17 October 2022
During an inspection looking at part of the service
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.