Handford House Care Home

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• 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

We assessed a total of 6 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 inadequate. Leaders had failed to ensure adequate governance systems were in place to identify the serious concerns we found during inspection. This resulted in a breach of Regulation 17 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.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We asked staff if they felt the service was well-led. One staff stated, “On the units, no. We do not have senior carers so only the nurses are in charge of the floors, and they are too busy.” Another staff member said, “Staff meetings and handovers can feel stifled, not progressive or transparent sometimes and regular threats of disciplinary action to all staff in general rather than to certain members of staff who are constantly neglecting their responsibilities. It saddens me to say that we are not managed and led sufficiently, and I do worry about the safety and welfare of [people] sometimes.” A third member of staff commented, “It's very sad that's got to this point, as Handford House was a great place to work, with lovely atmosphere and a nice team.”

Whilst the service was experiencing a challenging time, the management did try to ensure staff were kept up to date with any changes in the service and the requirements of their role, such as in staff meetings and group supervisions. However, there was a lack of 1 to 1 supervision meetings where individual staff could receive feedback about their work and raise any concerns with their line manager, rather than in a group setting. Annual appraisals were being carried out. There was a whistleblowing policy in place and staff confirmed they understood this. Staff were advised in a staff meeting in May 2024 to challenge their colleagues if they identified they were not following processes, such as walking around corridors wearing gloves inappropriately.

There were mixed views about the leadership at all levels. Some staff felt they could have had more support from leaders, especially those who were employed at a higher level with some staff telling us they did not feel the management team above the registered manager were kind and considerate to the staff team. A staff member said, “I really really love my job, [registered manager] is a brilliant manager but the management above [registered manager] ... are very much how the unit looks rather than what [people] want. They don't have any idea the amount of work they put on us. The staff I've seen in tears because of them, it is horrendous.” Another staff member said, “[Registered manager] is very approachable and will speak to us and make us feel appreciated. The regional managers that come in are quite blunt and not very approachable towards any of the staff and can be rude sometimes.” We also received mixed feedback about the registered manager. Some staff told us the registered manager was approachable and some said they were not. Several staff stated that they would not see improvements made if they raised concerns. A staff member said, “You cannot complain about anything at Handford House. [Registered manager] does not care about the staff at all, the manager is always correct. I have had complaints regarding things, and nothing gets resolved. If you don’t like it leave.”

Staff meeting minutes in March 2024 demonstrated the registered manager had challenged staff and advised of their responsibilities, day staff had raised that night staff were not assisting people up in the morning and dressed. The registered manager told the staff team that it was not good practice for night staff to have set number of people to be getting up in the morning and this could be abusive and that the times people are supported to get ready for their day must be in line with their choice. An employee survey report July 2024, recently carried out by the provider, identified mixed views about working in the service, with several raising concerns about the management and culture within the home.

Staff told us they did not always feel their concerns or suggestions were listened to or acted upon. A staff member said, “We are listened to, but I don’t believe a lot is ever really done.” Another staff member told us they felt their confidentiality was not maintained when they had raised a concern to senior leaders about the service’s management. In addition, they told us they were asked to sign a supervision document which was prefilled in the corridor, which could be overheard by others. Another staff member said, “You are able to raise concerns with management but often not always listened to, had to go higher at times.”

The processes in place to support staff to raise concerns, such as 1 to 1 supervisions, had not been consistently implemented to ensure that staff felt listened to and supported. A recent employee survey had been carried out, and the report was completed 26 July 2024. This gave the provider staff’s views of working in the service. Staff told us they understood the whistleblowing procedure.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The management team told us they had already undertaken internal audits and were aware of some of the shortfalls identified. They had developed an action plan to address these and actions for improvements were being implemented, this included environmental changes and records. They had not been aware of all of the shortfalls identified during our assessment; however, they understood improvements were needed and working on implementing them and embedding them in practice. The registered manager told us they undertook walk rounds the service; however, we were concerned that during these walk rounds, the infection control shortfalls we had seen during our visits had not been identified and addressed by the registered manager. The registered manager told us they had regular meetings with heads of departments, to discuss any issues, however, we were concerned that these had also not identified and addressed shortfalls.

Audits were being completed; however, they had not been consistently effective and where shortfalls had been identified by the provider, we were concerned improvements had not been implemented swiftly. For example, in a staff meeting in May 2024, staff had been advised their training needed to be up to date and gaps were identified in repositioning records, for which it was stated the registered manager would be making random checks. Staff had been told disciplinary actions would be taken if improvements had not been made. During our assessment, 2 months after the meeting, we found there were still shortfalls in training and in records which showed when people were being supported to move position. Therefore, the systems in place at the time of our assessment were not always effective and staff had not followed the instructions given. A range of audits were undertaken, including care plan, complaints, health and safety, deprivation of liberty safeguards and staff personnel files. Whilst we noted some shortfalls were identified such as the lack of documented staff supervision and improvements needed in people’s capacity documentation such as best interest decisions. We were concerned that all of the shortfalls identified during this assessment and by other professionals had either not been identified independently by the service and/or not addressed at the time of our assessment. For example, we found shortfalls in the infection control in the service which had not been identified and addressed.

People’s feedback about their involvement with care planning was inconsistent. Whilst some relatives told us they had been asked if they were happy with their family member’s care plans despite not having access to them, they said they had not been asked formally for feedback on the service. A relative stated, “This is the first time I have been asked for feedback.” Some relatives told us they attended relative meetings, which were held via video calls. However, a relative told us these were not well attended and felt reminders sent to relatives would improve attendance. We received mixed views from people and relatives about the management of the service, with several saying they were not confident actions would be taken as a result of their comments. A relative said, “I have met and spoken to the care home manager on a number of occasions and [they are] always pleasant and accommodating. [Registered manager] promises resolution of any issues raised however I’m never convinced [registered manager] actually has knowledge of what is happening. More importantly if [registered manager] is absent on leave or away from the home the deputy is even less informed. This suggests to me that the management structure is weak and is far too dependent on 1 person.” Another relative told us, “The manager at the home is very nice I can always speak with [them] if I have any concerns.”

The management team told us that they were working with the local authority, integrated care board and infection control team to implement improvements and an improvement plan for the service was in place. However, these improvements were ongoing and were not fully embedded at the service at the time of our assessment. The management team told us they had not sent out satisfaction for surveys in 2023 to relatives and people using the service but were planning to formally ask for feedback this year. We fed back some of the general concerns we had received from relatives, and most relatives felt they had not been asked for feedback nor consulted and were not confident any concerns would be addressed. A member of the management team, who was overseeing the service during the registered manager’s leave, told us they had already started to speak with relatives for feedback individually when they were visiting. This was confirmed by a relative who told us they felt better about the service since they had this discussion.

We received feedback from health and social care professionals prior to, during and following our visits. The provider was working with health and social care professionals to improve the service and reduce risks. This included meetings, training and they were accepting guidance and support. We were concerned the service had not independently identified and addressed all of the shortfalls found by external professionals.

We saw minutes from ‘resident meetings and an action plan was in place to address their comments. For example, a meeting in February 2024 people had raised concerns that staff at night were in a hurry, impatient and at times rough. Actions identified were to speak with night staff and to get feedback from people in the mornings. However, there was no evidence that a review of night staff levels, which may contribute to the night staff rushing had taken place. People had also raised concerns about their clothing being mixed up, this concern still remained 5 months after the meeting. Therefore, we were not assured people’s comments were always being addressed. Minutes of a relative meeting held in May 2024 showed 10 relatives attended, they discussed issues with the laundry, for example and gave suggestions for meals. Relatives asked for access to their family member’s care records, they were advised this would be possible if they held POA for health and welfare and could book an appointment with the registered manager. Despite this, some relatives told us they had still not been provided access to their family member’s care plans or consulted about their care at the time of our assessment. We saw ‘you said we did’ notice in the service which identified actions taken as a result of people’s comments. This included various actions in relation to the local football club.

The management team told us they undertook lessons learned where shortfalls had been identified. They were working on a service improvement plan and committed to make the necessary improvements in the service. They understood improvements were needed in the service; however, these were not yet fully implemented. One staff member told us, “Every week there will be a policy/ procedure for all staff to read and sign, so staff are aware of almost all the policies and procedures.”

Whilst audits had been completed, they had not been applied consistently and accurately enough and action had not been taken to address all the concerns found. The registered manager told us they completed regular ‘walk arounds’ the service to view what was happening and any quality issues. Despite this they failed to identify and act on the concerns we found as reported in the other key questions of this report. There was a duty of candour policy in place. We saw copies of letters to people’s relatives confirming the policy was being followed. However, some of the letters had a handwritten note by the registered manager stating the relatives had been spoken with and did not need the letter to be sent to them but kept on file. The date of the note was after the date of the letter, which identified that the letters were not sent on that date. A member of the senior management team told us they had advised the registered manager they must send the letters to relatives and not rely on a discussion to ensure the policy was followed. The provider’s safeguarding log showed in May 2024, it was noted a duty of candour letter was not required as the relative had been informed of the referral from the hospital, despite the person living in the service at the time. Following our inspection, the provider told us, they thought the service was not required to submit a response in line with duty of candour because it was the hospital who raised the safeguarding concerns against the care home.