Eastside Gardens

Updated 22 June 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by three inspectors including a pharmacy inspector.

Service and service type

Howdon Care Centre is a ‘care home.’ People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Howdon Care Centre is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post. She was the regional manager and employed in an interim position until a permanent registered manager was in post. There was a new manager in place at our second visit to the home, she was applying to be a registered manager with CQC.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 12 members of staff including the regional manager, registered manager, the new manager, deputy manager, clinical lead, nurse, senior care and care staff, the administrator and receptionist. We also spoke with 6 people and 1 relative. We reviewed records relating to people’s care, medicines and records relating to the management of the service.

Updated 22 June 2023

About the service

Howdon Care Centre is a care home providing personal and nursing care for up to 90 people across four units, including a winter pressures assessment unit. The winter pressures unit is for people waiting for a care package at home or admission to a long term care facility. At the time of inspection there were 77 people living at the home, some of whom were living with dementia.

People’s experience of using this service and what we found

Medicines were not managed safely. Quantities of remaining medicines did not always match the records of doses administered, so we could not be assured medicines were administered as prescribed. Guidance and records were not always in place to support the safe administration of topical medicines. A recent provider audit had picked up some of the issues we found on inspection, but an action plan was not yet in place.

Whilst a system was in place to monitor and manage risks; improvements made at previous inspections had not always been sustained. The regional manager explained the new management team at the home and systems in place, would ensure a proactive, rather than reactive approach was followed in relation to the management of risk.

Lessons learned had been identified following several incidents at the home. Action was being taken to help reduce the likelihood of any reoccurrence of these incidents. New protocols had been introduced and additional falls equipment purchased. Further coaching sessions and training were being carried out in relation to falls management since records did not always demonstrate that the provider’s policy had been followed.

The provider had a history of non-compliance at the home. There had been a number of management changes at the home over recent years. There was a registered manager in post. She was the regional manager and employed in an interim position until a permanent registered manager was in post. There was a new manager in place at our second visit to the home.

An effective communication system to ensure information relating to people’s care and support was passed to staff in a timely manner was not fully in place. Some staff explained the quality of handover information was dependant upon the nurse on duty.

Records did not fully demonstrate how the provider was meeting their responsibilities under the duty of candour. We have made a recommendation about this.

At the time of the inspection, there were sufficient staff deployed to meet people’s needs. The home was clean and staff had access to and used PPE safely. There were no restrictions around visiting arrangements.

People spoke positively about the caring nature of staff. One person told us, "The staff are all lovely - I'm happy." Staff also spoke positively about the people they supported. One staff member told us, “I love it here, we’re a good team, it's not about the money - I love looking after them.”

Management staff were honest and open with us during the inspection. They themselves exhibited caring values and spoke positively about the changes which were being made to sustain improvements at the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 24 May 2022). We carried out a targeted inspection in November 2022 to check concerns relating to IPC and the management of the service. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We made a recommendation in the well-led key question in relation to sustaining improvements and the management and support of the home. At this inspection, not enough action had been taken and the provider was in breach of the regulations.

Why we inspected

The inspection was prompted by concerns about people’s care and support, the management of falls and medicines management. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Howdon Care Centre on our website at www.cqc.org.uk.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We have identified breaches in relation to medicines management and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

We have made a recommendation in the well-led key question in relation to duty of candour. Please see this section for further details.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.