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

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 62 (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.

We saw evidence and were told by staff timely referrals had been made to agencies to improve the effectiveness of people’s care and support. However, 1 health professional we spoke with told us that although timely referrals were being made to their service the recommended equipment which had been suggested to improve the effective support of people and improve their quality of life had not been purchased/sourced in a timely way. This meant people were being cared for in bed rather than being able to sit out in suitable chairs. The registered manager told us that decision not to purchase a piece of specialised equipment as recommended had been made following consultation with the GP and NoK. This information did not appear to have been shared with the assessing health professional who had advised this equipment should be purchased. One relative though did tell us how the provider had purchased a specialised chair so that their loved 1 could sit out of bed.

The provider failed to ensure people’s support plans always clearly included all their needs or most up to date level of risks. For example, for 1 person who had experienced several falls in recent months, their support plan and risk assessment had not been updated to reflect this. For another person who had poor skin their support plan contained conflicting information on the level of support they needed. This meant staff could not be clear as to the correct support they should provide, placing the person’s skin at further risk of deterioration.

For at least 2 people who required enhanced monitoring or support with repositioning in relation to their skin integrity and hourly safety checks, there was a lack of evidence this had been consistently provided.For some people whose fluids were being monitored due to being at risk of dehydration, there was a lack of evidence to demonstrate their fluid targets were being met or monitored as targets were not clearly or consistently recorded in peoples support plans or fluid charts. The providers check or monitoring of the completion of such records to ensure such records contained this information was not robust in identifying these shortfalls.

Whilst we found no harm had occurred there was the potential this may occur due to the lack of clear documentation recorded by staff and management oversight.

We continued to receive mixed feedback at this assessment in regard to people and their relatives being involved and consulted relation to assessment or review of their care needs and wishes. Four relatives still told us they had not been involved in developing their loved one’s support plans. However, others said they were involved with 1 relative telling us, “I sit down with [Name] registered manager and go through mum’s care plan. I can use the portal too (digital care plan system), to see what support mum has had.”

Where people were unable to make verbal choices regarding their mealtime choice, pictorial menus were in place or people were visually shown the options to give them the opportunity to choose at mealtimes. This meant people were unable to communicate their preferences were given the same options as those who were.

We found assessments of people’s needs were more robust and actions had been taken to improve at least 1 person’s independence since our last assessment.

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.

The provider’s processes for ensuring people were consistently involved in their care planning and that the information recorded in support plans was accurate, had been improved. However, based on feedback from 4 relatives there was still room for improvement.

People’s support plans reflected national and best practice guidance in relation to support with specific health care needs, such as diabetes and strokes.

Where people were assessed as requiring specialised diets, we found these needs were suitably met. The choice of meals, pudding and snacks on offer were varied and met individual needs and known food preferences. The catering team were aware of everyone’s dietary needs including those with known allergies. Mealtimes were a pleasant experience; the dining room was laid appropriately prior to meals being served.

We observed drinks were accessible in the communal areas and people’s bedrooms including snacks and fresh fruit.

At mealtimes a choice of drinks were offered. Condiments were offered and made available and people had clothes protectors put on them with consultation.

The registered manager told us they carried out call bell response times checks. This was a structured and robust approach which clearly demonstrated if these were managed in an acceptable timeframe and met the needs of people.

The provider did not always 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.

Feedback from health professionals we spoke with was mixed. Some felt that communication with the service still needed to be improved, as did the records, to clearly demonstrate the support people received met their needs. One health professional told us how staff followed their instructions which had led to improved conditions and positive outcomes for several people using the using the service. Another health professional however raised concerns that the lack of action by the provider to source equipment had led to people being cared for in bed for much longer than was necessary. They told us, “I feel the equipment is not adequate to meet the needs of their resident’s needs. There is only one type of shower chair (standard upright shower chair on wheels) and all the lounge chairs in the communal lounge are high backed chairs. There are no tilt in space shower chairs or tilt in space lounge chairs which are appropriate for patients with reduced core strength.”

There was positive feedback overall from people and relatives about the service. Two health professionals gave positive feedback for 1 member of the nursing team, the health professional told us, “[Name] nurse is always very helpful to us, has a lovely manner with the patients and can always answer any queries we may have.” All people and their relatives told us they had either spoken with or seen the registered manager. One relative told us, “The manager is friendly and will action concerns. I usually see the head nurse. Most communication is by phone. I have completed questionnaires in the past.” Feedback from people and relatives about whether they had been asked to complete feedback forms was mixed.

We were told by staff and records demonstrated that team meetings took place. These meetings were now consistently used to drive improvements giving staff opportunities where areas of concern or positive feedback could be discussed and actioned. Staff told us they felt supported by the registered manager.

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.

The system and processes to ensure care records and risk assessments were reflective of the support people required with their health needs were not always robust. The registered manager shared with us the tools, systems and processes which they used to support and help drive improvements in ensuring care records were up to date and reflective of peoples changing needs. These needed further improving to ensure they were robust in making and driving improvements regarding people’s health and well-being. This meant staff did not consistently have the correct guidance in a timely way to support people appropriately to manage their health and wellbeing, whilst encouraging independence.

Nursing staff could tell us how they would access additional support from healthcare professionals to help people manage their health, should this be required. Records demonstrated that staff had received training to support people with their specific health conditions, such as strokes, learning disabilities, complex mental health conditions, specific communication needs and distressed behaviours.

People told us they were able to make choices and decisions, but not all people were involved in reviewing or consulted about their health and well-being needs.

People or their relatives told us they felt medical referrals were made where necessary, in a timely way, and were happy with this area of support. One relative told us, “[Name] became unwell recently so they [staff] called an ambulance, she was checked over at hospital and came back the next day.”

We saw evidence that referrals were made and people had accesses to dentists, opticians, chiropodist and GPs as required.

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.

Since our last assessment the provider has introduced ‘residents of the day’. All staff from all departments have a key part to play on this day to ensure the person has 1:1 time with the activity co-ordinator and staff. This day is also allocated to ensuring all the person’s equipment they use is safe/checked and their care plans and risk assessments are reviewed.

Supervisions and appraisals had taken place and demonstrated that staff were provided with an opportunity to discuss any concerns they may have about people’s care or how it could be improved.

The provider carried out investigations when incidents occurred. Evidence of lessons learnt from these to drive improvements for positive outcomes for people were followed up with staff via supervisions and recorded. This demonstrated how lessons could be used to ensure people using the service were safe and received appropriate care and support.

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

The provider was compliant with the Mental Capacity Act (MCA) 2005. The provider had consistently obtained evidence that those making decisions on people’s behalf had the necessary legal authority to do so. This meant the provider could assure themselves people were being supported in the least restrictive way and decisions were not being made on their behalf inappropriately. Where best interest decisions had been made on people’s behalf, these were clearly recorded in people’s support plans. Applications for Deprivation of Liberty Safeguards (DoLS) authorisations were also clearly recorded or monitored. The registered manager had a list of people for whom they had made referrals for and when they had been approved.

Two care staff members we spoke with were unable to tell us which people had DoLS authorisations in place or how to find this information. This was of particular concern as without staff knowing this information it was unclear how they could ensure they were adhering to the specific conditions on these once approved. This placed people at risk of being unlawfully or inappropriately restricted. However, staff did say they would ask the nurse.

We observed staff consistently knocking and waiting to be invited in before entering rooms. Some people told us staff did speak to them prior to providing support.

The provider could demonstrate that staff had received training in relation to consent, MCA and DoLS. Most staff members we spoke with could tell us what this legislation and the associated principles meant for people using the service.