Handford House Care Home

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

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. At this inspection we found care was not always person centred. This resulted in a breach of Regulation 9 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 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s care was not person-centred. A relative said, “Sometimes (family member’s) fingernails are black, I do them, should be noted [by staff]. I have spoken to [staff] many times about this. It is attended to for a while then see it again, time and again.” Another relative told us they often found their family member with unclean hands and nails. Several relatives told us they often found their family members with food on their clothing and on the floor in their bedrooms. We received concerns from some relatives that their family member’s care needs were not addressed in a timely manner. A relative told us they had spoken with staff when they had found their family member in need of assistance with personal care, this had been addressed when they asked. They said staff had told them their family member had been assisted in the morning and then were, ‘First on the list at lunchtime.’ The relative felt their family member’s care should be provided when they needed it and not to a planned schedule. Two relatives told us they had found their family members when they visited sitting in a chair alone in their bedroom in the dark, when their curtains were closed, and no light was on. Another relative said they had told the staff what their family member liked to watch on television, but when they visited, they often found their family member without the television on, alone in their bedroom with no stimulation, and at times in the dark. People told us activities and social engagement opportunities were limited. A person said, “There is a sheet with all things going on that hardly happen. Mondays there are supposed to be 1 to 1s, do not do that. Things are on the board, it looks good but not always happening, nothing happens Saturday and Sunday.” Another person said, “I do go to activities, not much on though, not enough, not enough staff, no one comes in to spend time with me when I stay in my room.”

Some staff raised concerns about the lack of person centred care telling us, “Care plans are often unclear and/or inconsistent.” We also identified that care plans were poor in quality during the assessment. In addition, we received feedback about how the staffing levels and deployment affected care staff’s abilities in providing person centred care and ensuring activities are provided. The management team told us how they were working on improvements in people’s care plans. This was not yet fully implemented.

There were not enough activities to keep people occupied. We saw people sitting in the garden and helping staff to water the plants during 1 of our visits. A person attended the activities room with their 1 to 1 staff and was encouraged to engage in the books and magazines. We saw the activity staff sitting with a person in their bedroom on our second visit, the person told us they had been asking about if they were happy living in the service, which they said they were. We did not see any other activities/social engagement provided.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Providing Information during this assessment. The score for this quality statement is based on the previous rating for Responsive.

Several relatives told us they had not seen their family member’s care records, nor been consulted about the contents. Some felt without access to this information they could not be assured they were accurate, and person centred. Where the relatives of 1 person had been given access to the care records, they had identified they did not always reflect their family member’s needs or choices. A relative said, “I am asked every so often if I’m happy with [family member’s] care plan but I’ve never been told exactly as to what it is.” Another relative told us recently they had a telephone call from a nurse to ask if they were happy with their family member’s care plan, they told us they had not seen the care plan and would have liked some notice to make comments on their family member’s care so they could consider what they wanted to say. A relative said, “We have been asked verbally for feedback on [family member’s] care plan, which is confusing as at the time none of us had seen or heard of it. Have our suggestions and complaints been acted upon? No.” Another relative commented, “Consultation and communication about changes to [family member’s] care plan or significant care events such as hospital appointments etc are rarely if ever shared with me. I tend to find out when I visit by observation, or I get a letter from the hospital after the event letting me know what happened during the appointment. Advising me beforehand would be preferable as I would at least be given the opportunity to go along to the appointment with [family member] or make comment on any proposed change… Generally, I have not been asked for feedback on [family member’s] care but I’m not shy in coming forward and, if I observe issues that give me concern, I raise them in writing to the care home manager. The issues raised are noted and resolutions offered however, it takes far too long for those resolutions to materialise.”

Feedback was not always considered by the provider, meaning there may be missed opportunities for learning. The management team told us they had received 1 complaint in the past year, which was being managed in line with their complaint policy. However, we were told by several relatives that they had raised concerns, either electronically or by telephone. We asked the management team to provide documentation to show where these were recorded and actions taken, this was not received.

Despite having systems to engage with people using the service and seek their feedback about their care and experience of living at Handford House, the provider had not effectively implemented them at this home. Systems and processes to log any complaints received were not effective and did not record all concerns raised to enable the provider to listen to feedback and take appropriate action where required. A relative told us, “My [relative] has raised a complaint regarding the laundry and chased it today as [relative] hasn't had a response for approximately 10 days. Totally unsatisfactory. We have been discussing how we would raise a complaint higher than the manager but don't know how to do so.” Following our visit, the provider told us that their complaints policy approach was to respond within 20 working days from receipt of the concern.

We did not look at Equity in access during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

Relatives raised concerns about the end-of-life care provided to people in the service, we were told, “End of life care was not what we wished for, and we have to live with this every day.” Another relative contacted us to tell us they were distraught at the end of life care their family member received at the service.

We fed back to the management team that several people's care records did not include their end-of-life decisions and how they could improve on this. They assured us they would be reviewing people’s care records and would be including end of life decisions. This was not yet fully implemented.

People’s care plans and records did not always include their choices for their end-of-life care with the majority we viewed stating that the person had not wished to discuss this. There was no further information to show discussions had been held about where the person wished to be cared for if they became ill or to include things they particularly liked, which could be considered if the person needed end of life care. Some people had named representatives, who could make decisions on their family member’s behalf. There was no evidence to show relatives had been consulted about the end-of-life care people may want or had discussed with them prior to receiving care.