The inspection took place on 6 March 2018 and was unannounced. The last comprehensive inspection took place in April 2017, when the provider was rated Good. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Hatfield House’ on our website at www.cqc.org.uk.This inspection was brought forward due to concerns we received. We therefore needed to inspect the service to ensure people were receiving safe care.
Hatfield House is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Hatfield House provides residential care for older people and people living with dementia, who require personal care. It can accommodate up to 48 people over three floors. There is access to the floors by a passenger lift. All the bedrooms have an en-suite with toilet, wash basins and shower. The service is situated in Hatfield near Doncaster.
At the time of our inspection the service did not have registered manager. 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.
The registered provider had appointed a manager who had left prior to our inspection. This manager had been replaced and a new manager commenced in post on 5 March 2018. The regional support manager had been based at the home for three weeks supporting the previous manager and the new manager. The regional support manager told us they would remain at the home for some time supporting the new manager.
We observed there was a lack of staff which put people at risk. The dependency tool used by the manager was not effective and did not include all people currently living at the service. It was not always reflective of people’s current needs. Risks associated with people’s care were identified, but they were not always reviewed and there was a lack of action taken to minimise risks to people.
Accident and incident analysis was not taking place and there was no evidence that trends or patterns were being identified and actions taken to reduce hazards in relation to people’s care.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. This was because the new management were not aware of who had an authorised Deprivation of Liberty Safeguards or if any conditions were attached.
People were supported to maintain a balanced diet which met their needs. However, food and fluid charts were poorly completed and some people had lost weight and this had not been addressed.
Staff told us they received training and support to carry out their roles and responsibilities. However, we found records did not support this.
We spoke with people who used the service and they told us that staff were kind and caring. We observed staff interacting with people and found they had a gentle and caring manner. However, staff could not always respond to people’s needs in a timely way and therefore care was not always person centred.
We found people did not always receive care that was responsive to their needs. Care plans we looked at contradicted each other and were not always followed in line with people’s current needs. We observed a lack of social stimulation for people who used the service. This did not meet the social needs of people.
All the people we spoke with knew how to raise a complaint and said they felt comfortable speaking with any of the staff.
We found that there had been a lack of consistent managers and a lack of registered provider oversight and governance which had contributed to the decline of the service. Audits in place to monitor the quality of service provision did not always take place in line with the registered provider's policy. Where audits had taken place they were not effective and did not always identify the concerns we had raised as part of this inspection. Some concerns were highlighted as part of the audit process but there was no evidence that sufficient action had taken place to correct them.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in; Regulation 9; Person-centred care, Regulation 11; Need for consent, Regulation 17; Good governance. Regulation 18; Staffing. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to the more serious concerns found during inspections are added to reports after any representations and appeals have been concluded.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.