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Reports


Inspection carried out on 16 October 2018

During a routine inspection

This comprehensive inspection took place on 16 October 2018 and was unannounced. The last comprehensive inspection took place in March 2018, when we identified four breaches of Regulation. People did not always receive care and treatment which was person-centred and met their needs. The registered provider did not always act in accordance with the Mental Capacity Act 2005. The provider did not always ensure there were sufficient staff available to meet people’s needs in a timely manner. There was a lack of governance and oversight as the service had not been effectively managed. The service was rated as inadequate and was placed in special measures.

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 req

Inspection carried out on 6 March 2018

During a routine inspection

The inspection took place on 6 March 2018 and was unannounced. The last comprehensive inspection took place in April 2017, when the provider was rated 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.

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 provide

Inspection carried out on 25 April 2017

During a routine inspection

The inspection took place on 25 April 2017 and was unannounced. The last comprehensive inspection took place in February 2015, when the provider was meeting the regulations.

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.

Inspection carried out on 10 and 11 February 2015

During a routine inspection

Hatfield House is a care home for older people who require personal care. It also accommodates people who have dementia. It can accommodate up to 48 people over three floors. The middle floor specialises in providing care to people whose dementia is more advanced. The service is situated in Hatfield, north of Doncaster. At the time of the inspection 39 people were living in the home.

This inspection took place on 10 and 11 February 2015 and was unannounced. The home was previously inspected in April 2014, when no breaches of legal requirements were found.

The service had 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 and associated Regulations about how the service is run. .

All the people we spoke with who used the service and their visiting relatives said something positive about the service. For instance, one person who used the service said, “The staff are great, they are helpful. I’ve never heard a cross word.”

Some people told us that they enjoyed the range of activities available in the home, while others felt there should be more activities available. Some people told us there were enough staff, while others felt there should be more staff at night and at busy times during the day. The management team were aware of the issues, a staffing review was being undertaken and the registered manager was working to an action plan in order to make improvements in these areas.

Staff understood people’s needs and preferences, people’s healthcare and nutritional needs were being met and people’s medicines were stored and handled safely.

People and those who mattered to them were involved in the assessment about their care, support and health needs and involved in producing their care plans. One visitor said, “Mum says she feels loved here, which is a strong word for her.” Another visitor said, “The staff are absolutely lovely.”

Staff received a good level of training and the registered manager was working on improving the support they received by scheduling more frequent staff supervision and team meetings.

There was a system for the managers to review the quality of care being provided, and the staff team learned from incidents and accidents. The management team asked people to give feedback about their care and support to see if there were any improvements they needed to make. We saw instances where people’s feedback and learning from incidents and accidents had been used to improve the service.

There were safe recruitment systems, so new staff were only employed if they were suitable to work in the service. The staff employed by the service were aware of their responsibility to protect people from harm or abuse. They told us they would be confident reporting any concerns to a senior person in the service or to the local authority or CQC. One visitor said they felt their mother was, “Incredibly safe. That’s why she’s here.”

There was information available about how to make a complaint and people were confident they would be listened to.