The inspection took place on 02 and 20 March 2015 and was unannounced. At our last inspection on 07 May 2014, the service was found to be meeting the required standards.
Hatfield Nursing Home is a nursing and residential care home that provides accommodation and personal care for up to 118 older people, some of whom live with dementia. The home is comprised of separate nursing, residential and dementia care units spread over five floors where staff look after people with varying needs and levels of dependency. At the time of our inspection there were 110 people living at the home.
There is a manager in post who is in the process of registering with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.
The CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection a number of applications had been made to the local authority in relation to people who lived at the home.
People told us they felt safe at the home. Staff had received training in how to safeguard people against the risks of abuse. They were provided with guidance about how to report any concerns which included a ‘whistle blowing’ procedure. Safe and effective recruitment practices were followed to check that staff were of good character, physically and mentally fit for the role and able to meet people’s needs.
People who lived at the home and their relatives expressed mixed views about staffing levels. Our observations found that the effectiveness of staffing levels lacked consistency across different units at the home. In some units we saw there were sufficient numbers of staff to meet people’s needs promptly in a calm and patient way. However, in others units, particularly where people’s needs and dependency levels were greater, there were often insufficient staff to cope with the demands placed upon them.
We found that people had not been supported to take their medicines on time or as prescribed in all cases. People told us that potential risks to their health and well-being had been identified, discussed with them and their relatives and reduced wherever possible.
We found that staff obtained people’s consent before providing the day to day care they required. However, we found that people’s consent had not been obtained in line with the MCA 2005 in all cases. We also found that ‘do not attempt cardio pulmonary resuscitation’ (DNACPR) decisions had been taken in relation to a number of people without their proper involvement or consent.
People were positive about the skills, experience and abilities of the staff who looked after them. We found that most staff had received training and refresher updates relevant to their roles. People liked the food provided at the home and enjoyed a healthy balanced diet. They felt their day to day health needs were met and they had access to health care professionals when necessary.
People told us they were looked after in a kind and compassionate way by staff who knew them and their relatives well. Relatives told us they were involved in decisions about the care provided and that staff kept them informed of any proposed changes or developments. We found that personal care was provided in a way that promoted people’s dignity and respected their privacy. However, the confidentiality of people’s medical histories and personal information had not been preserved in all cases and they did not have access to independent advocacy services.
People told us they received personalised care that met their needs and took account of their preferences. We found that staff had taken time to get to know the people they looked and were knowledgeable about their likes, dislikes and personal circumstances. However, we found that the guidance and information provided about people’s backgrounds and life histories was both incomplete and inconsistent in many cases.
People expressed mixed views about the opportunities available for people to pursue their social interests or take part in meaningful activities relevant to their needs. We found the opportunities provided varied and lacked consistency across different units at the home. People and their relatives told us that staff listened to them and responded to any concerns they had in a positive way.
People, their relatives, staff and healthcare professionals were all very positive about the management and leadership arrangements at the home.
At this inspection we found the service to be in breach of Regulations 9, 13 and 22 of the Health and Social care Act 2008 (Regulated Activities) Regulations 2010. These breaches correspond with Regulations 9, 12 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which came into force on 01 April 2015.
You can see what action we told the provider to take at the back of the full version of the report.