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 assessment we rated this key question inadequate. 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.

This service scored 50 (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 records included assessment of their physical and sensory/communication needs. The registered manager told us these were reviewed with people and their families monthly. The clinical lead spoke with people and updated families. There was a plan for this work to be handed over to the nurses.

People’s relatives confirmed involvement in people’s care had improved. A relative said, “We have more recently been involved in that, I think they have a digital system, so they are improving and when I saw I was impressed with the content, but it did take a long time. It was lacking in the beginning.” Another relative said, “I was contacted by the nurse to get some time in November, I was involved when it was initially set up.”

The provider had a condition on their registration at the time of our assessment which restricted them for admitting more people to the service. The registered manager was developing a plan in the event this was lifted. They told us if they had a new referral either the registered manager, clinical lead, or deputy manager would complete the assessment to confirm they could meet the person’s needs. They told us, “We would not go for complex nursing to start with. Would want to start with residential side. I’m aware none of the nurses have done any admissions as haven’t been any since they have been here. The team need to become aware of the admission process before moving on to nursing, but not complex.”

The provider did not always make sure people’s nutrition and hydration needs were met in line with current guidance.

The provider had not ensured there was effective communication between kitchen staff and care staff. Kitchen staff knew people’s needs, for example they were aware of people’s religious dietary requirements but were not always made aware of people’s health needs, such as pressure care. This meant there was a risk the kitchen staff were unable to make amendments to people’s diet which could help.

The chef was proactive in finding out about people. They told us, “So we have a food passport for new people, but once they arrive, I always go and speak with them because you never know if they filled it in, or if it was their family and they weren’t asked. Just good to get it straight from them and ask questions.” They told us there were 3 meal options for people to choose from each day plus various snacks. The chef said, “People are asked the night before what their choices are, but I always say it’s ok to ask for something different or change their mind.”

People’s feedback about the food was mostly positive. A person said, “Food and drink - food is very good and drinks.” They also told us they were not always given what they would like and added, “I am going to see if I can persuade them to do that. I get options for food though.” Another person told us, “I am not that hungry, but the food is good here, I like a cup of tea that is my favourite. I get enough drinks when I need them.”

Staff supported people to eat where required. We saw meals had been prepared to appropriate textures as needed, and staff spoke with people throughout the meal. The tables were well presented and trays for people in their rooms had a cloth. This helped enhance the mealtime experience for people. Staff ensured people eating in their rooms were sitting upright.

The provider did not always work well across teams and services to support people. They had not ensured effective communication between care staff and the kitchen staff. We found information about people’s needs was not always shared with the kitchen staff. This included where adaptations for their diets could improve their condition.Following our inspection, the provider shared examples of emails where information had been shared with staff. However, given the feedback we received during our visit, we were not assured this method was always effective.

Staff shift handovers were completed. There was a sheet with details about each person they supported as well as a clinical report completed by day and night staff to ensure a comprehensive handover with highlights of what had happened in the past 24 hours. A staff member said, “Communication has improved, and staff are kept well-informed through regular updates and handovers.” There was also a monthly statistics form displayed in the nurse station which included details of all infections, wounds, hospital admissions and incidents which gave staff a quick overview when they arrived.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

People were not always supported to ensure their social needs were met. We observed staff who were busy and tended to complete the task, then disengaged in the conversation to move onto the next task. Where people were in their bedrooms, particularly on 1 side of the home, there was not always a staff member present. This put them at risk of social isolation.

People were supported to access other services as required. A person told us, “If I need to see someone, I am able to. The doctors pop in when I need them to.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and

consistent, or that they met both clinical expectations and the expectations of people themselves.

Staff did not always document charts to show people had been supported with fluid intake or repositioning. This had been an issue at our last assessment and whilst additional checks had been implemented to improve this, we found these had not yet been effective.

Staff had received training in personal behaviour support for people in distress. However, risk assessments, care plan interventions and recording of distress did not identify how staff should support people safely.

Staff rarely recorded incidents of distress on behaviour charts. When documentation did occur, it relied on outdated terminology which framed behaviour as “problematic,” and “unwanted behaviour,” rather than focusing on understanding the person’s experience. The charts lacked important information, such as potential triggers, a description of the incident, and details on how the person was supported during and after the episode.

A person frequently displayed distressed behaviours, posing risks to themselves and others. Although care plans noted a preference for staying in their room and advised staff to be aware of distress triggers, no specific triggers were recorded. Distraction techniques were recommended, but there was no information on the person’s interests to guide effective support. We observed this person during our visit and found they were laying on their bed with no TV or music on. We did not see staff interact with them.

Staff were instructed to follow a "walk away" policy when the person became a risk, yet there were no guidelines on how often the individual should be monitored afterward, despite being at high risk of falls and self-harm due to isolation and placing themselves on the floor.

People’s care plans lacked instruction on how staff should document distress incidents. Where a person had complex needs and the service acknowledged it could not meet the person’s needs and alternative placement was necessary, there was no evidence of interim actions such as updated risk assessments or engagement strategies to improve the person’s quality of life.

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

People’s mental capacity assessments did not always show how they were supported to understand the decision being made. We reviewed some where the use of bed rails and/or sensor mats had been agreed. We found 1 person had a general mental capacity assessment which stated they had full mental capacity to understand simple tasks and consent to day to day living activities; this person had a sensor mat and bed rails, and these were not specifically mentioned in the capacity assessment. It was therefore unclear whether consent had been gained.

Another person’s capacity assessment for bed rails did not include evidence of how they were supported to understand and some of the responses on the form did not make sense. For example, for how they were supported it stated, “Person and their [family member] were informed about the decision to erect the bed rail.” For another person, the response to what attempts had been made to involve the person stated, “No attempts have been made.” It goes on to explain the person’s family, who had Power of Attorney (POA) had agreed to it, but they could only make the decision once it had been determined the person lacked capacity to do so. However, we reviewed a better example for someone who had a sensor mat. Staff described showing the person the mat and explaining how it worked before it was concluded they lacked capacity and implemented it in their best interests.