CQC report explained · a nursing home
What the CQC found at Howgate House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, December 2019
Rated Requires Improvement; inspectors found kind care and clear progress, but some safety, care records, staff skills and management systems still needed work, and the home was no longer in Special Measures.
Inspectors visited without notice on 8 and 23 October 2019. They spoke with people living at the home, relatives, staff and a health professional. They checked care records, medicines, recruitment, training, maintenance, audits and the building.
The home had improved since its previous inspection, when it was rated Inadequate and placed in Special Measures. Inspectors found kind and respectful care, better staffing, safer medicines management, improved risk assessments and a new manager who was making changes.
Some important problems remained. Care records did not always clearly show people's current needs, some staff skills needed strengthening, and there were gaps in recording risks, nutrition and communication support. The overall rating and the Safe, Effective, Responsive and Well-led ratings were Requires Improvement. Caring was rated Good.
Kind and respectful care
Inspectors saw staff treating people with kindness and patience. People’s privacy, dignity and independence were respected.
“We observed staff interacting with people in a kind and caring way. They were patient and considerate, addressing people by their name and showing respect.” from the report
Improving leadership
People, relatives, staff and professionals said the home had become calmer and more organised since the new manager started.
“Staff and external professionals told us they had seen improvements since the new manager started. They told us the service was calmer and more organised.” from the report
Better staffing arrangements
People generally felt there were enough staff, and inspectors did not see people waiting for care. Recruitment checks had been completed.
“They felt there were generally enough staff on duty to meet people's needs. Staff were available in the communal areas and we did not observe people waiting for care and support.” from the report
Improved medicines management
Medicines were stored securely and given by trained staff. Records generally showed that people received medicines as prescribed.
“Medicines were stored securely and administered by trained nurses or care practitioners.” from the report
Respect for choice and rights
Staff asked people before providing care. Mental capacity and best-interest processes were being followed, and people were supported to make daily choices.
“People told us, and we observed staff asked people before delivering care.” from the report
Out-of-date risk information
needs fixingOne person’s moving and handling plan did not match how they were being supported. The manager updated the records after the inspection, but this shows that checks were not always effective.
“However, this had not been risk assessed and was not clearly documented in the care plan.” from the report
Staff skills
needs fixingSome people felt that some staff did not have enough training or experience for complex needs. The manager was addressing this through training and a review of working patterns.
“Some people had concerns about the skill mix. They felt some staff were not adequately skilled and experienced to meet their needs.” from the report
Nutrition records
needs fixingOne nutritional screening score underestimated the risk of poor nutrition. Fluid charts also recorded supplements inconsistently, which could give an incorrect picture of fluid intake.
“We found some inconsistencies in the recording of dietary supplements in people's fluid charts.” from the report
Care plans needed more detail
needs fixingSome care plans were difficult to understand or did not clearly show what had changed after reviews. The manager said these issues would be dealt with.
“Some of the reviews were not detailed enough to show if changes had been made to people's care plans.” from the report
Communication support
minorPeople’s communication needs were assessed, but support was not always provided consistently. Relatives said people were not always helped to wear their glasses.
“Further improvements were needed to make sure people consistently received the right support.” from the report
- 01How do you now check that moving and handling care plans match the equipment and methods staff are using?
- 02What training has been completed to make sure staff can support people with complex needs?
- 03How are nutrition screening and fluid records checked for accuracy?
- 04How do you make sure care plan reviews clearly record changes in people’s needs and preferences?
- 05How do you ensure people receive consistent support with communication needs, including wearing glasses?
This was an unannounced planned inspection covering all five key questions, including the building and care provided, and it followed the previous Inadequate rating. This explanation was written from the published report of 6 December 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.
What inspectors found, May 2019
Rated Inadequate and placed in special measures; inspectors found serious problems with staffing, safety, care records, nutrition, complaints and leadership.
This was an unannounced inspection on 04 February 2019. Three inspectors observed care, spoke with people, a relative, staff and a health professional, and checked seven care records, medicines records and other documents.
The inspectors found not enough suitable staff at times. People could be left for long periods with little social interaction. Risks, medicines, nutrition and care records were not managed reliably. Some people may not have received the care they needed, including support with weight loss, pressure care, diabetes and end of life wishes.
Staff were often kind and had improved training and support. A new manager had started audits and plans for improvement, but there was no registered manager and the provider could not show that it had learned from problems or used feedback effectively. The overall rating was Inadequate, with four key questions rated Inadequate and Caring rated Requires Improvement.
Kind and respectful staff
Inspectors saw staff being kind, patient and respectful. People and a relative also said staff treated people well.
“Staff were caring and treated people with dignity and respect.” from the report
Safe recruitment
The required recruitment checks had been completed, and staff understood how to recognise and report abuse.
“Staff had been recruited safely and all the required checks had been done to make sure they were suitable to work with vulnerable people.” from the report
Improved staff training
Staff said they had good access to training and felt supported by the new manager. This was an improvement from the previous inspection.
“During this inspection staff told us they had good access to training and felt well supported by the new manager.” from the report
Clean environment
The home was clean, and inspectors saw staff using protective clothing appropriately. An infection control problem found at the previous inspection had been addressed.
“The home was clean and free of unpleasant odours.” from the report
New manager identified improvements
The new manager had begun audits and was reviewing care plans, bedding and mealtime arrangements. A visiting health professional said communication had improved.
“We found the new manager had high standards.” from the report
Staffing levels
seriousThere were not always enough suitably qualified staff. Agency staff were used regularly, and there were periods when people had little interaction or stimulation.
“There were not always enough staff deployed to ensure people experienced consistently good outcomes.” from the report
Risks and medicines
seriousSome risks were underestimated or not followed through. Creams and other medicines were not always recorded correctly, and medicine stock records did not always match.
“The management of medicines was not consistently in line with good practice guidelines.” from the report
Nutrition and weight loss
seriousTwo people had been losing weight for several months without extra strategies in their care plans or evidence that this had been raised with health professionals. Food and fluid records were not always complete or reviewed.
“People's nutritional risks were not always managed effectively.” from the report
Care records and personal care
seriousCare plans were not always up to date or detailed enough. Inspectors found missing or unclear information about pressure relief, diabetes, oral health and end of life wishes.
“Care was not always planned and delivered to meet people's needs.” from the report
Complaints and learning
needs fixingComplaints were not consistently recorded, and it was unclear what action had been taken. Archived records meant the provider could not show that it had learned from incidents or feedback.
“The provider did not have effective systems in place to improve the service in response to feedback from people.” from the report
- 01How many nurses and care staff are now on duty on each shift, and how do you respond when the planned staffing level is not met?
- 02What checks now ensure that creams, lotions, 'as required' medicines and medicine records are complete and accurate?
- 03How do you identify and respond to weight loss, poor nutrition and dehydration, and when do you involve health professionals?
- 04Have every person's care records been rewritten or reviewed, including plans for diabetes, pressure care, oral health and end of life wishes?
- 05How are complaints, incidents and relatives' feedback now recorded, investigated and used to make improvements?
This was an unannounced inspection covering all five key questions, including observations, discussions and records; the provider was not asked to complete a Provider Information Return. This explanation was written from the published report of 23 May 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 Howgate House
6 rated inspections over 4 years: the service has slipped, from Good to Requires improvement.
- December 2019Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- May 2019Inadequatedown from Requires improvementSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- September 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- September 2017Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- March 2017Inadequatedown from GoodSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- July 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2013
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- October 2011
Registered with the Care Quality Commission on 14 October 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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