Houndswood House 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 inspection, when the service was run by the previous provider, we rated this key question requires improvement. At this first assessment under the new provider the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to how the service was organised to meet people’s needs and how care was monitored to promote positive outcomes.

This service scored 33 (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 make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The provider assessed people’s needs before they came to live at the service. However, these assessments lacked detail about people’s preferences and social and emotional needs. Staff told us information from these assessments was not always shared efficiently to ensure people received effective care. For example, where people had specific dietary needs in relation to their religion or medical needs, this was not always shared in a timely way to ensure all staff who required this information had access to it.

People had not always received safe care in relation to their dietary needs. For example, one person with a medical dietary need had been offered the wrong food because staff had not all had appropriate training and did not understand what foods to avoid. Fortunately, the person recognised this and did not eat it. Although staff we spoke with appeared to understand about people’s modified diets, we found some people had been given fluid of the wrong consistency.

People cared for in bed did not always receive safe support to eat their meals. We observed 2 people lying down to eat their meal. While this may have been their choice, there were no staff on the floor to reduce the risk of choking.

Although most people gave positive feedback about the food, 2 people said they were not happy about the standard of food at weekends. We observed support at mealtimes needed to be improved. Staff did not always speak to the person and support was functional rather than used as an opportunity for engagement to promote a good mealtime experience. This is important as it provides encouragement to people to eat as well as providing positive social opportunities.

We saw there were snacks and drinks available for people to have in between meals should they wish.

The provider did not work well across teams and services to support people. Staff told us information was not shared effectively within the team. For example, information about people’s dietary needs. We found information about a person’s care was missed because it was held separately from their care records. This meant information was not coordinated or shared effectively to ensure people received safe, consistent care.

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Poor communication leading to a lack in continuity of care, and poor record keeping meant we could not be assured people received timely support to manage their health and wellbeing. For example, where people’s medicines were changed, information was not accurately updated and old stock disposed of. This led to staff being unsure what medicines and at what dose to give.

The provider did not effectively monitor people’s care and treatment to continuously improve it. They did not ensure outcomes were positive and consistent, met both clinical expectations and the expectations of people themselves.

Where people required specific aspects of their care to be closely monitored, such as fluid intake or repositioning, records showed people were not consistently receiving the right care. People’s care records showed they were frequently not receiving adequate fluid to meet their needs. On the third site visit there were 21 people under their fluid target for the day, but no action was recorded in relation to this. Records for a person showed for 7 out of 10 days they did not meet their fluid intake assessed target. This put them at significant risk of harm due to a medical need to ensure they met their daily target.

People who required support to manage distress or regulate their mood were not supported well. A person’s record stated staff should not crowd the person; we observed staff frequently standing over them with little engagement. Staff had not kept detailed monitoring records to identify triggers and strategies to reduce instances of distress. People cared for in bed had a lack of engagement with staff. Although some people had hourly checks, staff only checked they had come to no harm rather than to provide any meaningful engagement. A person told us, “I do get lonely. I don’t see anyone for long and don’t have enough to do.”

The provider did not always ensure people’s rights around consent were respected. Records showed some capacity assessments were completed in line with guidance. However, we found mental capacity assessments had not always been completed for people who lacked capacity to make decisions about their medicines. For example, we found paperwork had not been completed to ensure decisions to administer medicines covertly were made in people’s best interests. This meant the correct process had not been followed to ensure the person’s rights had been respected and appropriate people had been involved in making the decision.

1 person who had full mental capacity to make their own decisions was unaware they had the right to challenge decisions made by others, even when they were made by individuals with power of attorney for their care and welfare. This is because Power of Attorney powers only come into force once a person has lost capacity. This meant the person’s rights were not being protected. We raised this with the management team who said they would speak to the person to ensure they understood their rights.

We saw staff mostly asked people for their consent to care before it was provided.