Handford House Care Home

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We assessed a total of 3 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was good. Our rating for this key question is requires improvement. We received mixed feedback about how kind staff were, and we observed staff interactions that were not always caring. We were also not assured that people received care that promoted their independence, choice and control.

This service scored 55 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Whilst we received some mixed feedback about the kindness and compassion of staff and how people were treated with dignity, many people and relatives expressed their concerns about people’s care. A person told us, “They [staff] are all on their best behaviour today because you are here, take it with a pinch of salt. [Some staff] got told off for using their own language, not respectful, they do not do it anymore, but I do hear them when they are not with people… I think there is unrest in this home and between the staff, upset in the whole home, there are some very good staff who work hard, and they have to put up with bad staff who do not work.” Another person told us, “Some are very kind, some do not talk to me.” Another person commented, “Some staff are very good some staff are not so good, some better than others, some talk others do not. Laundry is not very good; we do not always get things back or we get someone else's.” Relatives told us they felt the majority of staff were kind and caring towards their family members. However, we did receive information where the approach of staff had not always been compassionate, such as a relative told us their family member, who spent the majority of their time in bed, had asked a staff member to put their bedside table nearer to their bed and had been told by the staff member to get up and do it themselves. People using the service told us some staff were better than others, with some people telling us the staff were always kind, others said some staff were not so caring. A person told us they had asked a staff member, when they were answering their call bell, for assistance, but they walked out of their bedroom without responding, “They just came for the bell.” We also received positive feedback about the kindness of staff. A relative said, “[Staff] know the residents extremely well and care for them with compassion and understanding. Some of the permanent staff are truly outstanding and I thank them”

We received mixed feedback from the staff regarding if they felt people received caring and compassionate care. Staff referred to how they felt some staff were caring and others not so much. For example, a staff member said, “I do believe people are well cared for by the majority of staff, but I can’t say all actually do care how they should… I think for the most part people are listened to but there are a pocket of staff who don’t listen and just do what they want but this is not all staff just a very small amount.” Staff also told us they felt the service people received was not always as caring as it should be due to the limitations of staff availability to spend time with people.

We received feedback from health and social care professionals relating to their concerns about the service provided, which did not demonstrate people were always receiving a caring and compassionate service.

Whilst we observed some kind interactions from some staff towards people, we also saw interactions that were not caring, such as staff not acknowledging the people they were supposed to be supporting. We saw a staff member support a person into the dining room, they did not ask the person where they wanted to sit, placed an apron on them without asking their permission and did not communicate with the person throughout. Other staff were more engaging and respectful to people. We saw a staff member assisting a person to move from the dining room to the lounge after their breakfast saying, “Where do you want to sit, shall I take this apron off you?” We saw housekeeping staff returning clothing to a person’s bedroom where we were talking with them, we left so they could continue with their work, we heard positive and caring interactions with the person.

People were not always treated as individuals because their appearance and personal belongings were not always looked after in a respectful manner. Many relatives raised concerns with us about their family member’s personal items. A relative said, “[Family member’s] clothing and personal belongings are not particularly well looked after. We are on [their] 3rd electric shaver since January. The first 2 were broken or had parts go missing… [Family member] has had to have new underclothes as those that [they] moved in with all went missing. On my last visit [family member] was wearing someone else’s slippers…. [Family member’s] own slippers were buried under [their] clothes in the wardrobe, but the insoles had been removed as had those for [their] outdoor shoes. I have replaced the slippers with brand new ones.” Relatives said they got frustrated when things got lost, such as spectacles, remote control, clothing and a cushion bought for a family member to sit up comfortably in bed. Another relative said, “The laundry is very bad. Clothes are ruined and sometimes just chucked in the wardrobe and not hung up. I have complained many times, but nothing appears to be done.” Relatives also told us how they had seen their family members wearing other people’s clothing, which upset them. A relative told us, “I was distressed during winter, [family member] had trousers and slippers on, no socks and a summer shirt, I complained, and the manager agreed it was not dignified. I think it is just staff convenience and it’s not really changed… I do get distressed when I go in and there is food down [family member’s] front.” We also received concerns from other relatives about how they had found their family member’s wet and/or with food and drink spilled on their clothing.

The management team told us they were working on improvements, such as reviewing the laundry systems, the inclusion of people’s relatives in their family member’s care planning, and the implementation of the resident of the day system. These improvements had not yet been fully implemented and embedded in practice to improve people's experience of the service.

We observed varying interactions between staff and people. Some staff spoke with people whilst providing support, others did not communicate with people. Staff had little time to spend with people with social interactions, the care and support provided was in the main ‘task’ based. This was confirmed in daily records, several people spent time in their bedrooms, with little social interactions. We observed staff using mobility equipment appropriately to support people to transfer, for example into another chair. People's bedrooms were personalised and reflected their individuality, for example having photographs and memorabilia. Signage was in place to assist people to navigate around the service.

We reviewed the daily care notes written by staff about their interactions with people and the care they had provided. The daily notes were not always respectful, and terminology used in care plan documentation was not always dignified and person centred. For example, the majority did not refer to the person by name, some referred to the person as ‘resident.’ A person’s notes, referred to their continence aid as a ‘diaper’ and when providing continence support used, ‘number 1 and number 2’. ‘Wandering’ was also used in a person’s daily notes which is a term which is no longer used to describe when people living with dementia walked with purpose, as was outdated terms in people’s records such as ‘bed bound’ and ‘chair bound.’ There was very little reference to any social interactions, such as how the person presented during the day, and if staff had spoken with people when supporting them with their personal care needs. People's care records were at times generic and not always person centred. The care plans and risk assessments did not fully describe people's needs and preferences or provided guidance to staff in how their person-centred care was to be delivered. A person’s records referred to another person, people's conditions were not always explained, nor how they affected the person. There was a lack of information to show how people and their relatives, where appropriate, had been consulted about the care they received to ensure it was person centred. There was very little information relating to people’s life history, which would provide the staff with information about that person, specifically what they enjoyed doing and what they had done before they started to receive care. e care.

People were not always supported in a dignified way. We received feedback from some relatives which identified they had raised concerns about their family member’s wellbeing, but this had not been identified by staff prior to this. This had resulted in relatives asking for health professionals to be contacted and had in some cases, led to hospitalisation. We received feedback from relatives that their family members received drinks, however, we did receive concerns that if people were in their bedrooms, drinks were left out of reach, or their family members would be unable to pour the drinks independently. A relative told us how they had found a warm milkshake in their family member’s bedroom, despite telling staff their family member did not like them. Another relative told us their family member was serviced meals in their bedroom and left to eat them, they often visited to find a lot of food down their front and on the floor and were concerned their family member’s abilities may have deteriorated. People told us they felt there were times they had to wait for their call bells to be answered, which worried them when they needed to use the toilet. A person said, “It has got worse recently, sometimes I have to wait for half an hour for them to come.” We also received some positive feedback. A person told us they felt their personal care needs were being met and said, “[Relative] came yesterday so I got ready, and I had a lovely shower and had my hair washed.” A relative told us how they had observed lunch time and liked the use of ‘show plates’ which supported people to make choices about what they wanted to eat. People told us they felt their choices were listened to relating to what they wanted to eat and how they spent their day. However, we did received feedback that there was little opportunity for social activities and interactions. We saw people’s personal space reflected their choices and individuality.

We received mixed feedback from staff about if they felt people’s choices were listened to and acted on. Several said they felt the staffing levels limited the provision of social interaction and acting on people’s choices at all times, and this was often impacted on by the staffing levels. A staff member told us, “I feel choices are respected and listened to especially during lunches and supper with the show plates.” Another staff member said, “People are respected, given choices, and listened to when cared for, in some situations, some staff members have to be reminded of people's choices.” Another staff member said, “Some of the resident's choices and how they want to be cared for are listened to and done by some staff. However, most of the staff do not listen to the residents because of the language barrier, and staff of the same language will speak to each other in that language in resident's rooms, around the home and in the staff room. I don’t think this is very fair at all on the residents.”

Staff encouraged people to make choices of the meal they wanted, with plated up meals which people could say which choice they preferred. There were discussions about the choices and staff answered any questions people had. People chose if they wanted to eat in their bedrooms or in the dining room. However, a person’s relative told us their family member would prefer to go to the dining room but not able to walk there. We saw a range of snacks, including fresh fruit in the dining rooms. Whilst this was displayed in the dining room, we only saw 1 person with fruit, and it was not being routinely offered, in addition some people lacked the ability to help themselves. Where people were being assisted with their food, we saw staff sat with the person and encouraged independence, where appropriate. However, some staff did not speak with the person when they were supporting them, such as what they wanted to eat next and if they were happy with their meal. We observed a staff speaking with a person during the morning, they asked if they wanted to get up, the staff member respected their choices and offered the person personal care support to ensure they were comfortable. A staff member returned to the kitchenette after taking the meal tray to a person, they collected a small pot with sauce in, which demonstrated people had a choice, and independence was encouraged by supporting the person to put how much they wanted on their plate from the pot.

Whilst people’s care plans included a section where some people had commented on their care, we found there was limited documentation to show people, and their relatives, where appropriate, had been consulted about their care and participated in care reviews. The service was in the process of improving in this area and a ‘resident of the day’ was being implemented where people and relatives were asked for the views of the care they received. However, some relatives told us they had not seen their family member’s care plans despite asking and felt it unusual to be asked to comment on the care plans when they had not seen them. There were some records which showed people’s independence was considered, but this needed further improvement to show how it was promoted, and people were included in decisions about their independence. People’s daily notes did not always identify where people's independence had been considered and promoted, there was some reference of when people had refused, for example, support with oral care, but this was rarely followed up, with this support being offered later in the day.

We did not look at Responding to people’s immediate needs during this assessment. The score for this quality statement is based on the previous rating for Caring.

We did not look at Workforce wellbeing and enablement during this assessment. The score for this quality statement is based on the previous rating for Caring.