Archived: Hatfield Lodge

Updated 11 March 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 15 December 2015 and was unannounced. The inspection team comprised of one inspector and an expert by experience that had experience of the care of older people and of people living with dementia. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at the information provided in the PIR and used this to help inform our inspection. We reviewed the records we held about the service, including the details of any safeguarding events and statutory notifications sent by the provider. Statutory notifications are reports of events that the provider is required by law to inform us about.

At inspection we met and spoke with many of the people who lived in the service and observed how they interacted with each other and with staff. We observed staff carrying out their duties and how they communicated and interacted with each other and the people they supported. We spoke in depth with seven people who use the service and two visiting relatives. Not everyone we met was able to speak with us so we used the strategic Short Observational Framework for Inspection (SOFI); SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also spoke with the registered manager, operational manager, a team leader and three other staff. After the inspection we contacted five relatives and a social care professional who represents a number of people at the service. We received feedback from four relatives who spoke positively about the service and raised no concerns.

We looked at three people’s care and health plans and risk assessments, medicine records, three staff recruitment training and supervision records, staff rotas, accident and incident reports, servicing and maintenance records and quality assurance surveys and audits.

Updated 11 March 2016

The inspection was unannounced and took place on 15 December 2015. The service is residential service for up 33 older people some of whom may have dementia type illnesses, 31 people were in residence on the day of inspection. People have their own bedrooms with ensuites and these are located over four floors accessed by a main shaft lift with some rooms accessed via stair lift for those who cannot manage stairs.

This service was last inspected on 15 January 2014 when we found the provider was meeting all the regulations.

There was a registered manager in post. A registered manager is a person who is 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.

People were treated with kindness and respect by staff. People told us they felt safe and liked the registered manager and staff that supported them. Relatives told us they had no concerns about the service and were satisfied with the overall standard of support provided. They felt confident in the quality of care and said they were kept fully informed by the service and that communication was good.

Medicines were managed well by trained staff but we have made a minor recommendation for improvement to the recording of administered creams in bedrooms. Staff had received fire training and understood fire procedures and the evacuation of the building, they attended fire drills. We have made a minor recommendation however, that the provider seek further advice from the fire service in regard to people's personal evacuation procedures.

There were enough staff with the right skills to support people properly. Recruitment processes ensured only suitable staff were employed. Staff received induction and a range of training to give them the knowledge and skills they needed. Staff felt listened to and supported staff received regular formal supervision and met regularly with their registered manager, records of these discussions were made available to view.

Staff were able to demonstrate they could recognise, respond and report concerns about potential abuse. The premises were clean, well maintained and undergoing a programme of upgrading to address identified shortfalls in the standard of accommodation in some areas. All necessary checks tests and routine servicing of equipment and installations were carried out.

People ate a varied diet that took account of their personal food preferences. Their health and wellbeing was monitored by staff that supported them to access regular health appointments when needed. People received information mostly in suitable formats and the registered manager was now looking at use of pictorial prompts for some people. People were supported to maintain their independence for as long as possible and at a pace to suit them.

Staff were guided in the support they gave to people through the development of individualised plans of care and support; risks were appropriately assessed to ensure measures implemented kept people safe. People were encouraged by staff to make everyday decisions for themselves, but staff understood and were working to the principles of the Mental Capacity Act 2005 (MCA) where people could not do so. The MCA provides a framework for acting and making decisions on behalf of people who lack mental capacity to make particular decisions for themselves.

People and relatives told us they found staff approachable and felt confident of raising concerns if they had them. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had referred a number of people for assessment for DoLS authorisations but these were still to be processed. The registered manager understood when an application should be made and the service was meeting the requirements of the Deprivation of Liberty Safeguards.

People said their needs were attended to by staff when and if they required it. People respected each other’s privacy. People were supported to maintain links with the important people in their lives and relatives told us they were always consulted and kept informed of important changes.

People and relatives were routinely asked to comment about the service and their views were analysed and action taken where improvements could be made. Quality assurance audits were undertaken, to monitor service quality and address any issues highlighted from these within set timescales.

We have made two recommendations:

We recommend that the registered manager review the recording of creams administered by staff and how omissions in administration are recorded in accordance with the providers medicine policy and good practice guidance in regard to managing medicines in care homes (published March 2014) NICE

We recommend that the provider consult the Fire Service regarding peoples personal evacuation plans to ensure these meet current fire legislation Regulatory Reform (Fire Safety) Order 2005.