Squeaks House Residential Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of the legal regulation in relation to consent.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s needs were assessed prior to their admission to the service. The assessment helped the management team assess and determine if the person's needs could be met and if the environment was suitable for them. Information gathered was used to inform the person’s care plan and accompanying risk assessments.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Staff were able to demonstrate a good understanding and knowledge of how people using the service should be supported. However, staff’s practice did not always evidence this. The dining experience was not as positive as it should be for people using the service. Staff did not showcase food choices through ‘show plates’ by allowing people to choose their meals at the point of service. Not all people were given a choice of drinks. Staff did not routinely explain to people what the meal provided was, despite many people living with dementia. Some members of staff were observed to be distracted while supporting individuals to eat. For example, by initiating support and then carrying out another task without explaining to the person being supported, what was happening. A person’s pureed meal was mixed together to a brown mush rather than being retained in separate portions. A person using the service received a pureed meal, even though they did not require their food to be modified in this way. These actions were not person-centred and were undignified as they can negatively impact a person’s dining experience.

The provider did not always work well across teams and services to support people. As already recorded the Local Authority completed an assessment to the service in February 2025, but at the time of this assessment there were still actions outstanding that had not been addressed.

Information demonstrated the service worked with others, for example, the Local Authority, healthcare professionals and services to support people’s ongoing care provision. Staff told us they had the information they needed to support people. The manager and staff confirmed daily handovers took place to discuss changes in people’s care and support needs. We attended a handover meeting but found no information was exchanged about people living at the service or what had happened during the previous shift. The latter is crucial for ensuring peoples’ safety, the continuity of care and to help facilitate the accurate transfer of information between staff.

The provider did not always support people to manage their health and wellbeing. Staff did not always support people to live healthier lives.

Information for a person using the service recorded staff had failed to act on their duty of care to seek advice and to ensure effective action was taken at the earliest opportunity as the person’s health significantly declined. For example, to contact NHS 111, a free service offering immediate medical advice and help to determine the best course of action to take. Information recorded there had been concerns about the person’s condition for over 6 hours before staff contacted the national emergency telephone number, and an ambulance was requested.

The provider did not always routinely monitor people’s care and treatment effectively to continuously improve it.

An electronic software system was being used for care planning. Staff used handheld devices to access people’s care records and record the day-to-day support people received. Although there were arrangements in place to monitor people’s weights, food and fluid intake, records relating to the latter were not always consistent with targets set within their individual care plan. The fluid intake for some people were below recommended quantities, either because people had not received sufficient fluids or because the monitoring system was not accurately reflecting what had been given by staff. Without closely monitoring a person’s fluid intake and taking appropriate action, there was a risk of them becoming dehydrated.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The Mental Capacity Act 2005 [MCA] provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards [DoLS].

We found the service was not working within the principles of the MCA. Staff did not demonstrate sufficient knowledge and understanding of the key requirements of the MCA and how this affected people using the service. MCA assessments were not completed where people had an infrared sensor placed in their bedroom to alert staff when they mobilised. Legal authorisations were now in place to deprive a person of their liberty but had not always been applied for in a timely manner.