Harefield Lodge

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 remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People participated in their assessments and reviews. People had communication care plans and documents to take to hospital with them when required.

Staff and those who knew people well were also involved in people’s assessments to ensure their views and opinions were captured. Staff told us people’s views were sought during daily support and in key worker meetings with them.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff used nationally recognised tools appropriately to assess and monitor people’s needs. This included tools to identify when people’s health was deteriorating and people at risk of malnutrition.

Staff ensured people had enough to eat and drink. When there was a concern in this area, staff had completed a referral to the relevant health professional requesting additional support. This prevented people’s health deteriorating.

People were supported to maintain relationships with friends and family through visits and by making phone and video calls. This enhanced people’s social skills and maintained their wellbeing.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The provider’s processes ensured care and support was coordinated in the best interests of people using the service. This included collaboration with professionals and information sharing.

We sought feedback from professionals who worked closely with the service. Professionals told us the provider kept them informed and sought their advice. One professional told us, “The service has shown a willingness to work in partnership with a range of agencies and professionals to support individuals' needs. Communication has generally been timely and constructive, enabling coordinated care and positive outcomes.”

People’s goals, dreams, and aspirations were communicated so a consistent approach was maintained between services. The service was mostly but not consistently supporting people in line with the ‘Right support, right care, right culture’ principles.

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

We reviewed food intake records for 3 people. Two people had a well-balanced diet. However, one person was at risk of developing a medical condition. The risk of developing the condition could be reduced if they ate a healthy balanced diet. We observed this person did not follow a healthy diet as detailed in their care plan. We spoke with the registered manager about this, who told us the person had capacity to make unwise decisions. This was not detailed in the person’s care plan. Following our discussion with the registered manager they completed a mental capacity assessment (MCA) which demonstrated the person did not have the capacity to understand the medical condition they were at risk of developing and the impact this could have on their life. We were concerned this risk had not been identified.

Care records captured the support people required with their health needs. However, these did not always detail what action staff should take when an individual’s health deteriorated. This meant early detection when people were becoming unwell could be missed.

Relatives told us people were supported to lead healthy lives. One relative told us, “If there have been any concerns, they have let me know. I have supported my relative to the GP with staff. We have discussed vaccinations and staff seek consent.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff worked collaboratively to plan and deliver people’s care, reduce risks, and achieve best outcomes for people.

We received mixed feedback from relatives. One relative discussed 2 safeguarding concerns they believed meant their relative did not consistently experience positive outcomes at the service. Another relative gave us an example of when their relative had been supported which had improved their outcomes.

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

We reviewed mental capacity assessments (MCAs) and best interest decisions (BI) which were not always completed in line with the Mental Capacity Act 2005. For some decisions these were not in place, for example, for 1 person where a lap belt was used on their wheelchair. Where they were in place they were not always decision specific and did not always show how the person had been involved in the assessment and how the provider had attempted to support them to understand the decision. The registered manager told us they would commence work on the MCAs to ensure they were completed in line with the Mental Capacity Act 2005 and were in place for all important decisions.

A DoLS tracker was in place to ensure the provider knew when these needed to be reapplied for.

We observed staff gaining people’s consent. Staff told us they always sought consent from people and explained what they needed to do to support the individual safely.