CQC report explained · a residential care home
What the CQC found at Howbury House Resource Centre
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Some people's risks were not reviewed or reassessed. Information about modified food and drinks did not always match care plans or specialist advice, creating a risk of choking.
- Effective?
- Good
- This key question was not inspected during this visit. Its previous rating was used to calculate the overall rating.
- Caring?
- Good
- This key question was not inspected during this visit. Its previous rating was used to calculate the overall rating.
- Responsive?
- Requires improvement
- Staff responded promptly and spent time with people, but some care plans did not give enough detail for staff to provide consistent, individualised care.
- Well-led?
- Requires improvement
- Quality checks did not reliably identify or act on gaps in care records, risk management and medicine monitoring. The provider's quality assurance systems were not effective enough.
What inspectors found, November 2022
Rated Requires Improvement; staffing had improved, but inspectors found unsafe risk management and weak quality checks.
This was an unannounced inspection on 17 October 2022. Two inspectors spoke with five people, seven care staff and managers. They reviewed care records, medicine records, staffing information, safety checks and quality audits.
There were enough staff on duty, and people said staff had time to support them. Staff were kind, knew people well and responded promptly. The home was clean, infection control measures were in place, and visiting was supported.
However, some risks were not reviewed or managed properly. Information about modified food and drinks was unclear or inconsistent, putting some people at risk of choking. Weight checks and other care records were also incomplete or not up to date.
The overall rating stayed at Requires Improvement. Safe, Responsive and Well-led were rated Requires Improvement. Effective and Caring were not inspected in this visit, so their previous ratings were used to calculate the overall rating.
Kind and attentive staff
People spoke positively about staff. Inspectors saw staff spend time talking with people and respond promptly when support was needed.
“Staff interacted with people at their pace, unrushed and joked and laughed with each other.” from the report
Clean and infection-controlled environment
The home was clean, staff used protective equipment and inspectors were assured that infection risks were being managed.
“We were assured that the provider was using PPE effectively and safely.” from the report
Choking risks were not managed consistently
seriousCare plans and staff instructions for modified food and drinks were sometimes unclear or inconsistent. Kitchen staff did not always follow care plans or specialist advice.
“Kitchen staff prepared meals in a way that did not match what the person's care plan or advice from a speech and language therapist.” from the report
Missed weight monitoring
seriousA person identified as needing weekly weight checks had not been weighed weekly, and there was no clear action to address ongoing weight loss.
“Records showed they had not been weighed weekly or weighed since 29 August 2022.” from the report
Weak quality assurance
seriousAudits did not consistently identify gaps or show that issues had been followed up. Problems found at the inspection had not been properly recognised or acted on by the home's own checks.
“The providers systems and processes failed to identify, drive and sustain improvement through effective quality assurance.” from the report
Medicine counts were incomplete
needs fixingBoxed medicines were not counted routinely. This meant the home could not accurately compare the amount left with the medicine records.
“This meant it was not possible to accurately check the amount of medicine remaining against what was recorded on the medicines records as being given.” from the report
- 01What has changed since the inspection to make sure modified food and drinks match each person's care plan and specialist advice?
- 02How do you now check and respond to weight loss when weekly weight monitoring is required?
- 03How are care plans and risk assessments checked when a person's needs or behaviour changes?
- 04How are medicine counts now completed and followed up when an audit finds a gap?
- 05Can you show us the action plan sent to the CQC and explain which improvements have been completed?
This was a focused inspection of Safe, Responsive and Well-led; Effective and Caring were not inspected and their previous ratings were used for the overall rating. This explanation was written from the published report of 26 November 2022 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, November 2019
Rated Requires Improvement; inspectors found kind and effective care, but staffing, care records and activities did not always meet people's needs.
This was an unannounced inspection on 30 September and 01 October 2019. One inspector spoke with people, relatives, staff and managers. They observed care and checked care records, medicines, audits and other management records.
The home was caring and effective. People were treated with dignity, had choice over their care, enjoyed the food and were supported to access healthcare. Medicines were managed safely and the home was clean.
However, there were not enough staff at some times to keep people safe and meet their needs. Risks were not always monitored properly, care records were sometimes incomplete or inaccurate, and people living with dementia did not always have enough meaningful activities.
The overall rating changed from Good to Requires Improvement. Safe, Responsive and Well-led were rated Requires Improvement, while Effective and Caring remained Good. The provider was asked to send an action plan and CQC said it would monitor progress and re-inspect.
Kind and respectful care
People and relatives spoke positively about the staff. Inspectors saw friendly, supportive conversations and respectful care that protected privacy and dignity.
“We saw all staff supported people in a dignified way, and respected and promoted their privacy.” from the report
Effective support
Staff knew people's needs and had relevant training. The home worked with healthcare professionals and followed their advice.
“They felt people were supported to stay well and staff accessed their support should they have any concerns.” from the report
Food and special diets
People enjoyed the meals and had choices, snacks and fresh fruit. Staff and catering workers understood individual dietary needs.
“We found there was good communication between the catering staff and the care staff to ensure people ate meals that were individualised to their specific needs.” from the report
Safe medicines and cleanliness
Medicines were received, stored, given and disposed of using safe procedures. Inspectors found the home clean and saw good infection-control practice.
“People's medicines were managed and stored in a safe way.” from the report
Not enough staff
seriousStaff were sometimes unavailable in communal areas and some units had only one worker when two were needed for certain care. This created a risk that people might not receive help quickly or safely.
“There were not enough staff on duty to keep people safe and meet their needs.” from the report
Risks not consistently reviewed
needs fixingImportant risks were not always followed up in care records. One person's weight was not recorded for several months after a recorded 10kg weight loss.
“Risk associated with people's individual care needs was not consistently assessed, monitored and reviewed.” from the report
Limited activities
needs fixingSome people living with dementia were left in communal areas without anything interesting to do. Staff said they did not have enough time for one-to-one activities.
“We found some people were content with watching the television, while other people, who lived with dementia, were sat in a communal areas without anything of interest for them to do.” from the report
Inaccurate care records
needs fixingSome care plans did not reflect people's current needs. This could make it harder for staff and managers to confirm that care was safe and appropriate.
“We found care records were not always accurate or complete.” from the report
- 01How are current staffing levels matched to each person's needs in each of the eight units?
- 02What has changed since the inspection to make sure people are supervised and helped promptly?
- 03How does the new dependency tool identify when more staff are needed?
- 04How are care records checked now to make sure they accurately reflect changes in people's health and support needs?
- 05What regular activities and one-to-one time are now available for people living with dementia?
This was an unannounced planned inspection covering the home, the care provided and all five CQC questions; the previous inspection ratings were also compared. This explanation was written from the published report of 8 November 2019 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 Howbury House Resource Centre
4 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.
- November 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
Read what inspectors found at Howbury House Resource Centre →
- November 2019Requires improvementdown from GoodSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
Read what inspectors found at Howbury House Resource Centre →
- April 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2014
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- June 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 24 January 2011.
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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