Hatfield Lodge

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safe staff recruitment.

This service scored 59 (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 have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. There had been significant improvements since our last assessment. There was now a system in place to review incidents to identify what had gone wrong and what had gone well. An action plan had been put in place, including speaking to staff about what they did well or when improvements could be made.

However, it was not always clear if people’s care plans had been reviewed following incidents. For example, there had been incidents involving people who had become distressed following known triggering situations. The person’s care plan had not been reviewed or additional guidance for staff to manage incidents in the future had not been added. Staff told us they were told about any changes to people’s needs and were involved in the review after an incident.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services. There had been no admissions to the service since our last assessment. However, a decision had been made to use a detailed paper pre-assessment form to make sure all areas of people’s lives were discussed. We were unable to assess if this change is effective to rectify the shortfall found at our last assessment as the from is yet to be used and embedded in good practice.

When people had returned from hospital their care plans had been updated with any changes to their needs. Staff told us they were informed of any changes when people came back from hospital.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. There had been significant improvements since our last assessment. The registered manager now recognised and notified both the local safeguarding authority and CQC of incidents when they happened. There had been a significant increase in the number of notifications received including when there had been incidents between people. This had enabled the local safeguarding authority to investigate incidents to make sure people remained safe and reduce the risk of them happening again.

Staff described how they recognised and reported abuse including to external agencies if required. Staff told us they were now confident the management team would take the appropriate action when they raised concerns or reported incidents.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. There had been improvements made since our last assessment, but more improvements were needed. People’s care plans had been reviewed, and some guidance had been made more person specific. However, there continued to be gaps in the guidance, for example, when people did not want staff to support them with their catheter care. Staff had not always been able to support with the changing of the drainage bag weekly, following best practice to reduce the risk of infection. There was no guidance for staff about how long the bag change could be left for and what action to take if the bag could not be changed.

Some people were assessed as at risk of falls, while people’s care plans recognised people were at risk, there was no specific care plan and guidance for staff to reduce the risk. Some people were prescribed medicines to thin their blood placing people at risk of excessive bleeding. There were care plans about the risks of these medicines, but they did not always include what to do in the event of an injury. The guidance was found in other parts of the care plan including in relation to blood clots. There was a continued risk staff did not have access to guidance to provide consistent care and support.

Some people had specific medical conditions such as osteoporosis, there was general information about the condition but not how the condition affected the person and the risks this presented.

Staff understood the risks to people’s health and wellbeing. Staff who were trained to administer insulin described how they checked people’s blood sugar levels and how they used guidance to decide if it was safe to give the insulin.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. At our last assessment we raised concerns about how people would be kept safe during a fire and staff understanding of evacuation. The fire department had visited the service to check the environment, and systems were now safe, and they were satisfied with what was in place. All staff had now completed fire drills including an evacuation drill to make sure they understood how to keep people safe. During our last assessment, it was identified staff did not always know how to open locked areas such as the gate in the garden. Staff could now describe how to open the gate and other areas which were locked.

Since our last assessment, changes had been made to the service including the addition of a ground floor toilet and changes to the bathrooms. These changes had made it easier for people to access areas independently.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs. Improvements had been made to the deployment of staff; however, we found some shortfalls in the processes to recruit staff. We reviewed recruitment records for 2 staff who had started since our last assessment. The application forms had not been fully completed with some gaps in employment, the reasons for why staff had left their previous had not been fully explored or recorded. The management team had not always requested references from previous social care providers. When there had been concerns about why the staff member had left their previous role this had not been recorded or risk assessed, to show the risks of employing the person had been reduced. Following the assessment the registered manager sent us reviewed application forms and risk assessments to cover the shortfalls identified.

At our last assessment, the deployment of staff had not supported people to have a good quality of life. At this assessment, there had been a change to the staff routine and the way people were supported. Staff told us they were happy, with the changes which had been made. People were now being supported to have their breakfast by 9:30am and supported to get up when they wanted. Staff told us this had a positive impact on people’s mood and appetite. We observed the lunchtime meal and people’s experience had improved. People received their meals at the same time and there were staff available to support them.

The provider had reviewed the hours of the domestic and catering staff since our last inspection. Previously, in the evening, care staff had to complete the laundry and the evening meal meaning people did not have a choice of a hot meal. At this inspection, the cook provided the evening meal and people now had an option of a hot meal, which had been popular. The laundry staff hours had been increased and staff told us they could now give more time to people especially in the afternoon.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The provider had replaced stained and broken furniture, and all furniture was now washable to improve infection control. The shortfalls identified by the infection control audits had been rectified including limescale staining around taps and torn flooring.

Staff wore personal protective equipment (PPE) such as aprons and gloves when appropriate. There were supplies of PPE available around the building.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning. There had been improvements since our last inspection, but further improvement was still needed. Some people were prescribed medicines on a ‘when required’ such as pain relief and medicines for constipation. There was limited guidance for staff about when to give the medicine, how often and what action to take if it was not effective. This continued to place people at potential risk of not receiving their medicines when they needed it.

There were now procedures in place to make sure medicines were ordered, stored, administered and disposed of safely. The electronic medicine stock levels were now accurate, the number of tablets in the boxes matched the number on the system. The records for medicines which had additional recording requirements were now accurate. Staff told us, they had received refresher training, and this had been beneficial. They also described how the change in routine had made the medicine rounds quicker and people received their medicines at the time required.