Howard Court Care Home

At the last comprehensive inspection of this service in August 2017 we found the provider had breached Regulations 11, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because people’s consent had not always been recorded. Also, there were shortfalls in relation to staff training in dementia care; and the provider’s quality assurance system was not effective in monitoring the quality of the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective and Well-Led to at least good. At this inspection we found the provider had made improvements and had addressed these shortfalls. People’s consent was now recorded. Staff had more training opportunities in relevant areas of care. The provider had put in place a schedule of audits as part of its quality assurance check of the service.

Howard Court Care Home 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.

Howard Court Care Home accommodates up to 28 people in one adapted building. There were 24 people living here at the time of this inspection, including people who were living with dementia.

The home had a registered manager who had worked there for several years. 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 and relatives said the home was a safe and friendly place to live. Staff understood how to report any concerns. The provider carried out checks to make sure only suitable staff were employed. People were assisted with their medicines in a safe way. The home was clean and comfortable.

People told us they were happy with the care and felt there were enough staff to assist them. They told us staff responded quickly to any requests for support. People’s consent and permission was sought. If people were subject to any restrictions to keep them safe, such as giving medicines in a disguised way, this had been arranged in people’s best interests.

Before people moved to the home their needs were assessed to make sure the home could provide the right care. Staff said they had good training and support to care for people in the right way. Staff worked well with other health agencies and people were supported to access health services.

People said the meals were “very good”. They had choices about their meals and where to dine. Staff encouraged people to eat and drink enough and used fortifying drinks to help people to keep their weight up.

People felt the staff were caring and friendly. There were good relationships between people and staff and a warm, positive atmosphere in the home. Staff spoke to people in a respectful and s sensitive way. People’s individual choices were respected and their dignity was upheld. People’s needs were supported with compassion at the end stages of their lives.

People received personalised care that was based on their unique preferences and needs. Staff were knowledgeable about people’s individual care needs and how they wanted to be assisted. People had opportunities to join in activities or go out with staff from time to time.

People, relatives and professionals said the management team were open and approachable. People and staff had opportunities to make suggestions about the service.

The provider had made some improvements to its quality assurance checks to make sure any shortfalls were identified and acted upon. The provider was also introducing new technology to support the service. This included a computerised management tool to check when staff training was due. Computerised care records were also being developed so, in future, staff would have instant access to people’s records wherever they were in the home.

At the last inspection on 27 and 30 July 2015, the service was rated ‘Good’.

During this inspection we found the service to be in breach of three regulations under the Health and Social Care Act, 2008 (Regulated Activities) Regulations 2014. The breaches were in respect of Regulations 11 seeking consent, Regulation 18 staff training and Regulation 17 good governance. This included shortfalls in the effective implementation and operation of effective quality assurance processes to assess, monitor and improve the quality of the service provided. A failure to seek and record consent and failure to provide staff with ongoing training and development. You can see what action we told the registered provider to take at the back of the full version of the report.

Feedback from people and their relatives regarding the care quality was overwhelmingly positive. Views from professionals were also positive.

People who lived at Howard Court Care Home told us that they felt safe and there was sufficient staff available to help them when they needed this. Visitors and people who lived at the home spoke highly of the registered manager and the owner who is also the provider. They told us they were happy with the care and treatment.

People had received their medicines as prescribed and staff had been trained in the safe management of medicines. However, we found areas that required improvement in the medication administration records. The registered manager and the registered provider took immediate action to make the required improvement soon after the inspection. Medicines were stored securely to ensure they were safe.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People’s consent to various aspects of their care was considered and where required DoLS authorisations had been sought from the local authority. However the systems for assessing and recording to mental capacity assessments were not in place. The registered manager took action immediately after the inspection and made the required improvements to the documentation.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Recruitment checks were carried out to ensure suitable people were employed to work at the home. We noted that the recruitment policy needed updating to ensure it was in line with current legislation. Our observations and discussions with staff and people who lived at the home confirmed sufficient staff were on duty.

Risk assessments had been developed to minimise the potential risk of harm to people who lived at the home. These had been kept under review and were relevant to the care and support people required. Risk associated with fire had been managed and fire prevention equipment serviced in line with related regulations. However people did not have personal emergency evacuation plans in their files. This was resolved immediately by the registered manager.

Care plans were in place detailing how people wished to be supported. People who received support, and their relatives, told us they were involved in their care planning. However, this had not always been recorded. People’s independence was promoted.

The provider had sought people’s opinions on the quality of care and treatment being provided. Relatives and residents meetings and surveys had been undertaken to seek people’s opinions. However the surveys had not been analysed and feedback provided to people on the outcome of the surveys.

We observed regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. People’s nutritional needs were met. Risks of malnutrition and dehydration had been assessed and monitored. Comments from people who lived at the home were all positive about the quality of meals provided. One person said, “The food here is the best.” We found people had access to healthcare professionals and their healthcare needs were met. Where people's health and well-being were at risk, relevant health care advice had been sought so that people could receive the treatment and support they needed. Health and safety concerns were identified and rectified.

Governance and management systems in the home required some improvement. Internal audit and quality assurance systems were in place. However; they had not always been effectively implemented to assess and improve the quality of the service and to proactively identify areas of improvement.

People who lived at the home told us they were encouraged to participate in activities of their choice and a range of activities that had been organised. We observed the care staff engaging people and offering a range of activities. People who used the service and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise concerns.

All Staff had received induction and training including National Vocational Qualifications (NVQ); however we found shortfalls in relation to ongoing training required for the role. There was a policy on staff supervision and appraisals and staff had received regular supervision.

Staff told us there was a positive culture within the service. Staff we spoke with told us they enjoyed their work and wanted to do their best to enhance the experience of people who lived at the home. We received positive feedback from visiting professionals and relatives of people who lived at the home.

The registered manager used a variety of methods to assess and monitor the quality of care at Howard Court Care Home. These included, regular infection control checks, medicines audits, surveys and staff and resident meetings to seek the views of people about the quality of care being provided. However we found shortfalls in the systems and processes for monitoring and assessing quality in the home.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

We saw that the staff team had not been trained to cope with challenging behaviour and that behavioural planning was inadequate. People in the home and the staff were not always safe when supporting people who found managing their emotions and behaviour difficult.

We also discovered that some incidents in the home had not been reported to the local authority as safeguarding. A number of staff needed updates to their safeguarding training. Some recruitment and disciplinary matters needed improvement.

We looked at the environment and found problems with fire safety, infection control and general cleanliness. Some equipment and furniture needed to be repaired or replaced. We saw a number of potential health and safety hazards around the home.

Is the service effective?

We found that the care planning in the service did not meet people's needs in an effective way. For example care plans did not give effective strategies for managing nutritional needs or challenging behaviour.

We had evidence to show that there were not enough staff to cover all the care, housekeeping, catering and social care needs in the home. We also judged that more training, supervision and appraisal was needed so that staff could meet the needs of the people in the home. We had evidence to show that further developments were needed so that dementia care and safeguarding were being dealt with appropriately.

Is the service caring?

We saw a number of caring and sensitive interactions between staff and people in the home. People told us that the team were:

"Lovely...very caring."

We had a lot of comments about the way the manager tried to understand everyone's needs and one visitor said:

"The manager is very good and understands all my partner's needs. She is always around and is a very caring person."

However because of the issues with safeguarding and care planning we judged that despite the caring attitude of staff some people were not being adequately cared for.

Is the service responsive?

We found very little evidence to show that people were involved in care planning. We judged that this meant that individual needs were not always responded to appropriately.

On the day we did see that staff tried to respond to need but that sometimes this was difficult because staffing levels were not appropriate.

Is the service well-led?

People in the home knew the manager well and felt they could trust her. A number of people said they would go to her or to the provider if there were any concerns or problems.

We saw that the manager had made a good attempt to update some of the paperwork around care planning. We also had evidence of her work with staff who needed support.

We discovered that the service did not have a functioning quality assurance system. We discovered problems in a number of areas that had not been picked up by the manager. We learned that, for example, the manager needed further training on some aspects of employment law.

The provider was in the home on a regular basis but both he and the manager had not made plans to improve the service until regulators had pointed out deficiencies to them. We were concerned that issues around fire and food safety, the environment and behavioural planning had not been picked up by them.

'I like living here as my family are able to visit'.

The staff are very good, really nice girls'.

We found that people's care and support needs had been assessed and kept under review to help ensure people received the care they needed. We saw that people had access to health care professionals. The people we spoke to told us they received the help they needed when they needed it and that staff did encourage them to remain as independent as possible.

There were procedures in place for medicines handling and storage. Medicines records were, on the whole, up to date but the checks were not always up to date. We have made reference to this in the body of the report.

Records with regards to the maintenance of equipment were in place and were available for inspection.