The inspection took place on 5 October 2017 and was unannounced.Hatfield Lodge is a large detached house in a quiet residential area. It provides care and support for up to 34 older people some of whom are living with dementia. There were 29 people living at the service when we inspected.
The service had a 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. This is the first inspection since a change of registration for the provider in October 2016.
People and their relatives told us they felt safe at the service. Staff had received training about protecting people from abuse and understood their responsibilities in reporting any concerns. Staff were confident that the registered manager would address any concerns reported to them. Risks to people were identified, assessed and plans were put in place which gave staff the guidance needed to manage and minimise the risks. People's medicines were managed safely and in the way they preferred. People were supported to be involved in managing their medicines if they wished to.
People were supported by staff who had built positive caring relationships with them. There were enough staff to meet people’s needs and keep them safe. Staff were recruited safely and all necessary checks were completed to ensure staff were suitable for their role. Staff told us they received the training and support they needed to do their job. Some staff had begun additional training to become a ‘champion’ in areas such as dignity or dementia. Staff completed a comprehensive induction and competency assessments before supporting people independently.
People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this. Staff asked for people’s consent before giving support and explained to people what was happening. The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm.
Staff tailored their support to the needs of each individual, communicating with people in the way they preferred and understood. Staff knew people well, interactions between people and staff were affectionate and relaxed. Staff offered people reassurance and encouragement. People were laughing with staff throughout the day. People could have visitors whenever they liked and were supported to maintain relationships with family and friends.
People told us the food was nice and they always had lots of choice. There was a menu board displayed in the dining room with pictures of the meals on offer that day. When people needed their food in a specific way this was provided. When people needed support to eat their meal, staff offered this in a patient and dignified way. When people were unwell or were living with a health condition such as diabetes, staff supported them to book and attend any health appointments. Any recommendations from health professionals were recorded in the person’s care plan and followed by staff.
People and their loved ones were involved in developing and updating their care plans. People’s care plans were detailed and contained information about their life history, what they could do for themselves and the staff support they required. The plans were reviewed and updated on a regular basis and when people’s needs changed. There was an activity co-ordinator at the service and people told us they had lots to do. We saw people taking part in playing skittles, using sensory objects and taking part in a quiz. There was a picture board in the dining room letting people know what activities were happening each day, alongside a board showing the day, date, season and weather.
The registered manager and staff told us the focus of the service was to give people care and support in the way they preferred and to keep improving the quality of care offered. People, staff and relatives told us the registered manager and the provider were accessible and approachable. Staff told us they felt valued and that they had a voice in the service.
Risks to the environment were identified and assessed, plans were put in place to minimise risks in the way which was least restrictive to people. Regular fire drills were carried out and weekly fire checks were carried out. People had personal emergency evacuation plans which detailed the support people would need emotionally and physically to leave the building in the event of an emergency. Regular audits were completed in relation to health and safety and infection control. Action was taken to address any shortfalls. The registered manager completed other audits related to the quality of care and people’s care plans.
The registered manager asked people for feedback about the service and their care on a regular basis and took action to address any issues raised. People had meetings where they could put forward their opinions about the food they were offered and activities they wanted to take part in. Complaints were recorded and responded to appropriately. The registered manager attended local forums for managers and shared their learning with staff through team meetings. Staff treated people with dignity and respect; they understood confidentiality and people's records were stored securely. Both the registered manager and the provider had clear oversight of the service and addressed any issues as they arose.