Howbury House Resource Centre

Updated 26 November 2022

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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection visit was carried out by two inspectors.

Service and service type

Howbury House Resource Centre is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Howbury House Resource Centre is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection visit was unannounced.

What we did before inspection

We reviewed the information we held, such as people and relatives’ feedback and statutory notifications, as well as any information shared with us by the local authority. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with five people who received a service to get their experiences about the quality of care received. We spoke with seven members of care staff, a chef, a registered manager and an interim provider services manager.

We reviewed a range of records. This included examples of four people’s care records and samples of medicine records and associated records of their care. We looked at records that related to the management and quality assurance of the service, fire safety and environmental risks and records for infection control and risk management. We also reviewed two agency staff profiles.

Updated 26 November 2022

About 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.