Hatfield Lodge

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 means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.The service was in breach of legal regulation in relation to how people’s needs were assessed and consent.

This service scored 33 (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. Some relatives told us they had been involved in people’s care plans, others told us they wanted to be more involved. People’s care plans had been regularly reviewed, however, changes to people’s needs had not always been recorded. There was no record of any involvement of people or their relatives in the creation of the care plan.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards. Staff did not understand how to support people with their specific diets including diabetes. Guidance from Diabetes UK and the NHS guidance recommends people eat a balanced diet and not eat large amounts of refined carbohydrates such as pasta as these can lead to rapid increases in blood sugar. However, the menu on the day of our onsite inspection included 2 choices which were mainly pasta with garlic bread. We discussed the menu with the chef, they did not have a specific diabetic menu. When we asked about the carbohydrates in the meals, the chef told us they always gave people plenty of carbohydrates. The management and staff had not identified the meals being provided did not follow guidance to support people’s needs.

People’s needs were assessed using recognised tools such as Waterlow score to assess people’s risk of skin damage. However, the guidance from these tools had not been followed such as moving people to relieve pressure and setting pressure relieving mattresses to people’s weight. We observed people sat in the same position from 9am to 4pm in the lounge and not all the pressure relieving mattresses were correctly set.

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. Staff were allocated tasks to complete each shift, allocation sheets did not contain any space to add any changes to people’s support, to update staff. During a staff meeting the registered manager had to remind staff to arrive in time for handover, as staff had been arriving late. There was a risk not all staff would know all the changes to people’s support.

People’s care records were not completed with accurate information. People’s food charts and documentation was not clear how much people had eaten. Staff used statements such as ‘standard portion’ and ‘ate most of it’, this did not provide a clear picture of how much people were eating. We observed different staff giving people their meals and taking them away, there was a risk staff would not know how much people had eaten. There is a risk healthcare professionals would not get accurate information to inform decisions about people’s care.

Healthcare professionals told us staff called them when needed and knew people well. They described how staff provided information about people when there was an emergency, which we observed during our onsite inspection.

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support. The choice of meals given to people did not support people with health conditions to eat as healthy as possible. People living with diabetes were not given options to support the management of their blood sugar levels. People who required specific textures of food were not always given the correct food.

People were not always supported to take part in activities to maintain their fitness. We observed the activities co-ordinator start armchair exercises, however, they did not sit so everyone could see what they were doing. Staff were not available to help in the session to support people to do as much as they could. People spent their time sat in the communal lounge and were not supported to move around to keep them as mobile as possible.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. People’s care plans had been reviewed regularly but the reviews had not reviewed the outcomes for people. We observed people in the communal lounge, there was little stimulation or contact with staff, people were withdrawn or asleep. This had not been identified by the management team as not being a positive outcome for people and acted to make improvements.

When people required their diet and fluid intake to be monitored, the recording of their intake was not clear or consistent. Staff had not made clear the size of the meals or the percentage of the meal people had eaten, not having accurate information could affect the decisions made about people’s care.

People’s capacity to make decisions had been assessed. When people had been assessed as not having capacity to make decisions this had been recorded in their care plan. Staff had not always recorded decisions following the Mental Capacity Act 2005 (MCA). Most decisions had been recorded under the MCA, however, when changes to people’s care had been required these had not always been recorded under a best interest decision. For example, a person had become distressed when being hoisted, healthcare professionals had assessed it was not safe to continue to hoist the person. Staff had recorded in the care plan the person would now be cared for in bed, but a best interest decision had not been recorded to show how the decision had been made and why it was the least restrictive option available. Staff had not always recorded how other decisions had been made including the use of bed rails when this had been a change.

Depravation of Liberty Safeguards (DoLS) had been applied for, however, the process in place to track and monitor applications and when authorisations needed to be renewed was not accurate. The registered manager sent us their current DoLS tracker dated May 2025, some DoLS had not been recorded, there was a risk the application for renewal would not be applied for appropriately. The document showed authorisations expired in July 2025, there was no record the renewals had been applied for or there had been a change in the people’s care, so the DoLS was not needed.