Hafod Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

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

This meant people’s needs were met through good organisation and delivery.

This service scored 64 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Records did not always provide staff with detailed guidance about people’s individual needs.

Some people’s care records lacked detail. For example, 1 person who had fallen on several occasions there were no systems in place to alert staff should the person get up to walk independently. When we spoke to the registered manager about this, they told us they had tried all options, none of which had been successful. The persons support plans and risk assessments did not demonstrate that alternate options had been tried, when these had been tried or what the outcome had been. This meant we could not be assured all options to mitigate the risk of falls had been taken. A referral to the falls team had been made for further guidance.

Whilst improvements had been made to the lounge, dining room and activity room the environment still needed further adaptation to meet the needs of people the provider supported. For example, the garden area was not conducive to supporting or promoting the independence of people living with dementia. Signage was displayed to help people navigate the service and locate key areas such as lounges and dining rooms. Menus and meal choices included both pictorial and large print formats to meet people’s needs or preferences.

There were no accessible baths in the service, only showers. This meant that if anyone wished to have a bath, this was not an option. Since our last inspection the registered manager had carried out a survey with people using the service from which they concluded that people using the service were happy to have showers and not baths. However, if people’s preferences changed this meant the provider could not be assured, they would be able to meet people’s individual needs and wishes.

The provider worked in partnership with people and their relatives to decide how to respond to any relevant changes in people’s needs. The provider operated a system involving people and their relatives in the updating and development of person-centred care plans although 4 relatives told us they had not been involved or asked for their feedback. We found that changes to people’s needs had not always been reflected in their current care plans or risk assessments. However, relatives told us they received calls from staff if something happened to their loved one.

Where people’s known choices had been identified staff worked to consider these where supporting people. This meant that overall people had their wishes met.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

More work was needed to ensure all people using the service had the opportunity and were supported to integrate in the community by visiting local shops, cafes and places of interest. However, we saw and were told that external organisations came into the home. This included local organisations or groups such as exercise classes, entertainers and church groups in which people may have links or interest, and the local school also visited.

We saw that handovers took place between shifts. Where agency nursing staff had been used that they had received a full induction into the service ensuring robust continuity of care. The registered manager was able to provide assurances and evidence this had been carried out.

Staff had received specialist or enhanced training in supporting people with complex dementia and mental health, to ensure they had the knowledge and ability to take appropriate action when supporting such people when they became distressed. Although staff had completed this training 1 health professional who shared their feedback with us told us, “I feel staff should have better understanding, knowledge and skills to manage dementia patients.”

Relatives told us they felt the service worked with them when they were required to do so, although some raised concerns around the different staff supporting their loved ones. The rotas we viewed indicated there was a stable and consistent staff team.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The registered manager ensured people’s information was made accessible to meet their individual needs, such as information translated into other relevant languages, pictorial versions and large print. Some staff were of the same ethnicity as people using the service which supported effective communication. Other methods of communication, such as the use of online translation applications had also been considered by the provider. This meant people received information to meet their individual needs reducing the potential to cause isolation and frustration to them as they were enabled to express their needs or wishes. We observed the use of alternative communication methods to support a person to communicate their feelings and needs, which were then subsequently met by the staff team.

We found people’s care records were stored securely to prevent unauthorised people from gaining access to their personal information.

Information held electronically was in a written format, and the registered manager told us this could be generated in a format all people could access. Some relatives told us they did not have access to the electronic records.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

The provider sought feedback from people using the service. We saw that surveys were also available in a format to meet people’s preferred communication methods or their abilities. This meant people were able to provide their views and opinions and partake in meetings or surveys.

We saw that where ‘residents’ meetings’ took place, these were inclusive, ensuring all those who lived at the home were encouraged to attend. Where people had shared their views and requested changes during these meetings, we found these had been actioned. For example, 1 person requested choc ices and ice lollies, and we saw these had been added to the food order. We also observed these being offered during our assessment. Relatives were invited to attend but the registered manager advised us that often no relatives had attended.

Compliments and complaints about the service were recorded. These were analysed to help drive improvement however, there were no patterns in the types of complaints raised.

People and the relatives we spoke with told us they knew how to raise a complaint and felt overall these would be addressed and appropriate actions taken. However, 1 person told us they had e-mailed the registered manager several times but had not received a response. Where needed we found investigations had taken place.

Where needed, some people had an advocate appointed to ensure their voice was heard.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

People were supported to access healthcare professionals and appointments or receive emergency healthcare as needed. This included, dentist, optician, chiropodist, dieticians and other supporting professionals.

There was a GP linked to the service who carried out weekly visits to the service. The nurse on duty was required to prepare a list of people prior to the GP visit of whom they felt needed to be reviewed that week. The GP was reliant on the nursing staff to ensure they referred anyone requiring a check-up or review to prevent any delays in care and treatment. In addition, this included updating the GP on anyone whose health or condition had deteriorated and required further referrals to other health professionals.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

The provider failed to robustly recognise the inequalities people they supported may face. These inequalities and people’s needs were not always considered. People were not supported to participate in the community and to go out on trips to places of interest due to both financial and physical restrictions due to transport. People living with dementia or physical disabilities were not robustly supported to address and remove barriers ensuring they had equal opportunities to live a full and varied life. Reasonable adjustments within the service had not been fully considered or timely action taken to resolve known accessibility issues. This included a lack of timely steps taken to make the garden more accessible, inspiring and safer for people to use independently and enjoy the outside space.

The registered manager and staff had worked hard to develop areas in the service such as reminiscence areas, indoor gardening station and reading area in the activity room and they had developed the lounge and dining areas to be a more inclusive environments, enhancing the experience of people using the service.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

At the time of the assessment the provider was not supporting anyone on the end-of-life pathway, although there were many people who were at different stages of this journey.

We saw that information had been obtained in relation to people’s end of life wishes but further work would ensure staff had the necessary information to support people appropriately. This included around their specific and individual cultural requirements.

Some people living in the service were supported by loved ones and others by advocates. Where people had indicated they did not currently wish to discuss their end-of-life journey there was no clear structure for when this lack of vital information should be revisited with the person or their loved ones. This meant if end of life support was needed unexpectedly, something which was important to that person may not be actioned.

Where people had made the decision not to receive active treatment in the event their heart should stop, this was recorded in peoples support plans.