff received infection prevention and control training and understood when to use personal protective equipment such as gloves and aprons.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People received their medicines as prescribed. Medicines administration records were well maintained, supporting safe administration practices. As and when required medicines were well managed with specific protocols in place to ensure staff had the necessary guidance. Topical medicines such as creams and pain relief patches were managed safely. This included the use of body maps to ensure the site of application was clear to staff. Where people required their medicines to be administered covertly, meaning their medicines were hidden in food or drink and administered without the persons knowledge or consent, these were managed safely. The necessary assessments and care plans were in place and records were well maintained.

Where people had the ability to manage their medicines or part of their administration process independently, the service supported with this safely. One person told us, “The staff bring our medicines up and wait while we take it every day.”