Howbury House Resource Centre

Howbury House Resource Centre is registered to provide accommodation and personal care for up to 32 older people, including people with dementia. At the time of our visit there were 23 people living at the home.

Howbury House Resource Centre is an adapted building with care and support provided across one floor. The home is divided into four main units and all units had communal lounge and dining areas. Not all bedrooms were ensuite but there were further bathroom facilities located on each floor. External garden areas were accessible for people and these areas were safe and secure.

People's experience of using this service and what we found

At our last inspection, we found some improvements were required. There were not enough staff on duty to keep people safe and meet their needs. Potential risks to people’s individual care needs were not consistently monitored and reviewed. There was a lack of effective oversight of people’s individual care needs and reviews of their care to ensure the quality of care was what people expected. In response to our last inspection, the provider completed an action plan to tell us how staffing levels would be better managed to ensure people’s needs were met.

At this inspection, we found staffing levels had been increased and people told us, staff were able to support them more effectively. However, further improvements were needed to care planning, risk management and quality assurance systems to help keep people protected and to ensure the provider had effective oversight of the service.

Care plans and risk assessments were completed, however, in some cases where support was required for eating and drinking, these were not always completed accurately or reviewed in a timely way. Other records associated with the support people received were not accurate or detailed enough.

People were complimentary of staff and said staff had time to spend with them. People felt the service was responsive to their needs. Staff knew people well and we saw during staff quickly responded to situations to help maintain an environment that promoted good care outcomes.

Staff interacted with people at their pace, unrushed and joked and laughed with each other. Staff were involved and engaged and had time to sit and chat to people which helped develop relaxed and supportive relationships.

The provider had their own staff team and had local initiatives to increase the recruitment of staff. The registered manager relied on agency staff to support safe staffing levels and the same agency staff were used for continuity of care. This meant staff who supported people knew them well. Staff had received training in key areas and staff said they felt supported to pursue additional training and opportunities to increase their knowledge and confidence.

Infection control systems ensured the home was clean. Housekeeping staff supported the home and staff wore personal protective equipment to help minimise the risk of cross infection. Maintenance and regular environmental checks on health and safety ensured the home remained safe for people.

People’s overall feedback to us about the service they received was positive. People and relatives could attend meetings to share any feedback about the service. Post pandemic, plans were in place to increase the frequency of these meetings.

Visitors were welcomed and there were no restrictions on visiting arrangements.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff understood their responsibility to report any concerns to protect people from the risk of abuse.

Positive links with a local GP practice ensured people were reviewed and seen promptly. People were supported by a nurse practitioner who attended the service weekly to review and support people’s physical and emotional needs. The nurse practitioner liaised with local health professionals to ensure people received external support when needed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 08 November 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements related to the breach of staffing had been made, however other areas of the service were not managed effectively. The provider remains in breach of the regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service and to check the provider had improved certain areas identified at our last visit.

This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has stated the same. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Howbury House Resource Centre on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Howbury House Recourse Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Howbury House accommodates 32 people in one adapted building across one floor, which is separated into eight units. There were 30 people living at the home at the time of our inspection.

People’s experience of using this service

There were not enough staff on duty to keep people safe and meet their needs. Potential risks to people’s individual care needs were not consistently monitored and reviewed. People continued to tell us they felt safe from abuse. Staff had a good understanding in how they protected people from harm and recognised different types of abuse and how to report it. People’s medicines were managed and stored in a safe way. Safe practice was carried out to reduce the risk of infection.

People’s care continued to be assessed and reviewed with the person involved throughout. People were supported to have a healthy balanced diet and were given food they enjoyed. 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 support this practice. Staff worked with external healthcare professionals and followed their guidance and advice about how to support people following best practice.

Staff treated people as individuals and respected the choices they made. Staff treated people with respect and maintained their dignity.

Staff recognised that people who lived with a dementia illness needed better support with fun and interesting things for them to do. Changes in people’s care was communicated clearly to the staff team. People had access to information about how to raise a complaint. People were supported with end of life care in a dignified and respectful way.

There was a lack of oversight of people’s individual care needs and reviews of their care. Care records were not always accurate or complete. The registered manager was visible in the home, listened and responded to those who lived in the home and the staff who worked there. The checks the registered manager made to ensure the service was meeting people’s needs focused upon people’s views and experiences.

Rating at last inspection

The last rating for this service was Good. The last report was published 07 April 2017.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We have identified breaches in relation to insufficient staffing levels at this inspection.

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

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home is registered to provide accommodation and personal care, for a maximum of 32 people. There were 25 people living at the home on the day of the inspection.

At the last inspection on 22 and 24 July 2015 the service was rated as good. Since the last inspection the home has changed from providing rehabilitation services to providing longer term residential care. There was a registered manager in place at the time of our inspection. 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 told us they felt safe and well cared for. Staff were able to demonstrate they had sufficient knowledge and skills to carry out their roles effectively and to ensure people who used the service were safe. People told us staff were available and responded when they needed care.

People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met. People were supported by staff to have their medicines when they needed them.

The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS) and had submitted applications where they had assessed that people were potentially receiving care that restricted their liberty. Staff sought people’s consent before providing care and provided choices so people could choose the support they received.

People told us they enjoyed meals times and were very positive about the choice and quality of the food they received. They told us they were offered a choice of drinks throughout the day. People were supported to access health care professionals and staff responded to the advice received in providing care to people.

People told us staff were caring and we saw people were comfortable around staff providing care. Relatives told us people had developed good relationships with staff and they felt welcomed into the home whenever they visited. Relatives said people’s privacy and dignity was maintained and our observations supported what relatives told us.

People we spoke with told us they got the care and support they wanted and they chose how they spent their day. Staff told us that activities could be improved to support people’s interests and the registered manager was in the process of planning new activities to make improvements.

People were involved in making day to day decisions about their care and said staff listened to them and they felt confident they could raise any issues should the need arise.

Staff said that the service had been through a period of change. They acknowledged recent improvements had been made but said further improvements were needed in activities. People, relatives and staff spoke positively of the management team and of the team work of the staff team.

People and relatives said the registered manager was approachable. Staff spoke highly of the registered manager and staff said they were supported through team meetings and training to provide care and support in line with people needs and wishes. The quality of service provision and care was monitored and actions taken where required to improve people’s experience of living at the home.

People and relatives were positive about the care and support they received and the service as a whole.

Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed and the records we looked at.

Is the service safe?

People told us that they felt safe. Risk assessments were well completed and actions to minimise risks identified were reflected in care plans. Risk assessments balanced risk with the rights of people to choice and independence.

The provider had appropriate systems and processes in place with regard to safeguarding adults and implementing the Mental Capacity Act 2005. Staff had received training and were clear about their role and responsibilities.

Records were kept securely and were available to read. Improvements were needed however, to ensure all records are accurately maintained and kept up to date. We have asked the provider to make some improvements in relation to record keeping at the service.

Is the service effective?

People we spoke with told us that the service they received helped them to regain their independence and confidence. People, who required it, received regular physiotherapy and occupational therapy. Staff demonstrated that they understood the care needs of the people they were caring for.

Staff had access to a range of training relevant to their role. Policies and procedures were appropriate, up to date, and reflected current research and guidance. Staff had access to information about meeting the needs of people from different cultures and faiths.

Is the service caring?

People told us that the staff were kind and caring. We observed staff treating people in a friendly and caring way. One person told us, "I couldn't wish for better care.' People told us that staff were always quick to respond to them if they needed assistance.

People on the dementia respite care unit were cared for in a calm atmosphere. Art and pictures were used to help people to find their way around the unit and to stimulate memories.

Is the service responsive?

People's needs were assessed prior to them being admitted. People told us that they had been involved in developing their care plan. One person told us, "The staff sat down with me when I first came. They went through what I could expect and asked me about my wishes.'

We saw evidence of a range of activities that had taken place. Some people told us that they were not aware of all the activities that were available to them. We brought this to the attention of the registered manager.

Is the service well led?

Staff we spoke with told us that they were well supported by the registered manager and senior staff.

People were invited to raise issues about the service with a specific member of staff and also at 'Have Your Say' meetings. People told us they would be comfortable raising issues with the registered manager. People told us they were confident any issues raised would be acted upon.

Regular audits were undertaken to monitor the quality of the service. Generally the audits were robust. However, the care plan audit was not as detailed as it should be. The registered manager showed us a new improved audit process which was about to be introduced.

People who used the service and staff were clear about the complaints process. Complaints that had been received by the provider had been investigated and responded to appropriately. Lessons learnt from incidents, feedback, and complaints and any subsequent actions were discussed at regular staff meetings.

People told us that they felt involved in any decisions that needed to be made about their care and these were made in their best interests. We found that proper steps had been taken to ensure that individualised care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found that medicines were prescribed and given to people appropriately that ensured they were managed safely. This meant that people received their medicines as prescribed.

Staff had been recruited in an appropriate way and checks had been undertaken that ensured they were suitable to care for vulnerable people.

We found that any comments and complaints people made had been responded to appropriately and ensured that people were listened to.