Archived: Hatfield House

We found the following examples of good practice.

Visitors to the home were required to follow infection control procedures and were asked to complete a lateral flow test. Personal protective equipment (PPE) was then supplied.

Family members had been supported to maintain contact with their relatives via the use of a screen, window visits and video and telephone calls. The home had a procedure in place to support face to face family visits.

Social distancing was observed as far as it was practicable to do so. Staff wore appropriate PPE, regularly washed their hands and applied hand sanitiser. Staff had completed training in infection control, COVID-19 and putting on and taking off PPE.

Staff and people using the service took part in the home’s testing programme. Actions was swiftly taken when anyone tested positive with COVID-19.

Welfare meetings were held with staff to discuss issues relating to COVID-19. This showed the provider supported staff throughout the pandemic.

The home was clean and there were no malodours. Staff had access to cleaning products and cleaning schedules included high touch areas such as door handles and handrails, which were cleaned regularly.

We were assured that this service met good infection prevention and control guidelines.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do to improve the service.

At this inspection we checked if improvements had been made. We found that the provider had addressed all the concerns raised at our last inspection and made sufficient improvement to meet the requirements of the regulations. The overall rating of the service improved to good. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Hatfield House’ on our website at www.cqc.org.uk.

Hatfield House is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hatfield House is a purpose-built care home located in the Hatfield area of Doncaster. Some people using the service are living with dementia. The service can accommodate up to 48 people over three floors. At the time of our inspection there were 39 people using the service.

At the time of our inspection the service did not have a registered manager. A registered manager is a person who has 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. The provider had appointed a manager who had worked at the home from March 2018 and was in the process of registering with the CQC.

There had been changes in the management team and they were beginning to establish and lead the service. Systems in place to monitor the service had not always identified areas of concern and required further embedding into practice.

People were safeguarded from the risk of abuse. Staff confirmed they received training in this subject and could explain what actions they would take if they suspected abuse.

Risks associated with people’s care were identified and managed appropriately which kept them safe.

There were sufficient staff available to support people who used the service in a timely manner.

Medication was predominantly managed in a safe way as errors had been identified and followed up. However, the documentation regarding medicine management could be improved.

The service was clean and people were protected against the risk of infections.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff received the training and support required for them to carry out their roles effectively. People received support from healthcare professionals when required and their advice was followed.

People were supported to maintain a healthy and balanced diet which included their choices and preferences.

We observed staff interacting with people who used the service and found they were kind, caring and considerate. Staff respected people’s privacy and dignity and involved them in their care and support.

The service was responsive to people’s needs. Care records we looked at contained current information required to assist staff in how to support people. People were involved in social activities and enjoyed a range of social events.

The provider had a complaints procedure which was available if people wanted to raise concerns. Complaints were dealt with appropriately and used to improve the service.

Further information is in the detailed findings below.

This inspection was brought forward due to concerns we received. We therefore needed to inspect the service to ensure people were receiving safe care.

Hatfield House is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Hatfield House provides residential care for older people and people living with dementia, who require personal care. It can accommodate up to 48 people over three floors. There is access to the floors by a passenger lift. All the bedrooms have an en-suite with toilet, wash basins and shower. The service is situated in Hatfield near Doncaster.

At the time of our inspection the service did not have registered manager. A registered manager is a person who has 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.

The registered provider had appointed a manager who had left prior to our inspection. This manager had been replaced and a new manager commenced in post on 5 March 2018. The regional support manager had been based at the home for three weeks supporting the previous manager and the new manager. The regional support manager told us they would remain at the home for some time supporting the new manager.

We observed there was a lack of staff which put people at risk. The dependency tool used by the manager was not effective and did not include all people currently living at the service. It was not always reflective of people’s current needs. Risks associated with people’s care were identified, but they were not always reviewed and there was a lack of action taken to minimise risks to people.

Accident and incident analysis was not taking place and there was no evidence that trends or patterns were being identified and actions taken to reduce hazards in relation to people’s care.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. This was because the new management were not aware of who had an authorised Deprivation of Liberty Safeguards or if any conditions were attached.

People were supported to maintain a balanced diet which met their needs. However, food and fluid charts were poorly completed and some people had lost weight and this had not been addressed.

Staff told us they received training and support to carry out their roles and responsibilities. However, we found records did not support this.

We spoke with people who used the service and they told us that staff were kind and caring. We observed staff interacting with people and found they had a gentle and caring manner. However, staff could not always respond to people’s needs in a timely way and therefore care was not always person centred.

We found people did not always receive care that was responsive to their needs. Care plans we looked at contradicted each other and were not always followed in line with people’s current needs. We observed a lack of social stimulation for people who used the service. This did not meet the social needs of people.

All the people we spoke with knew how to raise a complaint and said they felt comfortable speaking with any of the staff.

We found that there had been a lack of consistent managers and a lack of registered provider oversight and governance which had contributed to the decline of the service. Audits in place to monitor the quality of service provision did not always take place in line with the registered provider's policy. Where audits had taken place they were not effective and did not always identify the concerns we had raised as part of this inspection. Some concerns were highlighted as part of the audit process but there was no evidence that sufficient action had taken place to correct them.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in; Regulation 9; Person-centred care, Regulation 11; Need for consent, Regulation 17; Good governance. Regulation 18; Staffing. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to the more serious concerns found during inspections are added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Hatfield House is a care home for older people who require personal care. It can accommodate up to 48 people over three floors. These are accessed by a passenger lift. The middle floor specialises in providing care to people who are living with dementia. All the bedrooms have an en-suite with toilet, wash basin and shower. The service is situated in Hatfield, north of Doncaster.

At the time of our inspection there was no registered manager in post. A registered manager is a person who has 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. The provider informed us that they had appointed to this position and they were due to commence their role in June 2017. The home was being managed by a regional support manager, who had been based at the home, on a full time basis, since January 2017.

People were protected from abuse and avoidable harm. We spoke with staff who knew the process for reporting any safeguarding concerns and were confident their manager would take appropriate action.

Risks associated with people’s care were identified and plans were in place to help minimise the risk from occurring.

We found that medicines were managed in a safe way and people received their medicines as prescribed. Medicines were stored appropriately and temperatures were taken of the medicine rooms and fridge.

Through our observations and talking with relatives of people who used the service and the staff, we found there were enough staff to meet people’s needs. Staff told us they were busy but were able to meet people’s needs effectively.

The provider had a safe recruitment process in place. Pre-employment checks were carried out prior to the person commencing their employment at the service.

Staff we spoke with told us they felt supported by their managers and said they received supervision sessions since the regional support manager had been based at the home. Staff we spoke with told us they received appropriate training to do their job.

We found the service was meeting the requirements of the Mental Capacity Act 2005. Where people lacked capacity, best interest decisions had been made and these were documented.

People were supported to eat and drink enough to maintain a balanced diet. We observed lunch being served. We saw that the meal looked appealing and people appeared to enjoy it. We saw that regular drinks and snacks were available throughout the day.

People were supported to maintain good health and had access to healthcare services. Care records we looked at contained a section to record professional visits. We saw that this included visits from rheumatology, community psychiatric nurse, and GP, opticians and speech and language therapist.

We observed staff interacting with people who used the service. We saw staff were kind and caring and there was lots of friendly banter between people and the staff.

Staff respected people and ensured that their privacy and dignity was maintained.

We observed staff responding to people in line with their individual care plan, taking in to consideration people’s individual needs and preferences.

People engaged in activities and social stimulation. Staff were aware of people’s interests and offered appropriate stimulation.

The provider had a complaints procedure in place and people we spoke with felt happy to raise concerns if they had any. The provider kept a record of concerns raised and used them to develop the service.

We saw that audits took place to ensure policies and procedures were adhered to.