Background to this inspection
Updated
7 April 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by 3 inspectors.
Service and service type
Hatfield Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Hatfield Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was not a registered manager in post. However, a member of the provider’s management team was in post and managing the service.
Notice of inspection
This inspection was unannounced.
What we did before the inspection Notice of inspection
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection
We spoke with 9 people and 4 relatives about their experience of the care provided to their family members. We spoke with 11 members of staff including the manager, supporting manager, regional manager, care and ancillary staff.
We reviewed a range of records. This included 8 people’s care records. A variety of records relating to the management of the service, including policies and procedures were reviewed.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
Updated
7 April 2023
About the service
Hatfield Nursing Home is a residential care home providing personal and nursing care to up to 118 people. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 52 people using the service.
Hatfield Nursing Home accommodates up to 118 people in one purpose-built building.
People’s experience of using this service and what we found
There were monitoring processes in place to help ensure a good standard of service. Quality assurance systems identified any areas that needed further development and any remedial actions were implemented. However, the overview of some elements of safety such as repositioning, oxygen management, record keeping was not robust. Also seeking people’s views on their experience in the home needed to be more robust to help ensure any themes and trends were identified and if any additional actions were needed.
There were a high number of skin integrity issues and there was an indication there was a lack of repositioning and swift continence care which contributed to this. Storage cupboards containing cleaning products were not always secure which put people, particularly those living with dementia, at risk. There were areas of the home which needed further cleaning. There was a refurbishment programme in place to help address the areas needing repair making them difficult to clean.
Individual risks were assessed, and staff were aware of these. Reviews of events and accidents were carried out and any actions needed were undertaken. Medicines were managed in accordance with the prescribers’ instructions.
People gave mixed views about if they always felt safe and supported by the service. People did say at night some staff were not helpful and rude. Safeguarding processes in the home needed to be more robust. The management team were providing training for staff. Staff told us they knew how to report any concerns about a person’s safety or welfare.
People and relatives told us most of the day staff were kind and caring, they were happy living at Hatfield Nursing Home. Interactions observed were positive, staff responded to people in a way that anticipated their needs and demonstrated they knew people well. All observations found staff to be attentive and caring about the people they supported. However, on the nursing unit, engagement between staff and people was limited and this needed further development.
People gave mixed views about if there enough staff to meet their needs. Relatives and staff also gave mixed views. Our observations showed that this varied depending on the unit. The management team told us they had changed the allocation of staff on the nursing unit since our visit. Staff received appropriate training for their role and people felt they had good knowledge and skills. Staff felt supported by the new management team.
Staff enjoyed working at Hatfield Nursing Home and wanted to ensure people were happy and well cared for. Care plans included all information needed to support people safely and in accordance with their wishes and preferences. These were being reviewed.
People and staff told us that the manager was often around the home and meetings were held. The home was being managed by a member of the provider’s management team. There was additional support by a regional management team. After purchasing the home, the management team told us there was a significant of work to do. They prioritised safety, which they feel has improved but acknowledged there was further work and they would now be developing the remaining areas.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection This service was registered with us on 27 September 2022 and this is the first inspection. The last rating for the service under the previous provider was good published on 17 November 2018.
Why we inspected
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We received concerns in relation to safeguarding people, safe care and treatment, dignity and management. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service is requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe, caring and well led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
The provider implemented actions following our feedback to improve standards in the home. This included further checks, training and sharing lessons learned with staff.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hatfield Residential and Nursing Home on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to safety and governance at this inspection.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.