Hartfield House Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service continues to deliver safe care. There are effective systems in place to ensure that concerns for abuse are reported and investigated. Incidents and accidents are recorded and learnt from. However, due to changes in staff and clinical oversight there had been shortfalls in some systems. We were assured action was being taken to achieve stability in systems whilst a new staff structure was embedded.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt that the management and staff were honest and discussed safety with them. They told us they felt safe living at the home and had no concerns. One person told us they used to have falls when living at their home, but had not had any since living at the home. They felt that it was because the staff were good at protecting them.

Staff felt they had learnt from incidents and had time to talk with senior staff about how improvements could be made. One staff member told us, "I myself did a mistake with the medication. I had a supervision with [nurse] and learned how to do it better next time." The regional director for the provider told us, “We noted a few months ago there had been quite a few falls. We brought the team together and looked at those people's care plans and talked about what we could do about it to reduce the risk of falls. For some people, it was about looking at the environment in their room, for other people it was about reviewing and reducing their medication." The regional director said this had had a positive impact as the number of falls had reduced.

Incident records showed there had been prompt and thorough follow up actions to adapt care and keep people safe. Risk assessments had been carried out which reflected on records and evidenced a need for adaptations such as sensor mats to alert staff as necessary. Trend analysis into accidents had resulted in referrals for people to appropriate professionals and measures to reduce the risk in certain areas of the service and times of day shown to be higher risk.

People told us that staff responded promptly when they pressed their call-bells and they felt safe. People who spoke with us felt that their health needs were monitored and they were able to see healthcare professionals when this was needed. One person stated they had been moved from one hospital to another before coming to live at the home, and the transition had been smooth and they had felt involved.

Staff told us there were systems in place to ensure effective communication amongst the staff team. One member of staff told us, "We have a 10 at 10 [meeting] every day. All the team leaders come. A representative from the kitchen and housekeeping and the management. We say what the problems are, what they have to help us with. It is good; at least you get to the see management and to tell them what the problems are. And it is good for the team leaders because you get to find out what is going on, on the other floors."

Partners fed back that the change in staff had been more than usual which had impacted effective communication. One partner told us, “the information that I receive … are variable and very staff-dependent.” Feedback included that staff moving between the units seemed to result in fragmented and variable information that care home staff were providing to health services. However, we heard that staff are caring and trying their best to meet patient's needs. Partners also fed back that they were confident that risk was identified and appropriate action taken when needed.

Electronic recording of the care provided ensured care was delivered safely and consistently. For example, staff recorded clearly which position they had supported someone to move from and to in bed. This meant the next staff member knew the best position to support the person into to achieve evenly distributed pressure points and minimise risk of deterioration. People had grab sheets with key information relating to their care, medicines, allergies and risks which could accompany someone as they transitioned into another setting such as hospital. This enabled a safe transfer with continuity of care.

People who were able to talk with us told us they felt safe living at the home. They said the staff were responsive to their needs and kept them safe from harm. We saw the staff consulting people before providing care and support. The staff were attentive to people’s needs and ensured people were safe.

Staff told us they were clear of their responsibilities when it came to safeguarding. Senior staff supported colleagues to be confident in identifying safeguarding concerns. One staff member told us, "We ask them at supervision about safeguarding. We make sure they understand. We talk to them about whistle-blowing. They know how to raise concerns." The manager told us they were confident in staff safeguarding people. They told us, “Staff are very vigilant and let me know straight away if they have concerns. We talk about safeguarding in monthly meetings with night and day staff.” The regional director added, “There is always someone available on-call. We work in a very open and transparent way and ensure staff feel comfortable with raising things.”

We saw the staff consulting people before providing care and support. The staff were attentive to people’s needs and ensured people were safe. Where people were at risk of falls, there were suitable systems in place to prevent this from happening. For example, people had sensor mats in their bedrooms to alert the staff if they were getting up. The mats were suitably placed and in working order.

Safeguarding concerns had been reported to the local authority for investigation where necessary. The provider monitored the progress of them and took measures to keep people safe in the meantime. A discussion about safeguarding and e-learning was scheduled to be provided early on in new staff induction timetables.

People told us the staff knew about risks to their health and wellbeing and protected them from harm. One person gave us an example of when the staff acted promptly when they were unwell. We observed the staff being present and monitoring people discreetly and respectfully, for example when a person was walking around and slightly unsteady. They ensured they provided support by walking with them whilst chatting.

The management team told us that they focused on the importance of positive risk taking and personalised risk management. The manager told us, "The measures we put in place depend on the level of risk. For example, one person who is at high risk of falls is on 30 minute observations. She has got a sensor mat when she is in bed." The regional director told us, "It is about taking an individual approach. We do not want to deprive people of anything." We were given examples of how people were supported to organise their occupations, such as bowling with friends and decide how they would like to manage risks associated with their condition within an assessment completed with staff. The manager told us people were encouraged to be independent, saying, “We have a bistro which is always busy and [person] makes her own tea and helps herself to a cake and will wash her cup up afterwards. She was used to doing that at home and we wouldn’t want to stop her from doing that here despite the increased risk.”

We observed the staff being present and monitoring people discreetly and respectfully, for example when a person was walking around and slightly unsteady. They ensured they provided support by walking with them whilst chatting. The environment was safe, clean and hazard-free. There were plenty of areas for people to sit and rest when walking around.

We saw that where people wished to take risks, documented discussion and assessment showed they were involved in how risks could be managed. People were supported to have choice and control and took positive risks where they wished to do so.

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

The people we spoke with felt there were enough staff to meet their needs. They told us they never had to wait long when they called and had their needs met promptly. They also felt the staff knew their jobs well and were well trained. We observed care and support in the upstairs unit, where people living with dementia lived. We saw the staff were available and responded to people’s needs promptly and efficiently. There were good and respectful interactions with people and a calm and restful atmosphere.

Staff told us they received good training and new staff felt their induction was adequate to prepare them for their role. One new member of staff told us, "I had a very good induction. The training was good and doing the double ups they showed me how to use the hoist. They corrected me if I went wrong." Staff told us they received a message if a member of staff called in sick to ask if they could cover a shift. However, shortages could not always be covered at short notice and sometimes care staff were asked to cover domestic duties. One staff member told us, “Some residents we have to mobilise with full body hoists and sometimes also for their personal care. Mornings and evenings are difficult. Everybody wants to get up between 8 and 9. Sometimes they have to wait for their care." The management team told us that sickness rates were improving and recruitment had proven successful in filling vacancies. Once recruitment had been completed, the regional director explained there would be, “a buffer to take account of staff absence through sickness”. The regional director explained that it was a contingency measure to request staff complete some domestic duties at times. There was a recognition from the management team that the staff would benefit from being involved in the calculation of dependency on staff and reassured staffing was sufficient. The manager told us that when staff support in the kitchen or domestic areas was needed, the management went around and ensured it was safe but also completed a wellbeing check on the staff. The regional director told us, “There will be specific times for staff to establish proper meaningful relationships with people and we always make sure it does not impact the residents in a negative way.”

We observed that staff were available and people did not have to wait for care and support when they needed it. Staff engaged proactively and positively with people and were caring in their approach.   Staff communicated effectively with one another to ensure people received the care they needed. For example, if a member of staff was busy supporting a person and another person said they needed support, the member of staff alerted a colleague.   People who needed one to one support to eat and drink received this, including people who ate their meals in their rooms. Staff provided this support in a respectful and dignified way.

Staff meetings were held for day and night staff with consistent messages communicated across both as well as shift specific discussions. The provider had assessed the appropriate staffing level for the people receiving a service and this was reviewed weekly. Staff levels were meeting this assessment. Response times to call bells were recorded and analysed with generally prompt responses. The provider did use agency staff but contracted staff who were familiar with the service and the people they supported. Staff had been recruited safely with appropriate background checks, skills and experience. Most staff had received necessary training except for new starters and an action plan was in place to improve this without delay.

People on the ground floor told us cleaning was frequent and the home including their own bedrooms were always clean and hygienic. People on the first floor were unable to express their opinions apart from one person who said it was clean.

Staff we spoke to said they had attended training relating to infection prevention and control in their induction and that this formed part of the mandatory training staff received. They told us there was a housekeeping team who were responsible for maintaining the cleanliness/hygiene of the home. The regional director told us that the clinical director completed a robust audit of the environment. The manager told us that oversight would improve further once a new housekeeping manager had been appointed.

We observed staff were available when people needed them. People did not have to wait for care and support when they needed it. Staff engaged proactively and positively with people and were caring in their approach. Staff communicated effectively with one another to ensure people received the care they needed. For example, if a member of staff was busy supporting a person and another person said they needed support, the member of staff alerted a colleague. People who needed one to one support to eat and drink received this.

The manager had completed an audit of infection control which demonstrated practices were being completed which ensured a clean and safe environment. Areas for improvement were immediately responded to. Responses included staff meetings where prompts to avoid cross-contamination were provided to staff.

People told us they received their medicines regularly by senior staff and were happy and had no concerns. One person told us, “I always get my medication when I need it” Another person told us, “They always give me my medication at the right time”.

Staff said they received regular training and competency training which was a mixture of face to face and online. Specialist training for managing PEGs [percutaneous endoscopic gastrostomy] and syringe drivers for end-of-life care, was also provided. Staff said the service could meet people’s needs and people had access to the care they needed. The staff nurse had recently taken on the role of deputy manager but was also still working as the only qualified nurse when they were on shift. They told us their time was not protected to complete management tasks such as audits, as people’s care was prioritised. As the management team were all quite new, they were still working on how the team would work together effectively.

Staff had been trained to support people with psychological intervention rather than medicines. The dementia lead had received specialist training to map people’s behaviour and create non pharmaceutical intervention care plans. This had improved outcomes for people who experienced distress and anxiety. There was only one permanent nurse employed to work during the day who had multiple responsibilities. There were processes in place to support the safe management of medicines which staff were mostly following. Monthly medicines audits had not been completed since February 2024 however, staff had implemented changes to the areas identified as needing improvement. Medicines that were prescribed ‘when required’ [PRN] and as a variable dose did not always have clear records. People’s needs had been assessed and there were risk assessments in place however, care plans did not always contain the most up to date information about people’s medicines or their specific health condition. People received their medicines as prescribed, and medicines were ordered and stored safely. There were processes in place to ensure covert medicines [medicines hidden in food or drink] were given safely and in line with best practice.