Squeaks House Residential Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of the legal regulation in relation to safe care and treatment.

This service scored 47 (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 did not always have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice.

Prior to our assessment on 12 and 13 March 2025, the Local Authority had undertaken a PAMMS audit of Squeaks House Residential Care Home in February 2025. This is an audit to help Local Authorities assess the quality of care provided by adult social care services. As part of that audit, the Local Authority had highlighted not all members of night staff had had their competency assessed at regular intervals to ensure their practice remained safe when supporting people with their medicines. Additionally, no emergency fire grab bag was at the service. This is a portable pre-packed kit of essential items designed to assist staff during a fire emergency and evacuation. At our assessment we found the above remained outstanding and had not been addressed despite these areas being easy to resolve.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

People’s needs were assessed prior to their admission to the service and this information was used to inform their care plan and associated risk assessments. The manager told us about the service’s assessment and admission process. They confirmed that people’s care and support was planned where possible with the person, those acting on their behalf and other key partners to ensure continuity of care.

Information viewed showed people’s safety was not routinely managed to ensure positive outcomes. This referred to a person’s health declining, but healthcare advice and support was not sought at the earliest opportunity. Another person received a meal that did not meet their specific dietary needs.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

The manager was aware of their responsibility to notify the Care Quality Commission and the Local Authority of any allegations or incidents of abuse, but this did not routinely happen in practice. 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 when the person’s health had significantly declined. The manager had failed to raise the above as a safeguarding concern to the Local Authority and Care Quality Commission; and to complete any initial internal investigation regarding this incident. The manager was advised to retrospectively raise a safeguarding alert to the Local Authority and to complete a notification to the Care Quality Commission. These were completed 5 days after our assessment.

Staff were able to tell us about the different types of abuse and what to do to make sure people were protected from harm. Staff told us they would escalate any concerns to the provider, registered manager, Local Authority or Care Quality Commission. A member of staff told us, “I would report any concerns to the manager or senior on duty.” Staff had completed appropriate safeguarding training.

Though the above is not positive, people and those acting on their behalf told us they or their loved one were safe at Squeaks House Residential Care Home. Comments included, “I do feel safe, because there’s people [staff] about looking after us”, “The staff make me feel safe, they’re friendly” and “[Name of person using the service] is safe, staff always keep an eye on them.”

The provider did not ensure all risks to people’s safety and wellbeing were identified or provided enough detail as to how these should be mitigated. Staff did not always provide care to meet people’s needs that was safe.

Not all risks to people’s safety and wellbeing were identified or provided enough detail as to how recognised risks should be mitigated. This referred specifically where people were judged to be at risk of dehydration and required their fluid intake to be monitored and recorded, records demonstrated their fluid targets were not always maintained and there was a lack of evidence to show what was being done to monitor and address this. Potential risks associated with catheter and stoma care were not identified and recorded. A catheter is a medical device used to empty the bladder and collect urine in a drainage bag. A stoma is a surgically created opening in the abdomen that allows faeces and urine to be diverted out of the body. Furthermore, we could not be assured the person’s catheter bag was regularly emptied as the records were not consistently completed.

We observed a member of staff perform unsafe moving and handling practices whilst supporting a person to mobilise while using a specific item of equipment. The member of staff did not ensure the seat flaps were in place to support the person’s back or ensure they were placed in position after the person was raised to a standing position. Although this equipment allows a lone member of staff to provide support for a person when transferring from a seated position to a standing position and vice versa, the person’s care plan recorded 2 members of staff were required for all transfers. This did not happen as only 1 member of staff was routinely used to transfer the person with their moving and handling needs. Staff used this item of equipment as a transport aid for room-to-room transfers and this was not appropriate.

We identified concerns with fire safety. The service’s Personal Emergency Evacuation Plan [PEEP] folder was viewed. A PEEP is a bespoke ‘escape plan’ for individuals who may not be able to reach a place of safety unaided or within a satisfactory period in the event of a fire emergency. PEEPs were not sufficiently detailed as no consideration had been made to identify people’s physical and neurological needs which would affect their ability to evacuate, their ability to communicate and understand instructions and where they could be anxious and distressed. Where people had a risk assessment for emollients within their individual care plan, this information had not been transferred to the PEEP.

Limited records were available to demonstrate regular fire drills for both day and night staff were being conducted at Squeaks House Residential Care Home. For example, the most recent fire drill recorded was 8 January 2025 and the previous one recorded was 29 September 2023. There were insufficient fire wardens on each shift to ensure the safe evacuation of people in the event of a fire, by leading and coordinating the evacuation process. Not all fire wardens training were up to date.

The provider controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People and relatives did not express any concern in relation to the safety of the environment.People had access to an outside space that was secure and safe. Regular environmental and equipment checks were completed to ensure the premises were safe. For example, safety checks were completed relating to the service’s electrical and gas installation system, portable appliances throughout the service and fire safety equipment checks. Specialist or adaptive equipment was made available for people’s use to ensure their needs were met.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development.

People’s and relatives’ comments relating to staffing were generally positive. A person using the service told us, “There’s plenty of staff around.” Another person told us, “There are usually staff about all day.” A relative told us, “I think there’s always plenty of staff around, they’re friendly.” On the first day of our assessment there were not enough staff deployed in line with staffing levels as stated by the manager due to unforeseen circumstances. The manager told us steps had been taken to obtain ‘off duty’ and agency staff to plug the staffing deficit, but this was not successful. Appropriate staffing levels were deployed to the service on the second day of our assessment.

Observation of staff’s practice did not provide assurance staff were skilled and competent to effectively apply their learning in their everyday practice. There were people at the service who were living with dementia, but not all staff demonstrated and delivered effective person-centred dementia care and support. Not all staff were skilled and supportive whilst supporting people at mealtimes or with people’s moving and handling needs. The training matrix provided by the manager demonstrated there were gaps in staff training. For example, 15 members of staff did not have up to date moving and handling training despite there being a designated moving and handling trainer available for the service. There was no evidence to support staff had received specialist training relating to catheter and stoma care. The assistant manager confirmed they were the service’s infection, prevention and control lead but had not attained a higher level of training.

Not all staff had received regular formal supervision, and this included the manager. The manager had not received formal supervision since commencing in post in June 2024. A member of staff who commenced in post in August 2024 had not received formal supervision. Where staff supervisions were happening in line with the registered person’s expectations and issues were raised by a staff member, there was a lack of information recorded as to how this was to be monitored in the longer term and the action to be taken.

The provider did not have effective recruitment and selection procedures in place. For example, none of the staff personnel files viewed had a recent photograph and proof of identification. Another staff member’s file showed in addition to the above, no written references or evidence of interview notes had been retained or sought. The latter provides a clear rationale for why the prospective member of staff was selected for the role. No information was recorded to demonstrate the progress and satisfactory completion of an employee’s performance and probation review during their initial employment period.

Not all newly employed staff had received a robust induction when they commenced employment at Squeaks House Residential Care Home.

The provider did not always ensure they managed the risk of infection. We observed toilet brushes left sitting in water. Although the water was not dirty, this practice can promote bacteria growth and is considered poor hygiene practice due to the potential infection risks posed. Some of the toilet brush holders were stained.

The majority of staff were clear about their roles and responsibilities to ensure people were protected by the prevention and control of infection arrangements at Squeaks House Residential Care Home. Nonetheless, we observed staff handling people’s biscuits with their fingers rather than using tongs or wearing gloves. This meant there was a risk of cross-contamination and foodborne illnesses, leading to the spread of bacteria and viruses.

Staff had access to sufficient Personal Protective Equipment [PPE]. Staff were observed using Personal Protective Equipment [PPE] appropriately and when required. The service was visibly clean and odour free. A relative told us, “The place is always clean. I find it’s always clean and tidy plus it’s odour free. Their wardrobe is arranged neatly, their clothes are hung in order.”

The provider did not always make sure that medicines management was safe and met people’s needs. Improvements were required as there was no body map for the administration of insulin so as to identify the site of injection. Where a variable does of medication was prescribed, for example, 1 or 2 tablets, the actual amount of medication administered was not consistently recorded. Where people were prescribed a transdermal patch to deliver a specific medicine through the skin, a record depicting the site of application was not completed by staff. The record of fridge temperatures demonstrated medication requiring cold storage were not stored at the correct temperature. The latter was fed back to the manager, whereby new thermometers to monitor the fridge temperature were purchased and available on the second day of our assessment.

Staff were observed to administer people’s medicines appropriately and in line with current guidance. The medication rounds were evenly spaced out throughout the day to ensure people did not receive their medicines too close together or too late. Observation of staff practice showed staff undertook this task with dignity and respect for the people being supported.

Medication Administration Records [MAR] demonstrated people received their medicines as they should and in line with the prescriber’s instructions. The service ensured people's behaviour when anxious and distressed was not controlled by excessive and inappropriate use of medicines.

Staff confirmed they had received appropriate medicines training and had their competency assessed at regular intervals to ensure their practice remained safe when supporting people with their medicines. However, we found there was no evidence of competency assessments for night staff. This had been raised by the Local Authority during their assessment of the service in February 2025 but remained outstanding.