Hadfield House

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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

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.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Although relatives told us they were informed about people’s care, most people we spoke with told us they had never been involved in any discussions about their care or support.

People’s support plans were not always person-centred or contained sufficient detail for staff on how to meet their needs. The provider was aware of shortfalls in this area and was reviewing care plans to ensure they were improved.

People’s care needs were not always reviewed or documented in a timely manner. There was various documentation, including oral care and monitoring observations, which were not up to date, with various entries missing.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People’s care plans and risk assessments were not routinely reviewed. Care plans and risk assessments were sometimes incomplete or did not provide detailed guidance in line with evidence-based practice.

Staff’s training records showed low completion rates across key subjects. In the absence of evidence that staff had completed essential training, we could not be assured staff had the competence needed to deliver care that was consistently in line with evidence – based practice.

The provider’s policies did not contain version control details and were not always tailored to the service. For example, the medicines policy was generic and not service specific. The safeguarding policy did not provide a clear explanation of who staff should report suspected abuse to if the registered manager was not available, nor did it provide local authority details. The covert medicines policy suggested reviews to be taking place every 3 months but in practice this was not occurring. Therefore, we were not assured staff had access to the most appropriate information which would support them in their roles and whether policies were being adhered to.

People’s nutrition and hydration needs were either not met in line with current guidance or not documented effectively. Staff were not always accurately recording what people had eaten and drank throughout the day. The provider did not have sufficient governance processes to ensure these omissions were being identified.

The provider worked well across teams and services to support people.

Overall, the provider evidenced good partnership working with external professionals such as GP’s, pharmacists and specialist nurses to support people’s health needs.

Most staff felt the team worked well together, however some felt there were divisions between the day, evening and night staff. Most staff told us they had a good relationship with external partners and agencies and felt they worked well together.

The provider evidenced the healthcare task of insulin being administered being delegated to staff by an appropriately trained delegator. There were appropriate arrangements in place.

External professionals were complimentary about their working relationship with the service and felt staff were well trained and escalated concerns appropriately. One professional confirmed, “I have no concerns in this area and have observed positive and effective working relationships between staff and external professionals.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People received medical attention when required and staff made appropriate referrals to healthcare professionals when needed. A person’s relative told us, “My [relative]…has been in and out of hospital. This is not a bad reflection on the home because every time [they have] been in, it has been justified. I feel really comforted knowing that staff will always contact for help if they need to. Another relative told us, “[Name] sees the doctor and the district nurse.”

A relative said, “My [relative] was in hospital then came here…My [relative] has improved a lot since being here because they talk with [them] a lot and do her exercises daily to help with stroke effects.”

People’s care records needed to be improved. However, records of people’s appointments with external professionals was up to date. Care records also demonstrated how people were supported to attend health assessments and checks were necessary.

An external professional said, “The service promotes healthy living through regular health monitoring, access to healthcare professionals, and support with nutrition, hydration and wellbeing.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. The provider did not have effective approaches to monitor people’s care, treatment and their outcomes.

The provider did not have effective oversight of documentation used for monitoring people within the home. There were various examples in which documentation had not been completed accurately which suggested staff had not completed observations. Furthermore, daily oral health logs and food and fluid charts were also inconsistently recorded meaning the provider could not be assured tasks were being regularly completed.

The provider ensured staff had access to visual body maps which they recorded when people sustained injuries, skin damage, pressure ulcers, bruising, wounds or other areas of concern but these were not always followed up appropriately by staff.

However, the provider completed routine service user assessments including weighing people, checking their body mass index and completing standardised medical tools such as the Waterlow scale and MUST (Malnutrition Universal Screening Tool) to monitor for pressure sores and malnutrition. The staff also told us about some of the residents who had made significant progress since arriving at the care home.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The provider did not always ensure consent forms were included within people’s care records as per best practice guidance. The area manager had plans to review the care records and to update the consent forms for all services owned by the provider.

The provider ensured a person who was receiving covert medicines had a best interests decision completed in 2023. However, the providers covert medicine policy and the National Institute for Health and Care Excellence (NICE) guidance states reviews of people on covert medicines should be taking place every 3 months and each review should consider if the person’s capacity has changed and whether administering medicines covertly was still necessary, but this was not occurring.

However, staff did have a good understanding of their requirements to seek consent and respected people’s wishes.