Background to this inspection
Updated
6 December 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by two inspectors and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Howgate House 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.
A new manager had been appointed and was in the process of applying to be registered with the Care Quality Commission. The manager who was registered with CQC had left. When a manager is registered with CQC they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced on both days.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with seven people, five relatives, a friend who was a regular visitor and one visiting health care professional. We spoke with eight members of staff included care assistants, care practitioners, nurses, the deputy manager, the home manager and the quality manager.
We looked at five people’s care records and several medications records. We observed people being supported in the communal rooms, visited people in their bedrooms and looked around the home. We looked at two staff recruitment files and other records relating to the management of the home. These included training and maintenance records, meeting notes, audits and policies and procedures.
After the inspection
We reviewed addition information sent to us by the manager. We spoke with a professional who regularly visits the service.
Updated
6 December 2019
About the service
Howgate House is a residential care home providing personal and nursing care. The service can accommodate up to 63 people and most people are aged 65 and over. At the time of our inspection 46 people were living at the home.
People’s experience of using this service and what we found
Most people, relatives and staff told us the service had improved since the last inspection. They said further improvements were needed but felt confident the service was moving the right direction under the leadership of the new manager.
People told us the service was safe and there were generally enough staff to meet their needs. A small number of people had concerns about the skills and knowledge of some of the staff team. The manager was addressing this through training and carrying out a review of working patterns.
People told us, and we observed staff were kind and caring. People’s privacy and dignity were respected, and people were supported to be as independent as possible.
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.
Improvements had been made to the way people were supported to share their views of the service. People were given feedback on the actions taken in response to their comments.
Improvements had been made to the way risks to people’s safety and welfare were identified and managed. The home was clean, and equipment and installations were maintained. Some refurbishment had taken place, and more was planned.
The way people’s medicines were managed had improved.
Feedback about the food was varied; some people said there was room for improvement. This was being dealt with and people were being consulted about the menus. Improvements had been made to the support given to people at risk of poor nutrition and hydration. People’s oral health was considered and where necessary people were referred for dental treatment.
People’s needs were assessed, and their care records had improved. Further improvements were being made in this area to ensure staff had clear information about people’s current needs.
Improvements had been made to the systems and processes in place to monitor the safety and quality of the service. The manager was proactive in developing links with external professionals and local community groups for the benefit of people who used the service.
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 inadequate (published 23 May 2019). There were multiple breaches of regulations and the service was placed in Special Measures. During this inspection the provider demonstrated improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, the service is no longer in Special Measures.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.