Handford 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

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. We found concerns with the application of the Mental Capacity Act (2005). This meant the provider was not lawfully gathering people’s consent. This resulted in a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below. Our rating for this key question is requires improvement.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

Three relatives told us they had concerns about how staff were able to recognise a deterioration in their family member’s health and wellbeing, and health professional support had not been sought until the family members pointed out how unwell their family member was, some of which resulted in hospital admissions. A relative told us when they had reported their concerns to the registered manager, they felt they were, “Defensive.” People’s relatives told us they were not always kept updated when their family members had been visited by health professionals, or if there had been an incident, such as a fall. People's relatives told us, that whilst there were drinks available in their family member’s bedrooms, their family members were not always able to access these.

The registered manager told us how they had made improvements in how people’s fluid intake was monitored; this included a review at staff handover to check if people were on track to meet their assessed target. The management team told us they were learning lessons and actions implemented, when for example, they had identified staff had not followed the provider’s procedures relating to reporting accidents and incidents and informing relatives. They recognised improvements were needed in the service and had an action plan in place. All of these planned improvements were not yet fully implemented.

The service’s incident analysis confirmed, there had been times when people’s relatives had not been informed of incidents and accidents relating to their family members. In addition, we saw letters sent to people’s relatives when some incidents had happened which showed actions were not always taken in line with the provider’s procedures. For example, a person had fallen in July 2024, and it was noted there was no evidence to show the relative’s had been updated and 111 had not been called for guidance relating to a potential head injury. The provider’s policies and procedures included reference to industry recognised good practice guidelines including National Institute for Health and Care Excellence (NICE). There were systems in place to reduce the risks of dehydration, this included a target for daily fluids and a review of how much people had to drink throughout the day. Records showed people had, in the main, exceeded their fluid target. However, care records did not identify when staff should report concerns if a person was not drinking, for example how much below their target and for how long they had not reached their target for.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We received some concerns about the meals served and the quality of the food. A person expressed their dissatisfaction with the choice and quality of the food telling us, “Food is okay, I have to eat it, they think salt is a spice, it is so bland, but they have to meet everyone's choices.” Relatives also gave mixed feedback about the food available for their family member. A relative said, “One aspect that we feel could be improved is the quality of food that is provided. We are not inferring that the chef does not do a good job, merely that the quality of the food seems to be poor. We assume it comes down to the budget allocated for meals, but feel it is short sighted not to allocate a higher budget, as better-quality food would help to improve the health and mental wellbeing of [people].” Another relative said, “Not enough fruit is provided and there is not a good selection if you have someone who does not eat meat and who are in their 80’s and therefore only want plain food with no sauces or spice and don't eat pasta. There is not much fish on offer.” A relative also told us that they felt their family member didn’t always get access to medical care in a timely manner. They told us, “I feel [family member] is safe in this care home but some care intervention and preventative care/treatment is not always timely. I have to chase the care home to get things done such as chiropody care, hair dressing, replacement toiletries etc… [family member’s] hearing aid has been lost and we are still waiting for a referral to audiology to get it replaced…I’m still waiting to hear what the chiropodist has recommended despite raising the issue to the care home manager.”

During our second visit, a member of the management team told us how the head chef would be observing the lunch time experience to gauge what people were eating and how the lunchtime service went, and if any improvements could be made. We saw this happening. The registered manager told us how they were implementing resident of the day system, where the person and relatives were asked for feedback on the person’s care. However, we found there was some information recorded about people’s views, but there was very little in care plans which evidenced how people and their representatives, where appropriate, had contributed to the care they received and the formulation of their care plans. There was limited information how people’s relatives had been consulted, particularly for those people who lacked capacity to make their own decisions.

There were systems in place to monitor people’s weight and where concerns about people's weight or dietary intake were identified, relevant professionals were contacted for guidance and actions in place to reduce risks. We saw people were offered milkshakes and snacks to boost their calorie intake. There was fresh fruit available in the dining areas and saw a person with a peeled orange. People's care records varied in quality relating to their nutritional needs and how they were met. A person’s care records showed they were at risk of choking, this person had capacity to make their own decisions. There was information recorded to show the staff had discussed the risks associated with choking and what they chose to eat, to enable the person to make informed choice. Another person’s records stated they required a gluten free diet, however, there was no guidance of what gluten could be found in. People's daily records sometimes identified the meal provided but not always, for example a person’s notes stated they had ‘poached fish’ for lunch, there was no other reference to what was with the fish. In addition, records did not always include the amount eaten, nor the portion size to support the service to identify when and if there were issues with the person’s eating. Following our inspection, the provider told us records did indicate the size of meal and quantity consumed.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

Staff did not consistently seek people’s consent before providing any assistance and care. A relative told us they were concerned because their family member had not had a capacity nor mental health assessment since they moved into the service, despite raising concerns about their capacity. They told us other professionals had told them a DoLS should be in place, but was not, this had been reported to health and social care professionals. Some relatives told us their paperwork to evidence they had lasting power of attorney (LPA) in health and welfare had been asked for by the service, before they could access their family member’s care plans. This was confirmed by the management team. Some relatives told us they had asked several times to see their family member’s care plans so they could review if it reflected their family member and the care they required, but this had not been actioned. A relative told us they had asked for photographs to be sent to them of their family member when they were unable to visit to enable them to see how their family member was but had been told the person could not consent to this, this was despite their family member’s having LPA for health and welfare.

The management team told us they had asked relatives to provide evidence of their LPA status, before allowing access to their care records. They told us improvements were being made to people’s capacity assessments, which were not yet fully implemented. A staff member said, “Residents are supported with all their personal care needs. Residents who have capacity use the call bells if they need assistance and for those who don't have capacity, staff anticipated their needs and act in their best interest.” However, we found best interest decisions and capacity assessments were not always in place for people. Therefore, we were not assured staff were provided with the information they needed to ensure people were supported appropriately in line with the Mental Capacity Act 2005.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). People’s care plans did not include capacity assessments in all aspects of their care provision when they lacked capacity. Improvements were in the process of being made, however, these were not yet completed. A person’s records stated they lacked capacity to consent to their care, however, there was only 1 capacity assessment in place relating to if the person wanted to leave the service. Some people used bed rails, sensor alarms and received 1 to 1 support from staff, there was limited information in the care plans relating to best interest decisions and how their capacity had been assessed, and where representatives had been appointed to make decisions on people's behalf had been consulted. There were gaps in staff training relating to the MCA and DoLS. There was documentation of DoLS which had been referred to the local authority for approval, the records identified when they were made, when they were approved and when they needed reviewing.