CQC report explained · a residential care home
What the CQC found at Howard Court Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff, suitable safeguarding and recruitment checks, reviewed risk assessments and safe medicines support. They noted minor errors in recording variable medicine doses and one change to a medicines record that should have been made by the prescriber.
- Effective?
- Good
- Staff had improved access to training, including dementia and mental capacity training. People were supported with food, drinks and health care, and the home worked with outside health professionals.
- Caring?
- Good
- People and relatives spoke positively about friendly, patient staff. Inspectors saw respectful communication, support for dignity and privacy, and encouragement for people to make choices and remain independent.
- Responsive?
- Good
- Care plans reflected people's preferences, routines and needs. The home offered activities, community links and end-of-life care, and people and relatives knew how to complain.
- Well-led?
- Good
- The management was described as open and approachable. The provider had improved audits, action tracking and checks on the premises, staff training and medicines recording.
What inspectors found, October 2018
Rated Good; inspectors found safe, kind and personalised care, with minor medicines-recording and building-maintenance issues.
The inspection was unannounced on 28 September 2018, followed by an announced visit on 3 October. One inspector spoke with people, relatives, staff and a health professional, observed care, and checked care records, staff files, medicines and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People were described as safe, comfortable and happy. Inspectors found enough staff, suitable medicines support, good training, kind relationships and care tailored to people's needs.
The home had improved since earlier inspections. Consent records were now in place, staff had more relevant training and quality checks had been introduced. Inspectors found some minor medicines-recording errors, decorative wear and occasional odours, but these did not change the overall Good rating.
Enough staff
Inspectors found staffing levels were sufficient and that unexpected gaps were covered by trained existing staff.
“There were enough staff to meet the needs of the people who lived there.” from the report
Kind relationships
Staff treated people warmly and respectfully. Inspectors saw staff taking time to talk with people and support them during meals and activities.
“We saw all the staff, including housekeeping, management and office staff, took time to talk and assist people in a meaningful and caring way.” from the report
Personalised care
Care plans included people's routines, preferences, abilities and individual ways of being supported. Staff followed detailed instructions where these mattered to a person's wellbeing.
“People and relatives said they received a personalised service that met their individual needs.” from the report
Improved oversight
The provider introduced recorded checks and audits, including monitoring medicines errors, premises issues and staff training.
“The provider had improved the systems for checking the quality of the service.” from the report
Medicines recording
needs fixingOn one day, staff did not record which dose of a variable medicine had been given. One medicines record had also been changed to reflect a preferred dose, although this should have been changed by the prescriber.
“Where people could have a variable dose of medicines, such as one or two paracetamol tablets, we saw on one day staff had not recorded which dose they had administered.” from the report
Occasional odours
minorVisitors noticed an occasional odour at the entrance, and a rarely used shower room had a drainage odour. The provider had already replaced flooring at the entrance and was considering changes to the shower room.
“Some visitors commented on a fluctuating odour at the home's entrance.” from the report
Worn decoration
minorSome areas had minor decorative wear, including scuffed paintwork. Inspectors did not find any area that presented a safety hazard.
“There were a small number of minor decorative shortfalls in some parts of the home, such as scuffed paintwork, but there were no areas viewed that presented a safety hazard.” from the report
- 01How do you now check that staff record the exact dose when a medicine has a variable dose?
- 02What action was taken after the medicines record was changed to show a preferred number of daily doses?
- 03What has been done to prevent the occasional odour at the entrance and in the rarely used shower room?
- 04Have all staff now completed the dementia, mental capacity and behaviours which challenge training identified in the report?
- 05How are the new audits used to identify and follow up any further care or medicines problems?
This was an overall inspection covering all five key questions, with an unannounced visit on 28 September and an announced follow-up visit on 3 October 2018. This explanation was written from the published report of 31 October 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, September 2017
Rated Requires Improvement; inspectors found kind care, but gaps in consent, staff training and quality checks.
This was an unannounced inspection on 30 August 2017. Inspectors spoke with people living at the home, visitors, care staff, the manager and the provider. They reviewed care records, staff training and recruitment records, medicines information and records about how the home was managed.
People and relatives were mostly positive about the care. Inspectors found people were treated kindly, their health and nutrition needs were met, medicines were generally given as prescribed, and staffing levels were sufficient. There were also activities, links with families and a complaints procedure.
However, records did not always show consent or mental capacity decisions. Some staff had not received ongoing training, and quality checks had failed to identify important gaps in records and care processes. The home was in breach of Regulations 11, 17 and 18.
The overall rating was Requires Improvement. Caring was rated Good. Safe, Effective, Responsive and Well-led were all rated Requires Improvement. The previous rating was Good in July 2015.
Kind and respectful care
People and relatives spoke positively about staff. Inspectors saw staff protect privacy and dignity and encourage independence.
“People and their relatives spoke highly of care staff and felt they were treated in a kind and caring manner.” from the report
Health and nutrition
People received meals, drinks and support suited to their needs. Staff involved healthcare professionals when needed.
“People's nutritional needs were met. Risks of malnutrition and dehydration had been assessed and monitored.” from the report
Medicines generally given safely
Medicines were given as prescribed, stored securely and recorded after administration. Inspectors found a particular weakness in written guidance for as-needed medicines.
“Medicines had been checked on receipt into the home, given as prescribed and stored and disposed of correctly.” from the report
Family and community links
People were supported to keep in contact with relatives and maintain links with the local community.
“People had been supported to maintain contact with their family relations.” from the report
Consent records
seriousMental capacity assessments and some consent records had not been completed and filed as required. This was a breach of Regulation 11.
“full mental capacity assessments had not been recorded and filed in line with MCA 2005 principles.” from the report
Ongoing staff training
seriousStaff had induction, qualifications and supervision, but ongoing training in areas such as dementia and mental capacity was not consistent. This was a breach of Regulation 18.
“additional ongoing training in different areas had not been provided to staff on an ongoing basis.” from the report
Quality checks and records
seriousThe home's audits did not identify several important gaps, including missing records and altered water temperature records. This was a breach of Regulation 17.
“the governance systems in the service were not robust to identify concerns in a timely manner.” from the report
Emergency evacuation plans
needs fixingPeople did not initially have personal emergency evacuation plans to guide staff if they needed to be moved during an emergency. The manager acted immediately after the inspection.
“people did not have personal emergency evacuation plans (PEEPS).” from the report
Complaint records
needs fixingPeople knew how to complain and complaints were acknowledged, but records did not clearly set out the investigation, outcome or action taken.
“complaints records were lacking in describing the investigation process, the outcomes and the action taken in response.” from the report
As-needed medicines guidance
needs fixingWritten guidance was not consistent for medicines given when needed. The manager acted immediately and added guidance to people's records.
“did not have documentation to guide care staff on what these medicines were for and when to give it to people.” from the report
- 01What evidence can you show that mental capacity assessments and consent records are now completed and reviewed?
- 02What ongoing training have staff completed in mental capacity, dementia and managing challenging behaviour?
- 03How are as-needed medicines recorded, and how do staff know when each medicine should be given?
- 04How are personal emergency evacuation plans kept up to date for each person?
- 05How do your audits now check care records, complaints, staff records and the accuracy of other records?
This was an unannounced inspection of the overall service, including all five CQC question areas, and it followed a Good rating at the inspection in July 2015. This explanation was written from the published report of 29 September 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Howard Court Care Home
4 rated inspections over 4 years: the service has improved, from Inadequate to Good.
- October 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2015Goodup from InadequateSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2015InadequateSafe: InadequateEffective: InadequateCaring: InadequateResponsive: InadequateWell-led: Inadequate
- September 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- June 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 9 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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