CQC report explained · a nursing home
What the CQC found at Howe Dell Manor
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found that risks were assessed and reviewed, staff were recruited safely, staffing levels were sufficient and medicines were managed accurately. Infection prevention measures were also in place.
- Effective?
- Good
- People's needs were assessed before admission and staff worked with health professionals. Staff received training and supervision, although a revised training plan was still due to be delivered.
- Caring?
- Good
- People said staff were kind, listened to them and respected their privacy, dignity and choices. Care plans involved people in decisions about their support.
- Responsive?
- Good
- People received personalised care and had activities, hobbies and outings available. Some care plans needed more information, and staff needed further training for their key-working role.
- Well-led?
- Good
- Inspectors found a positive and open culture, with stronger quality monitoring and better partnership working. Some governance systems were still being developed to make improvements consistent.
What inspectors found, October 2023
Howe Dell Manor is rated Good; inspectors found safe, kind care, with some care records and improvements still being completed.
Inspectors visited unannounced on 11 and 17 October 2023. They spoke with people, staff and health and social care professionals. They reviewed care records, medicines records, staff training, incidents and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People said they felt safe and were happy with their care. Inspectors found medicines were managed well, staffing was sufficient and staff treated people with kindness and respect.
There had been improvements since the previous inspection, which was rated Requires Improvement in 2019. The Effective, Responsive and Well-led ratings improved to Good, while Safe and Caring remained Good. Some care plans needed more detail, staff training and practice needed to become more consistent, and some parts of the building needed repair or decoration.
People feel safe
People told inspectors they felt safe living at the home. Staff knew people's risks and how to support them when they became distressed.
“People told us they were happy with the care provided and felt safe living at the service.” from the report
Medicines managed well
People said medicines arrived on time. Inspectors found medicines were stored safely and records matched the medicines checked.
“Medicines were stored safely, and records were completed accurately.” from the report
Kind and respectful care
Staff knew people well and supported their privacy, dignity, independence and personal choices.
“People were involved in all decisions about their care.” from the report
Improved management
The report found better management systems and a significant improvement in the culture since the previous inspection.
“There had been a significant improvement to the culture in the home and improved use of governance systems.” from the report
Activities and outdoor space
People had communal areas and extensive grounds, and inspectors saw people taking part in activities and outings.
“People had access to ample communal areas and extensive grounds which were in use on the day of our visit.” from the report
Care plans need more detail
needs fixingSome care plans did not give staff enough information to support people safely and proactively. This included missing detail about how hallucinations presented and how staff should respond.
“However, these required further information to give staff all the information they needed to support people safely and pro-actively.” from the report
Some building work outstanding
minorInspectors found aged decoration, marks and stains, gaps in tile grouting and flooring that needed replacing. The provider had plans to address these issues.
“We saw marks scuffs and or stains on the walls, gaps in tile grouting round sinks and baths and noted some flooring required replacement.” from the report
Access for some people
needs fixingPeople who were free to leave the building had to ask for the door code. The manager had ordered electronic key fobs to provide unrestricted access.
“However, we were aware that people able to leave the service needed to ask for the code to the door, which impeded their free access.” from the report
Small mealtime shortfall
minorPeople were supported to eat well, but inspectors said the experience would be better if drinks were offered with meals.
“However, the experience could be improved by ensuring people were offered a drink with their meals.” from the report
- 01How are you adding more detail to care plans about hallucinations and the right support for each person?
- 02Have the electronic key fobs been installed, and can everyone who is allowed to leave access the building freely?
- 03What work has been completed on the stained walls, tile grouting and flooring?
- 04Are people now routinely offered a drink with their meals?
- 05Has the revised staff training plan been delivered, including training for the key-working role?
This was an unannounced inspection covering all five key questions and infection prevention and control, with visits on 11 and 17 October 2023. This explanation was written from the published report of 28 October 2023 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, July 2019
Rated Requires Improvement; care was safe and kind, but support plans, activities, food support and management still needed work, although the home left Special Measures.
Inspectors made an unannounced follow-up visit on 12 June 2019. They spoke with people and visitors, staff and managers, observed care, and checked care records, medicines, staff files and management records.
People said they felt safe and that staff were kind and caring. Medicines, staffing, safeguarding and infection control were found to be safe. Staff supported people to make choices and worked with health professionals when people's needs changed.
The overall rating was Requires Improvement. Effective, Responsive and Well-led were rated Requires Improvement. Care plans did not always give enough current, personalised detail. Activities, dietary support, staff training, incident investigations and the home environment also needed further improvement.
The previous inspection had rated the home Inadequate and placed it in Special Measures. Inspectors found significant improvements and said the home was no longer in breach of regulations, no longer Inadequate and no longer in Special Measures.
People felt safe
People said they felt safe, and staff understood how to report concerns and protect people from harm.
“People's told us they felt safe living at Howe Dell Manor.” from the report
Safe medicines and staffing
Inspectors found medicines were administered and recorded safely. There were enough staff to meet people's assessed needs, with regular agency staff used when needed.
“People were supported by sufficient numbers of staff to provide safe care.” from the report
Kind and respectful care
People described staff as kind and caring. Inspectors saw compassionate support and found that privacy, dignity and confidentiality were respected.
“People were cared for in a compassionate manner by staff who were caring and respectful to them.” from the report
Improved oversight
The provider had introduced stronger reporting, audits and board-level monitoring. These changes helped identify areas needing further improvement.
“The provider had undertaken a significant and substantive review of their governance framework.” from the report
Access to health professionals
Staff identified changes in people's needs and made referrals to health professionals, including GPs, dieticians, physiotherapists and mental health professionals.
“Staff were able to promptly identify when people`s needs changed and seek professional advice.” from the report
Care plans lacked current detail
needs fixingSome plans did not clearly show people's current needs or the exact support staff should provide. This included mental health symptoms and how to respond to challenging behaviour.
“These plans did not all contain enough details to guide staff about people's moods and the specific steps staff needed to take to be most effective in caring for people.” from the report
Dietary support needed improvement
needs fixingThe chef was not fully aware of people's dietary needs, including risks linked to weight loss and modified diets. Staff did not always follow advice when a person skipped meals.
“The chef's awareness of people`s needs were limited.” from the report
Activities were still developing
needs fixingPeople enjoyed trips and some therapeutic activities, but inspectors said activities needed further development so people were occupied and did not become bored.
“Activities needed further developing to ensure people were involved and had been occupied to avoid boredom.” from the report
Management was unsettled
needs fixingThere had been several management changes. Inspectors found uncertainty and a poor culture among staff, although the provider had identified this and had plans to address it.
“Continued management changes led to uncertainty and a poor culture with the staff team.” from the report
Incident learning was not consistent
needs fixingIncident monitoring had improved, but investigations were not always clearly recorded and lessons learned were not yet embedded in everyday practice.
“However, investigations of incidents were not always clearly documented.” from the report
- 01How do you make sure each care plan reflects the person's current mental health needs, preferences and support strategies?
- 02What training have staff completed in mental health, learning disabilities, nutrition and responding to challenging behaviour?
- 03How are people's dietary risks, weight loss risks and meal choices recorded and acted on?
- 04What regular activities and trips are now available for each person, and how do you check that they are meaningful to them?
- 05How are incidents investigated, and how do you show that lessons learned have changed day-to-day practice?
This was an unannounced follow-up inspection covering all five key questions after the previous Inadequate rating and Special Measures placement. This explanation was written from the published report of 27 July 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 Howe Dell Manor
5 rated inspections over 7 years: the service has held its Good rating throughout.
- October 2023Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2019Requires improvementup from InadequateSafe: GoodEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- March 2019Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- October 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- June 2016GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2013
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- June 2012
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 11 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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