Houndswood House Care Home

Houndswood House Care Home is a residential care home providing personal and nursing care to up to 50 people. The service provides support to older people, some of whom may be living with dementia. At the time of our inspection there were 34 people using the service.

Houndswood House Care Home accommodates people across 2 units, each of which has separate adapted facilities and adjoining communal areas.

People’s experience of using this service and what we found

Risks to people's safety were assessed and monitored and there were systems to safeguard people from the risk of abuse. The service’s infection prevention control measures were effective. People were supported by trained staff to take their medicines. However, we found covert medicines were not managed well; we have made a recommendation related to this.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We have made a recommendation related to this.

Whilst the home was well maintained, the décor was not dementia friendly. We have made a recommendation related to this.

Staff received an induction when starting in their role. Staff were knowledgeable about people’s nutrition/hydration needs and preferences and majority of feedback from people and families was positive about the food.

People and their families felt involved in people’s care.

People’s end of life care plans did not include people’s preferences or religious/spiritual needs. We have made a recommendation related to this. People were supported with activities, and we received positive feedback from people and families on this.

People and relatives spoke positively about the leadership of the service and the care people received from staff. People, relatives and staff felt comfortable raising any concerns and giving feedback. Staff felt supported by their managers and colleagues. The provider had systems to monitor the quality and safety of the service and staff worked effectively with other health professionals to support people's health and wellbeing.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 November 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Houndswood House Care Home on our website at www.cqc.org.uk.

Recommendations

We have made recommendations in relation to covert medicines, mental capacity assessments and best interest decisions, dementia-friendly décor and end of life care at this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Houndswood House Care Home is a residential care home providing personal and nursing care to 37 people aged 65 and over at the time of the inspection. The service can support up to 50 people.

Houndswood House Care Home accommodates up to 50 people across two units, both of which has separate facilities and adjoining communal areas.

People’s experience of using this service and what we found

People told us they felt safe and happy living at the service. However, two relatives raised concerns regarding the actions of specific members of staff. A safeguarding referral was made following the inspection in relation to these concerns. The registered manager took action to mitigate the potential risks posed to people whilst an investigation is completed.

There were several shortfalls and inconsistencies in the completion of the records used to record incidents, accidents and falls. This meant that all events had not been included in the reviews of risks to people's health, safety and wellbeing. Pressure relieving mattresses were found to be incorrectly set for people’s recorded weights and repositioning of people at high risk of pressure damage was not completed in accordance with care plans and risk assessments.

Processes followed to recruit new staff were not always fully completed. Staff files lacked information to demonstrate references provided had been checked and verified and reasons for leaving previous employment explored.

Checks and audits had been completed on all aspects of the service. However, these audits were not effective and did not identify the shortfalls found at this inspection. The quality assurance report submitted to the provider contained inaccurate information and was inconsistent with the findings of this inspection. This meant that appropriate action may not be taken to address any shortfalls or drive improvements at the service.

There was a consistent number of staff on duty. People received care in a timely manner and staff were attentive and able to respond promptly to requests from people. Medicines were being managed well and staff followed good infection control practices.

People and relatives felt the service was well-led. They knew who the registered manager was and said they were approachable, supportive and responsive to their needs. The registered manager and staff were responsive to suggestions and observations made during the inspection to improve practice. Staff received regular support for their role to ensure they had up to date knowledge for their role and felt involved in the development of the service. Regular meetings were held for people, relatives and staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 20 January 2018).

Why we inspected

We received concerns in relation to the management of incidents and accidents and people’s safety. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Houndswood House Care Home on our website at www.cqc.org.uk

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We may meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

When we last inspected the service on the 1 and 3 March 2017. We found that the provider had failed to maintain the health, safety and wellbeing of people in their care and were in breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014. The service was not consistently well led and there was no registered manager in post. The service was rated as requires improvement overall.

The provider submitted an action plan telling us how they intended to make the required improvements. In addition the provider made a change to their statement of purpose and the service no longer accepts people who live with Dementia. The home has recently undergone a major refurbishment which has greatly improved the living space and environment for people who used the service.

At this inspection we found that the provider had made the required improvements and were now meeting the regulations, and the service has been rated as good.

Houndswood House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. They are registered to provide accommodation care and nursing for up to 50 people. At the time of our inspection there were 15 people living at Houndswood House.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People felt safe living at Houndswood House Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed appropriately. People's needs were met by sufficient numbers of skilled and experienced staff. There was a robust recruitment process in place which helped to ensure that staff employed to provide care and support for people were of good character and fit for the roles they were employed for. People received their medicines regularly from staff who had been trained to administer medicines safely.

Staff received support from the management team which included regular one to one supervision with their line manager. Staff attended regular team meetings which made them feel supported and valued. People received support they needed to eat and drink sufficient quantities to help sustain their wellbeing and people’s health needs were met with appropriate support and access to a range of health care professionals when required.

People and their relatives were consistently complimentary about staff who were kind and caring. Staff were knowledgeable about individuals' support needs and preferences and people and or their relatives had been involved in the planning of their care.

People and their relatives were asked to give feedback about the service they received and their views were taken into account to help drive improvements. People were supported to raise any concerns through the complaints policy and were confident their views would be acted on. Compliments and positive feedback was also captured.

There was a warm open and inclusive atmosphere in the home. Staff had clear roles and responsibilities and felt valued and well supported. The registered manager had worked hard to develop a positive ‘can do’ culture and people were central to everything that happened at the service. The provider had suitable arrangements in place to regularly monitor the health, safety and quality of the care and support people received and had an appetite to make continual improvements.

Houndswood House provides accommodation for up to 50 people who require nursing and personal care, including people living with dementia. There are two separate units in the home, Magnolia Lodge for people living with dementia and Primrose House for people who require nursing care. At the time of our inspection there were 30 people living at the home.

There was a support manager who was managing the day to day running of the home. However they were not registered with CQC. The regional manager told us that they were in the process of trying to recruit a new manager who would be registered with CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

When we last inspected the service on 4 and 12 October 2016 we found the provider was not meeting the regulations and were in breach of regulations 9, 10, 17 and 18. There were not always sufficient numbers of suitable staff available to meet people’s needs. Governance arrangements were ineffective. Activities were not suited to people’s abilities or interests. People did not receive person centred care and people’s dignity was not always maintained. At this inspection we found that although improvements had been made. Further improvements were required to ensure compliance with the regulations was achieved.

People were unable to tell us whether they felt safe living at Houndswood house. However we observed improvements had been made to help keep people safe. Staff mostly understood how to keep people safe and risks to people's safety and well-being were assessed and were being kept under regular review to help to keep them safe. However staff did not always have access of peoples risk assessment and this put people at risk of injury.

People's medicines were managed safely. They were administered only by trained Nurses who had received training and had their competencies checked.

People had their needs met in a timely way and we observed there were sufficient numbers of staff who had the right skills and experience to support people safely. There was a robust recruitment process in place. This helped to ensure that staff who were employed at the service were suitable to work in this type of service.

Staff received support from their managers. This included both one to one supervision and team meetings. Staff told us they felt supported, although there had been several changes in the management structure which had meant a lack of consistency.

People received the assistance they needed to eat and drink adequate amounts of food and fluid to help keep them well. People were supported to maintain their physical and mental health and staff made referrals to healthcare professionals when required.

We observed staff to be kind and caring. Staff were knowledgeable about people’s individual requirements in relation to their care and support needs and preferences. People and or their relatives had been invited to participate in the planning of their care where they were able to and where this was appropriate.

People were supported to participate in some activities that were provided. However this was an area that required improvements. Activities were not always suited to people’s abilities. Feedback from relatives also indicated that there was less engagement at the weekends and it was not always evident how people who were cared for in their bedrooms were engaged.

People and their relatives were supported to give feedback about the service. People were able to raise any concerns they had and told us that in most cases they were confident they would be listened to and any issues they had would be addressed.

There were systems and processes in place to monitor the quality of the care and support provided for people who used the service. Where shortfalls were identified actions were in place to make the required improvements. The environment continues to be in need of refurbishment and this is planned to commence in May 2017. However we discussed how the environment could be maintained at an acceptable level until such time as the refurbishment is completed.

We received mixed feedback from people’s relatives. Most had seen some improvements but felt the home was still undergoing a period of transition with many changes of staff and management at the service. There was a detailed action plan in place which was being kept under regular review since the last inspection.

At this inspection we found the service to be in breach of Regulations 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

Houndswood house care home provides residential and nursing care for up to 50 older people, some of whom live with dementia. There were 45 people living at the home at the time of this inspection.

There was a registered manager at Houndswood House. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. We were informed by the provider that after this inspection the registered manager and deputy manager both resigned.

When we last inspected the service on 10, 11, 16 and 18 August 2016 we found the service was in breach of regulations 09, 12, 14, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure that there were sufficient numbers of staff to keep people safe at all times, and people did not always receive personal care in a timely way. The provider had failed to provide people with opportunities for engagement and activities and there were concerns relating to the management of medicines. The provider’s governance and quality monitoring systems also had not been effective in identifying these areas.

Following our inspection in August, we received an action plan to tell us how they would make the required improvements to meet the legal requirements. At this inspection we found that the provider had not made sufficient and sustainable improvements and further improvements were required. They were found to be in breach of regulations 9, 10,17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During the current inspection we found that people were left in communal areas with no staff present for three separate periods of up to 10 minutes. People were not always assisted or supported in a timely way and they did not always have access to their call bells to enable them to summon assistance when required. Staff had not received the training necessary to give them the skills and knowledge to support people’s individual health conditions, in particular people who lived with dementia. ”People`s nutritional needs were not consistently met by staff.” People were not always supported to engage in daily activities. Engagement was inconsistent and did not provide people with meaningful engagement or stimulation.

The provider had arrangements in place to monitor the quality of the service; however this was not always effective in identifying and addressing areas that fell below the required standards.

People and their relatives were complimentary about the care staff and told us they were kind, compassionate and caring. However, we found that the staff were not always able to spend quality time with people. The care provided was task orientated and did not support a dignified approach for people. The dementia unit was not decorated to reflect best practice for people with dementia offering little to provide stimulation or interest.

The environment in particular on Magnolia unit was 'scruffy' in appearance and was in need of refurbishment in order to provide a dignified home for people to enjoy. The provider acknowledged this and an extensive refurbishment plan was place, the date for commencement of the refurbishment was to be confirmed.

Some of the people told us they felt safe living at Houndswood house care home, however others felt there were not sufficient staff to keep them consistently safe. Staff demonstrated they knew how to keep people safe and risks to people's safety and well-being were assessed and recorded. However these were not always managed effectively. The home was busy at times and staff were struggling to keep people safe.

The provider had a robust recruitment process in place which helped to ensure that staff employed were suited to work in a care home environment. However two out of six staff spoken with had difficulties understanding and answering our questions because of their limited English language skills. People's medicines were not consistently managed and administered safely by staff. The most recent audit identified that a number of errors were still occurring.

Staff received regular support from their line managers and had one to one supervision meetings where they discussed a range of topics relevant to their roles. Staff did not always feel valued by the management team. Some of the people received the support they needed to eat and drink sufficiently to maintain their health, however people were not always supported in a timely way. People were supported to keep well in most cases their health needs were well taken care of with appropriate referrals made to a range of health professionals when required.

Regular staff were knowledgeable about people care and support needs and preferences and where possible people were involved in the planning and review of their care. However agency staff and 'replacement staff' did not always have the same understanding of people’s needs. People were asked for their consent and this was documented in people’s care records. Visitors were welcomed to the home at all times. The provider had systems in place to obtain feedback from people who used the service, their relatives, and staff about the services provided. There were quality assurance systems and audits in place to help monitor the service however this was not always effective in identifying some of the shortfalls we found during the inspection.

Following the Focused inspection, the provider wrote to us on 18/01/2016 to tell us how they would make the required improvements to meet the legal requirements. At this inspection we found that the provider had failed to make sustainable improvements around the safety and consistency of care and support provided to people.

Houndswood House is registered to provide accommodation and support for up to 50 people with health conditions, age related frailty and people living with dementia. It also provides nursing care. At the time of our inspection there were 46 people living in the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We could not be assured that there were adequate numbers of staff on duty to support people safely at all times. People were not always assisted in a timely way and at times people were left alone without any staff present to promote people’s safety and wellbeing.

People appeared unkempt and the support provided for their personal hygiene needs was not of a consistently good standard. People’s beds were not made properly and some had soiled sheets. Slings used to assist people to transfer were shared and some had other people's initials and room numbers on which meant they may have been placed at risk of injury if they were not using the slings that they had been assessed as needing.

Recruitment processes were not always consistent in ensuring staff employed at the service were suitable to carry out their responsibilities and meet people`s needs. For some of whom English was not their first language. We found they did not always understand the questions we asked them or what we were saying to them. The majority of the people who lived at the home had limited communication and therefore it was difficult to fully assess how this impacted on their health and welfare. We also noted that there were inconsistencies in the checks made for example about the validation of references and completion of documentation.

Most of the staff understood how to promote and protect people’s rights and maintain their privacy and dignity. However, we observed several instances where members of staff failed to respect people’s privacy or dignity.

Engagement with activities and hobbies was poor. Loud music was playing from the radio in conjunction with a television. We observed people were uninterested in either option and staff made no attempt to engage with people or offer people alternative choices of activities.

People’s care plans lacked detail or accurate information relating to people’s care and were not subject to regular review. Care plans were not person centred, and did not always contain sufficient detail to ensure they reflected people’s current needs and choices.

People were supported to take their medicines by appropriately trained staff. However, we found the process for the administration of medicines was not consistently safe.

Staff received some support through induction and a training schedule but most of the training was E learning which is training they completed online and was not consistently effective in providing them with the appropriate skills to help them meet the needs of the people who lived at the service. Staff told us that some of the training was completed at home and we could not be assured that staff were competent following completion of the training.

The service was not consistently well led and had not identified many of the issues we found during the course of our inspection. Where areas of concern had been identified appropriate actions had not been put in place to address these. Records were not completed in a timely way. Some of the staff were positive about their experience of working at the home while others were less positive.

The risk assessments in place were not personalised or detailed enough to support staff to keep people safe. Instructions were not always followed to minimise the potential for harm to occur.

People’s consent was gained before care and support was delivered. However, not all staff understood the principles of the Mental Capacity Act. Most of the staff understood the processes in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberties Safeguards (DoLS).

Staff told us people were able to choose their own meals and the meal choices were completed the day before. However, people were not offered an alternative choice on the day if they had changed their minds. There were no snacks or drinks available other than tea and biscuits during the mid- morning and mid- afternoon. The quality of the food we observed being served to people was of a poor quality and we were told it was 'portion controlled'.

There was little engagement between staff and people who used the service and the care provided was very 'task orientated'. Some people who were more able had developed relationships with staff who treated them kindly. Most of the staff were knowledgeable about how to meet people’s needs and understood how people preferred to be supported. However, we observed that staff sometimes assisted people without following their care plan and to fit in with the limited availability of staff.

Staff were knowledgeable about safeguarding procedures and we saw that they had received training. They were able to tell us what actions they took to keep people safe from possible abuse.

People had access to health care professionals to make sure they received care and treatment to meet their individual healthcare needs. Staff supported people to maintain their health where possible.

There were systems in place for recording, investigating and responding to complaints. People and their family members knew who to speak to if they wanted to raise a concern.

The registered and regional manager were extremely responsive to our feedback and took appropriate action to both alleviate our concerns and to work with senior staff to put a sustainable action plan in place to make the required improvements within an appropriate timeframe.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.