Hafod Nursing Home

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

Systems to monitor and assess the effectiveness of people’s care and support were not always robust and did not always ensure the best outcomes for people were supported and achieved. The service worked with other agencies to provide a person-centred approach to their care and support to maintain good physical, mental and emotional support. Managers were working to instil a culture of improvement to improve outcomes for people, but this was hindered by the provider’s lack of support, monitoring, and action to drive improvements. We found the safety and ongoing maintenance of the premises and equipment were poor due to the lack of timely actions by the provider. The equipment in use did not always meet the needs of people. The registered manager operated a system to identify areas of improvement and had an action plan which had been shared with the provider for their approval and financial agreement. People were supported to maintain family links. People were not always supported to develop new skills, interests, hobbies, and participate in work-based activities. This meant, at times, activities were not effective in meeting the needs of people and were not always meaningful, resulting in lack of stimulation and engagement. At the last 3 inspections it had been identified improvements were needed to ensure the care environment was adapted for people living with dementia. At this assessment we found some improvements including coloured bedroom doors and improved décor had been made but further work was still required. People’s bedrooms and communal bathrooms and toilets were still in need of improvements to meet the required dementia standards. Further improvements were needed, including adaptations to the garden to make it more accessible and appealing for people living with dementia.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us they were not consulted in relation to assessment or review of their care needs and wishes and had not been involved in developing their support plans. One person told us they felt their needs were not fully met due to restrictions in place which had not been regularly reviewed. People and relatives told us they had timely access to appropriate health care professionals, and we saw evidence of this taking place as people’s needs changed.

Whilst the registered manager told us they monitored the effectiveness of people’s support to ensure their assessed needs were met, this was not always reflected in what staff told us. For example, some staff felt there was a lack of the meaningful activities for people to participate in and lack of trips into the community. This information was shared with the registered manager who told us financial restrictions for additional staffing to accommodate trips out, ensuring the safety of people, was the main factor in these not taking place. We did see evidence that the activity co-ordinator spent time with people on a 1 to 1 basis including in people’s own rooms, if they chose not to participate in group activities or were unable to. There was an activity schedule displayed for people and staff to know what activities were planned for the forthcoming week. We saw evidence and were told by staff that they worked with other agencies to improve the effectiveness of people’s care and support. The registered manager and clinical lead told us how they assessed people’s needs before they moved into the service, taking into account the layout of the building and care equipment they required, which will dictate whether they are able to support any new referrals safely. The clinical lead also told us how care plans were reviewed each month; however, this currently did not include the person or their representative as part of this process. Staff told us how they communicated with people who had limited verbal communication or whose first language was not English; this included using online translation tools to communicate effectively.

We saw evidence that pre-assessments of people's needs were carried out prior to a person moving into the service to ensure they were able to meet their needs effectively. However, we did not see evidence of on-going assessments of people’s needs or people’s involvement during the care review process to ensure this was a collaborative and inclusive approach. Although clinical assessment tools were being used to assess people’s health and wellbeing, information recorded on these was not always reflective of their current support needs, although staff had reviewed the support plans.

People’s care and support did not always reflect good practice standards. One person spoke to us about the restrictions on their smoking. Their support plan indicated that being able to go outside to have a cigarette was used as a bargaining tool for them agreeing to be supported with personal care. There was no evidence of any consultation with, or consent from, the person about this restriction on their smoking to encourage support with personal care. Most people and relatives told us they had not been involved in any recent care reviews and had not seen their care plans. This meant they had not been involved in creating person-centred care plans to meet their needs and wishes. People and their relatives told us they were satisfied with the range and quality of food and drinks on offer at the service. We saw meal options were made available for people who required both a standard diet and for those who required a specialised diet. The meals for those who required a puree diet were well presented and varied. Snacks and fresh fruit were accessible in communal areas and people were encouraged to eat healthy diets with fresh fruit and vegetables available. One person told us how they had been involved in making recommendations for the menus, which had been implemented. Mealtimes were at set times, but people told us they had access to drinks and snacks during the day.

The clinical lead told us about the process of reviewing and updating support plans based on feedback from staff to ensure people’s care and support needs were appropriately met. However, we found this was not always effective as information and guidance for staff on how to meet people’s needs in line with good practice standards needed to be more robust. Staff told us they were confident people received safe care and that the information available to them was reflective of those they supported. The registered manager told us they would review the information held in people’s support plans to ensure they reflected their support and health needs and make the necessary amendments. We were advised by the registered manager the new electronic care planning system had only been operating a couple of months. We found support plans had been reviewed during this time, but the information missing from these, based upon the content of people’s previous care plans, had not been identified and addressed.

The provider’s processes for ensuring people were consistently involved in their care planning and that the information recorded in support plans was accurate, were not effective. Important information about people’s care and support needs had been omitted from some support plans on the new electronic care planning system. Some people’s support plans did not reflect national and best practice guidance in relation to support with specific health care needs, such as epilepsy and diabetes. For people who required enhanced monitoring in relation to their skin integrity or food and fluid intake, there was a lack of evidence this had been consistently provided. For example, staff were not accurately recording the amount of food people ate, to facilitate effective monitoring. For 2 people who smoked, there was a lack of evidence to demonstrate how the decision for staff to withhold their lighters had been made. The support plan for a person who refused personal care due to becoming anxious did not include information or guidance for staff on how to manage these refusals. At the time of the last inspection, the home environment required improvement, as it was not dementia friendly and did not reflect current national guidance for dementia friendly environments. Some improvements have been made such as bedroom doors were now different colours and the décor to communal area had been improved. However, there was still work required to improve people’s personal spaces and the garden to make it accessible and dementia friendly. The registered manager had developed a plan to improve the garden, but the provider had failed carry out the improvements which included replacing the uneven pathways. There was a ‘resident of the day’ system in place to ensure all people’s support plans were updated on a specific day of the month. The registered manager and clinical lead had been part of a pilot to help reduce hospital admissions and they have seen a 50% drop in hospital admissions.

There was positive feedback overall from people and relatives about the culture in the service. People felt the staff team worked well together and it was a relaxed atmosphere. However, some relatives told us it was very difficult to speak to or see the registered manager. One relative told us, ‘I would say [the registered manager] is trying to do the right things but they are not followed up on. The communication side and procedural things are lacking but I haven’t any immediate concerns. I have raised concerns in the past, but they are slow to respond.” Another relative told us, “We communicate mainly through e-mail. [The registered manager] is not so easy to get hold of.” We saw evidence that health professionals were involved in providing advice and guidance and this was working well.

We were told about, and saw evidence of, team meetings taking place together with daily handovers where areas of concern or positive feedback were discussed. Staff told us they felt teamwork was good and everyone helped each other. The registered manager and nursing team told us how they had built good relationships with external professionals for better outcomes for people using the service.

The health professional we spoke with felt there was a good working relationship with the service and any guidance was actioned. However, they had not been involved people’s care in recent months and had not visited the service.

We found for a person with a learning disability, they did not have a hospital passport in place as per national good practice guidance. These passports provide information on the person’s health needs for other services, should they require further support or treatment outside of Hafod Nursing Home. Handover took place each shift changeover and there was an option on the provider’s newly introduced electronic care planning system to generate an electronic handover to review any significant support needs, changes or incidents and accidents. This enabled a quick overview and effective handover. There was also a ‘risk board’ in the nurses’ office which identified any significant changes or additional monitoring for people who were noted as at risk from harm or had complex health needs. We observed this information was up to date.

People and relatives told us that when they needed to see a GP, dentist, optician or chiropodist, these appointments were arranged on their behalf. We saw evidence that people who smoked were encouraged to participate in cessation and were provided with advice. People told us they were able to make choices and decisions, but not all people were involved in reviewing or consulted about their health and well-being needs.

Staff could tell us how they would access additional support from healthcare professionals to help people manage their health, should they be required. However, records demonstrated that staff had not received training to support people with their specific health conditions. The registered manager told us they would arrange additional staff training, based on our feedback, to improve staff’s knowledge and skills in relation to people’s health needs, such as complex mental health, stoma care and supporting people with a learning disability.

The system and processes to ensure care records and risk assessments were reflective of the support people required with their health needs were not robust. This meant staff did not always have the correct guidance on how to support people appropriately to manage their health and wellbeing, whilst encouraging independence. The online training for supporting people with learning disabilities was not in line with the required training which has been a requirement since 2022. This states ‘all staff’ should receive training in how to interact appropriately with people with a learning disability at a level appropriate to their role. Also, staff must receive appropriate supervision in their role to ensure they demonstrate and maintain competence in understanding the needs of people with a learning disability and autistic people, including knowing how to support them in the best way. We saw that not all staff had received such training, and supervisions to assess staff competency and understanding had not been carried out. However, we saw evidence of meetings with health professionals to discuss people’s health and wellbeing, as required. This included a system for making applications for DoLS authorisations to ensure people were not unlawfully prevented from maintaining independence, choice, and control of their lives.

People and relatives told us how they felt the overall standard of care in the service had improved since the registered manager had been in post. People felt listened to and that concerns they raised would be addressed. However, some relatives felt standards of care still required improving, to ensure positive outcomes, as well as the accessibility of the registered manager. One person told us how they wished to be able to be independent when accessing the garden to smoke as they felt this impacted on their preferences and privacy. Another person told us how they wanted more support with rehabilitation to provide them with more independence.

Supervisions and appraisals took place and staff felt these were beneficial and provided them with an opportunity to discuss any concerns they may have about people’s care or how it could be improved. One staff member told us how they had been supported by the registered manager to undertake training to enable them to support the nursing team and so promote positive outcomes for people. The registered manager told us that investigations into staff conduct issues were carried out, as necessary. These were used to ensure people using the service were safe and received appropriate care and support. Lessons learnt from such investigations were then cascaded to the wider team. ‘Champions’ had been introduced in some areas of the service to help increase awareness and monitor performance. This required some development to ensure these roles were effective in driving standards and improvement.

Lessons learnt were taken from events, incidents, and accidents which occurred and, where possible, changes were implemented by the registered manager to improve outcomes for people. The outcomes of audits on the service were analysed and actions identified. We saw some actions were completed by the registered manager or wider team to improve outcomes for people using the service. However, the actions which required approval by the provider had not always been addressed in a timely way. In some cases, identified areas for improvement had been left unaddressed for longer than 12 months. A ‘resident of the day’ approach had been introduced which staff told us was a good opportunity to review care plans. However, this process of reviewing care plans did not include people or relatives currently. The robustness of these reviews needed to be improved as we identified areas where required changes and updates to care plans had not been made. Compliments and complaints about the service were used to help drive improvement. In some cases, where people had raised concerns, these had led to positive outcomes. However, some relatives felt there was an on-going issue with missing laundry and people wearing other people's clothes. One relative told us, “They [staff] put other people’s clothes on him.” Another relative told us, “[Name] complains to me about the home losing his clothes.” The registered manager’s and clinical lead’s involvement in the pilot to reduce hospital admissions to improve outcomes for people has had a positive impact for people. There was a risk management board which was kept up to date with details of people’s current risks and support needs, for a point of quick reference for staff and this was discussed at each handover. Audits were in place to monitor many areas of the service. There were only showers and no accessible bath. This was identified by the registered manager and reported to the provider in September 2023 but had not been actioned.

People and relatives did not always feel they were involved in their care and treatment. However, people were happy with the support they received overall and gave positive feedback on their care. People told us that staff respected their right to refuse care and support, and we saw evidence of this in daily records. We observed staff knocking doors and asking if people would like support and people confirmed this took place. We observed positive interactions with staff asking for consent prior to supporting people and clearly communicating what they were doing prior to commencing.

Staff had received training in relation to consent, MCA and DoLS. However, some staff could not tell us what this principle and legislation meant for people using the service even though they had received this training. The registered manager, clinical lead and nursing team demonstrated they had a good understanding of the MCA and application of best-interests and DoLS.

Best interests' decision-making had not always taken place, or been appropriately recorded, where decisions had been made for others, including decisions relating to smoking. We also identified concerns relating to the terminology used when recording such decisions. For example, we saw phrases such as ‘they should not be allowed’ were used rather than reference to encouraging a person to make a particular choice or decision. The registered manager told us they would review this issue. There was a matrix in place to monitor the application for and authorisation of DoLS. Where conditions had been applied to people’s DoLS authorisations, we saw that these had been actioned. There were policies in place in relation to MCA, DoLS and best interest decisions.