Houndswood House Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement: This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. The service was in breach of legal regulation in relation to governance at the service.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The culture of the home had improved since our last assessment. The provider promoted transparency, equity, equality, human rights, diversity and inclusion. While this reflected a commitment to openness and understanding challenges, people using the service and their families were not consistently engaged with.

The registered manager had encouraged staff to support each other and share information. We reviewed staff meeting minutes which showed staff had been encouraged to acknowledge mistakes, raise concerns and to focus on solutions, not blame. A member of staff told us, “I believe Houndswood House is now a much more positive, safe, and well-managed environment for both residents and staff. I’m proud to be part of the team here.”

The registered manager was not always visible to people and their relatives in the service. People we spoke with, and their relatives had little or no interaction with them. A person said, “I do not know the manager, I wouldn’t say they come around a lot.” A relative told us, “The manager of the home I have had almost no interaction with. A criticism would be that the overall manager changes reasonably frequently without any warning.” Another relative said, “The new home manager has not engaged with us as much as we would have expected and there was no communication about [them] taking up the post and [their] background when [they] joined.”

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The leadership team had stabilised since our last assessment. There was a registered manager in post and in addition to the clinical lead and deputy manager, a manager’s assistant role had been developed to further support the registered manager.

The registered manager had a realistic view of the status of the home and the amount of work still to be done to improve the service. They felt supported by the provider and the rest of the leadership team. The registered manager told us, “Lack of transparency has really improved on nursing and senior side. Even if the error has happened, they call me. They understand the importance. On the caring side, still only developing. No one is hiding anything, but they are more like, yes it happened, we missed to report it.”

Staff felt supported by the managers of the service. A staff member said, “I feel very supported by the home manager and other servicemanagers. They are approachable, understanding, and always willing to listen. They value staff contributions and provide encouragement, creating a positive and supportive working environment.”

The provider fostered a positive culture where people felt they could speak up, and their voice would be heard.

The registered manager was supportive of the staff team. They told us, “This door never closes…They come and tell me when they are fed up with their partners, their colleagues. I have encouraged them to support each other.”

Staff were aware of the whistle blowing policy. A staff member told us, “The manager is very supportive, and in my opinion, if anyone were to approach [them] for additional support or extra training, [they] would arrange it straight away. If I ever have any concerns, I would follow the whistleblowing policy and contact the ICB or CQC.”

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider had policies to support fair treatment of staff. The vast majority of staff gave positive feedback about support from managers and colleagues.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. At our last assessment of the service, we found they were in breach of regulation related to governance. Whilst some improvements had been made, we found they remained in breach at this assessment.

The provider’s processes to monitor the safety and quality of the service were not yet effective. They had a program of audits which were assigned to a lead to complete and identify actions. The registered manager reviewed these at the end of each month. We did not see an audit to monitor distressed behaviour. This was despite some people at the service displaying these behaviours and staff not always responding appropriately to this.

The provider had implemented a process to improve completion of monitoring charts; nurses were required to review re-positioning charts twice daily and if there were gaps in documentation complete a full body check of pressure areas. There was a similar process for fluid charts whereby nurses were to check people were on track to meet their targets. We found neither of these were yet effective as care staff did not always document actions and nurses did not always check them. This meant people remained at risk of pressure injury and dehydration.

The registered manager had a training matrix to monitor compliance with staff training. This did not include clinical training, or all conditions people had. It was unclear how the compliance percentages were calculated as 1 staff member showed as 100% compliant but had not completed safeguarding training. We would expect all staff to complete this regardless of their role. Therefore, we were not assured the tracker was robust.

At our last assessment, we found the provider had not ensured staff had sufficient training. Despite additional training and competency assessments some errors and incidents continued to occur. The registered manager told us they were at saturation point with training and had to address lack of staff competency as a performance issue. They told us some new staff had not passed probation. We reviewed staff supervision records and saw where mistakes were made these were addressed with staff and action plans agreed.

The provider demonstrated improved understanding of their duty to collaborate, so services worked seamlessly for people. They shared information and learning with partners and held meetings with other services. A professional told us, “Communication and collaboration between the home, pharmacy and GP have improved, supporting safer prescribing and timely medication reviews.”

The provider had implemented some processes to improve the service; these were not yet fully embedded but demonstrated they were learning from the issues we found at our last assessment and working towards improvement.

The registered manager was responsive to concerns we raised. They added the issues we fed back on the day of our visit including labelling of drinks and poor oral care to their service improvement plan with action taken to address and target date for completion. They had introduced various processes such as daily clinical updates and monthly clinical governance meetings for oversight of wound management, infections and incidents etc.

The clinical lead nurse had identified undignified practice was an issue among some staff. They had worked with staff to improve this through observed practice, coaching and development, individual 1-1s and promoting dignity at the beginning of every handover. They acknowledged there were still improvements to make, and this was reflected in observation documentation.

People and their relatives felt the service had improved. A relative told us, “There have been a number of changes of staff in the last year and there has been a definite improvement in the way they carry out their jobs.”