CQC report explained · a nursing home
What the CQC found at Howson Care Centre
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, April 2019
Howson Care Centre was rated Requires Improvement; inspectors found kind, personalised care but concerns about staffing, staff training, the environment and management checks.
This was an unannounced, comprehensive inspection on 30 January 2019. Inspectors spoke with people living at the home, a relative, staff and managers. They examined care records, medicines, staffing, training and quality checks.
The home was safe in some important areas. Medicines were managed safely, people's risks were assessed and health professionals were involved when needed. However, staffing levels were not clearly linked to people's needs, some staff lacked safeguarding knowledge, and parts of the home were dirty or difficult to clean.
People received kind and respectful care. Their care plans were personalised and regularly reviewed. Inspectors also found good support with food, drinks, healthcare, communication and day-to-day choices. Activities were available, although some people wanted more opportunities to go out or be stimulated.
The overall rating was Requires Improvement. The caring and responsive questions were rated Good. Safe, effective and well-led were rated Requires Improvement. Improvements had started since the previous inspection, but the new quality checks had not been running long enough to show they would be sustained.
Kind and respectful care
Staff knew people's preferences and treated them with dignity. People were supported to make choices and remain independent where possible.
“We found people's dignity was consistently respected.” from the report
Personalised care plans
Care plans described people's needs, preferences, communication and risks. They were regularly reviewed and updated.
“The plans were person centred and set out people's individual preferences.” from the report
Medicines managed safely
Medicines were stored securely, records were accurate and stock checks were correct for the medicines inspected.
“At this inspection we found medicines were managed safely.” from the report
Good healthcare support
Staff identified health concerns and made timely referrals. Records showed people received help from a range of healthcare professionals.
“Records showed that staff were proactive in their approach and made referrals to health professionals in a timely manner.” from the report
Support with food and drinks
Staff understood people's dietary needs and preferences. People were offered choices, alternatives, drinks and snacks.
“The lunchtime experience was relaxed and people accessed lunch in their own time.” from the report
Staffing levels were unclear
seriousStaffing varied between units and some staff felt there were not enough staff. The system did not clearly show how staffing numbers were decided from people's needs.
“The system for ensuring there were sufficient staff was not clear which meant there was a risk there were insufficient staff on duty according to the needs of people.” from the report
Training gaps
seriousSome staff had not completed safeguarding, first aid, moving and handling or other required training. Some staff did not feel fully equipped to manage challenging situations.
“There was a risk staff did not have the up to date skills to ensure they were able to provide safe care.” from the report
Poor cleanliness and maintenance in places
needs fixingThe kitchen in one unit needed a deep clean and some surfaces and equipment were dirty or damaged. Peeling paint and chipped plaster made some areas harder to clean.
“The oven needed a deep clean and the flooring had not been effectively cleaned.” from the report
Quality checks were too new
needs fixingNew monitoring systems had been introduced, but they had not operated for long enough to show that improvements would continue.
“However, they had not been in place sufficiently on a regular basis to evidence the service was able to maintain the improvements.” from the report
Activities were uneven
minorActivities were available, but some people said they wanted more stimulation or more chances to go out. The acting manager was reviewing how this could improve.
“Some people living in the Laurels said they would like to go out more.” from the report
- 01How do you decide how many staff are needed on each unit, and how do you respond when staff are moved between units?
- 02Which staff have now completed safeguarding, first aid, moving and handling and NAPPI training?
- 03What cleaning and repair work has been completed in the Laurels kitchen and the communal areas?
- 04What changes have been made to the Court to help people living with dementia find their way around?
- 05How do you check that the new quality monitoring systems are leading to lasting improvements?
This was an unannounced comprehensive inspection covering all five key questions, the premises and the care provided. This explanation was written from the published report of 4 April 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, July 2018
Rated Requires Improvement overall, with unsafe medicines arrangements and inadequate leadership that inspectors said had not fixed repeated problems.
This was an unannounced, comprehensive inspection on 23 May 2018. Inspectors visited all six units, spoke with people, staff, a relative and the manager, and checked care records, staffing, training and quality checks.
Inspectors found enough staff and kind, respectful care. People were supported with food, healthcare, activities, independence and relationships. However, medicines were not always managed safely, some risks were not properly addressed, care records were not kept fully up to date, and some staff had not completed a full induction.
The home was rated Requires Improvement overall and for Safe, Effective, Caring and Responsive. Well-led was rated Inadequate. This was the home's third consecutive Requires Improvement rating, and the report said earlier problems had not been fully resolved.
Kind and respectful staff
Inspectors saw staff offering reassurance and treating people with kindness. People's privacy, dignity, choices and independence were generally respected.
“People were treated with kindness and were given emotional support when needed.” from the report
Healthcare support
People were supported to see doctors and other healthcare professionals. Records showed ongoing help from services such as dentists, opticians and specialist nurses.
“People were supported to live healthy lives by receiving on-going healthcare support.” from the report
Activities and community links
People could take part in activities including baking, gardening, music and exercise. Some people attended local events and used community facilities.
“People had access to a range of activities and leisure pursuits.” from the report
Risks not fully managed
seriousSome people's risks, including frequent falls and skin problems, were assessed but did not have clear plans to reduce them. Inspectors also found a delay responding to a specialist feeding pump.
“Risk assessments were completed however plans to mitigate the risk were not consistently in place.” from the report
Weak quality checks
seriousAudits and checks did not identify problems found during this inspection or fully resolve issues from earlier inspections. This was the main reason for the Inadequate well-led rating.
“Quality checks had not consistently addressed the issues found at this and previous inspections.” from the report
Care records not kept current
needs fixingCare plans had been created with people, but reviews did not always record changing needs and wishes. Room-visit records also showed inconsistent gaps between checks.
“However, although care plans had been reviewed the reviews had not ensured they accurately reflected people's changing needs and wishes.” from the report
Incomplete staff induction
needs fixingTwo staff members said they had not received a full induction, and inspectors could not find induction evidence in five staff records.
“Two members of staff told us they had not received a full induction.” from the report
Incidents not reported
seriousThe provider had not correctly told CQC about some significant accidents, incidents and injuries.
“Records showed that the registered persons had not correctly told us about significant events that had occurred in the service, such as accidents, incidents and injuries.” from the report
- 01How are covert medicines checked so that they work properly and are given at safe, evenly spaced times?
- 02How do you identify and reduce risks for people who have frequent falls or are at high risk of skin damage?
- 03How often are care plans reviewed, and how do you make sure they reflect changes in people's needs and medicines?
- 04How do you check that people who stay in their rooms receive visits at the required intervals?
- 05What action has been taken to strengthen quality checks and ensure accidents, incidents and injuries are reported to CQC?
This was an unannounced comprehensive inspection covering all five questions and all six units; the previous overall rating was Requires Improvement in October 2016. This explanation was written from the published report of 28 July 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.
Every inspection of Howson Care Centre
4 rated inspections over 3 years: the service has held its Requires improvement rating throughout.
- April 2019Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- February 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- December 2015Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2014
Report published without a new overall rating.
- July 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- May 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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9 live-in carers within about an hour of Lincolnshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
8 can care for a couple. 10 years' experience on average.
“Martin was more than a carer, he managed the home and became my uncle's best friend, enriching his life during his last few years.”
“Magda was always positive and proactive about trying new things to keep dad busy. She also introduced new ideas for keeping dad healthy.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.