Haddon House Nursing Home

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 inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

This service scored 33 (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 make sure people’s care, and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

People’s needs were not suitably assessed or reviewed. Care plans contained inconsistent guidance on how people should be supported in relation to their skin integrity, and diet and this had not been identified during routine care plan reviews. This placed people at risk of receiving care which was not in line with their assessed needs.

People and their relatives were not always involved in assessments or reviews of their care. Records showed reviews were undertaken but this was completed by staff and did not always indicate people had been involved. Feedback from relatives included, “I've not been involved with the care planning.” And “We've had no reviews at all.” Another relative told us how they had observed their loved one change over time, and felt this had not been reviewed enough, welcoming more opportunities to sit down and discuss the person’s current needs. We shared this with the provider, who confirmed they would be embedding their resident of the day system, which meant each day focused on a specific person, including a review of their care with the person and their families.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

People’s nutritional needs were not consistently met. Records, and observations were significantly inconsistent regarding modified diets, which some people required to reduce risk of choking. For example, information in the kitchen which the cooks referred to when preparing meals contained different information to the levels of consistency recorded in some people’s care plans. There were also inconsistencies and incorrect information within people’s care plans, making it difficult to establish the correct and safe level of consistency people required. This meant people were at risk of receiving food which was not prepared to a safe texture for them to eat.

Following our first site visit, we asked the provider to take immediate action to ensure all information regarding modified diets was up to date and accurate. However, during our second site visit we found continued inconsistencies. In addition, one person had been given a normal consistency diet, despite the provider confirming their food should have been prepared to a minced and moist consistency. It was only after the inspection team explicitly requested that a speech and language therapist was contacted without delay, that we could confirm the person was not at risk of choking, or aspiration.

During our second site visit, the provider confirmed they would increase support at senior leader level and ensure clear accountability for overseeing nutrition support for people.

The provider did not work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Staff did not effectively work together to ensure people received safe and co-ordinated care. There was a disjointed approach between care staff, and senior staff with poor communication and information sharing. For example, staff were not always informed of important information relating to people’s care and risks, including wounds. One staff told us they felt they were often playing “catch up” and frequently had to ask for updates.

During our first site visit, we joined the daily meeting which was attended by a representative from each department. However, important information about people’s current needs and risks was not adequately discussed, and it was not clear who was responsible for action or follow up. For example, an out-of-stock barrier cream was raised during the daily meeting, but no confirmation on who was responsible for re-ordering and when. During our second site visit this was still an issue as a staff member confirmed it remained out-of-stock and had been for 2 weeks. This placed the person at risk of skin integrity breakdown.

We received mixed feedback from relatives about how well staff worked together to support their loved ones. Feedback included, “There are good and bad teams.” And “Everything runs at a bare minimum.”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

There were some systems in place for clinical oversight. This included monthly clinical meetings with nursing staff, regular ward rounds conducted by an external advanced nurse practitioner associated with the local GP surgery, and staff champions responsible for specific areas of care, such as continence. However, these systems were not always effective. Clinical meetings did not always identify clear actions with a responsible person to follow up. For example it was discussed that new admissions care plans were not being completed in a timely manner, but it was not confirmed who would ensure this was addressed going forward.

Healthcare professional advice or guidance was not always accurately recorded within records. For example, speech and language therapy recommendations. This placed people at risk of receiving care outside of healthcare professional recommendations. Additionally, CQC had to seek assurance that appropriate healthcare professional advice had been sought in response to some identified concerns during our assessment. Failing to take timely action or follow healthcare professional guidance placed people at risk of health deterioration. The provider told us they were pushing for more GP support and presence within the service to support people’s health and well-being.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Systems to monitor people’s care was not effective. We found significant shortfalls in the provider’s governance which had failed to identify or take effective action to address the inconsistencies in people’s care records. This placed people at risk of poor health outcomes. For example, wounds were not robustly monitored. Wound records did not always contain the required information in line with the provider’s policy. This included incomplete records, missing information and photographs. This meant the progression of the wound, or effectiveness of treatment could not be reliably assessed. During our second site visit we found improvements to wound records which had since been completed routinely to ensure clear monitoring of people’s wounds, and referrals to the tissue viability team were made.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

During our assessment we identified one personwho had potentially received care which was not considered the least restrictive option for their needs at the time. The provider took immediate action and updated records, to ensure staff were aware this was not current practice. Please see the ‘Safeguarding’ quality statement within the safe section of this report.

However, mental capacity assessments reviewed were found to be in line with the Mental Capacity Act (2005). Staff were observed to seek consent before supporting people. People and relatives confirmed staff asked for consent prior to supporting them. One relative shared, “They ask [person] and sometimes when they say no and are not compliant, they'll go back again and ask again.”