Hafod Nursing Home

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

During this assessment, the registered manager and clinical manager were responsive to our findings, but the provider did not respond to attempts made by inspectors to engage with them. We found audits and checks completed had not enabled them to identify and address significant concerns we found in relation to the safety and quality of people’s care. These included concerns regarding the assessment and management of risks to people and lack of clear information and guidance in people’s support plans. The provider did not have robust oversight of the service and failed to act on known risks within the service which had the potential to cause avoidable harm to people, staff and visitors. The service was previously in breach of the legal regulation relating to good governance. Lack of improvements meant at this assessment the service remained in breach of this regulation. Staff and management were clear about their roles and responsibilities, although some improvements were required in relation to staff knowledge and training particularly in relation to MCA, safeguarding and fire. Staff told us they felt well-supported by the registered manager. The registered manager and clinical lead had developed an action plan to improve people’s care and took prompt action to address some urgent areas of concern which we brought to their attention during the assessment, but significant further improvements were needed. The provider had failed to ensure staff, and the registered manager had the support, skills, knowledge, and tools they required to carry out their roles. The provider has failed to ensure effective governance systems at our last 3 inspections. A continued failure to drive timely improvement in the service put people at increased risk of avoidable harm.

This service scored 43 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most staff supported the management team’s current approach to driving improvements for people using the service. Staff and management told us they understood the importance of listening to the views of people and their relatives about the service. Most staff told us they felt involved and listened to in relation to improving the service. Feedback from staff about management was positive overall and most felt the direction and culture within the service was driving improvement. The registered manager adopted a transparent approach and shared with us their findings from audits of the service which had identified shortfalls to be actioned. They were receptive to our findings and had already started to implement changes to improve the way people were supported, and documentation was completed. However, the provider’s inaction on, or delays in acting on, shortfalls in the quality and safety of the service escalated to them by the registered manager did not demonstrate a shared understanding of challenges or a shared commitment to learning and improvement.

In their failure to take consistent, timely action in response to risks and concerns escalated by the registered manager, the provider had not prioritised safe and high-quality care or the promoted of a culture focused on learning and improvement. There were regular staff meetings and daily handovers which provided opportunities for staff to discuss any issues which may arise and supported a shared understanding of priorities and risks. We saw there was a ‘risk board’ in use to support staff with identifying and monitoring people most at risk and particular areas of concern; this was up to date and reflected current areas of concern in regard to people’s individual care risks. The supervision process for care staff was used effectively within the service to cascade and nurture the shared direction of the service, or to demonstrate inclusiveness to drive improvements and personal development. However, the provider had failed to carry out supervision with the registered manager. Reviews of people’s care plans had not always ensured a fully inclusive and collaborative process of care plan development. The provider’s staff training provision required improvement to better reflect people’s individual needs and so further promote equality and diversity. Risk assessment and care planning processes had not always resulted in care plans which reflected and acknowledged people’s diverse needs. There were regular staff meetings to monitor the service and help drive improvement. The daily handovers, manager’s walkabouts and handovers achieved some positive results in terms of a shared understanding of any challenges and priorities for people’s care. We saw posters informing people of how to complain and for staff on whistleblowing, which helped support an open and transparent culture.

Feedback from staff and the service’s management team indicated that the organisation’s senior leadership had not maintained a visible presence within the service. This had hindered oversight of the issues and priorities for the quality and safety of people’s care, and their ability to demonstrate how they ensured the management team had appropriate skills, knowledge and support. The registered manager did not raise any concerns regarding the support they received from the provider. However, the provider had not completed any supervisions or appraisals with them to ensure they had the skills and knowledge to be a competent leader and identify and additional support or development needs they may have. The management team told us how they worked to improve the service for people living at Hafod Nursing Home and their loved ones. They told us about the systems and processes they had in place to ensure people were supported in a compassionate way. The registered manager operated an open-door policy, to encourage open feedback and communication. Many staff told us things had improved since the last inspection but identified that further improvements were required, such as new flooring. They also told us they felt the registered manager was dedicated to making sure people received the best care.

The provider’s lack of support and oversight of the service had not supported the registered manager in the development of the service and its team. Although the registered manager and clinical lead had recently improved the systems and processes, they relied on to monitor the service and drive improvement, these required further work. Feedback gained from people and relatives demonstrated, overall, they had confidence in the manager. However, further improvements were needed to ensure an inclusive approach to involving people and their relatives in the running, development and improvement of the service, such as inclusive care review meetings.

Staff told us they had the opportunity to speak up in staff meetings or in their supervisions. Staff members told us the registered manager operated an open-door policy, and they felt able to raise concerns as they arose. We saw this was the case during the assessment. The registered manager told us staff surveys had been completed recently and there was an analysis of this feedback to be completed. Staff told us they knew about the service’s whistleblowing policy and hotline.

The provider’s whistleblowing hotline number was displayed around the home and there was a whistleblowing policy and procedure in place. Supervisions and staff meetings had been held where whistleblowing and safeguarding issues and guidance had been discussed. The service’s complaints process was clearly displayed, and any complaints were clearly recorded along with evidence they had been actioned. Residents’ meetings took place, but these were poorly attended. Such meetings can be an inclusive way to gain feedback and discuss prominent issues in the service.

Most staff we spoke with felt included in the making of decisions and helping to drive improvement within the service. Most staff felt that their equality and diverse backgrounds and culture were taken into consideration by management.

The provider did not have effective and inclusive systems in place to help staff who needed additional support to develop both language and professional skills. This did not reflect an inclusive culture focused on improving equality and equity for staff. The staff training provided was only available in English via an on-line platform. There were no systems in place, after such training had been completed, to assess staff understanding and application of this training, and any outstanding development needs. We found that some staff members’ ability to tell us what they had learnt from certain training modules was poor. For example, when asking 1 staff member what they had learnt from their MCA and DoLS training they told us, “If they feel discomfort, we can find something and ask to support them with personal care, food and activities.” Another staff member could not tell us who they could escalate safeguarding concerns to, aside from the registered manager. However, team meetings did take place and staff felt able to speak up and make suggestions during these. Supervisions took place but had not been used as effectively as they could. For example, these did not include discussions or assessments of staff learning from online training. In addition, supervision for the registered manager by the provider had not been carried out. Staff had received equality and diversity training, to improve their awareness of these principles.

The registered manager understood their role and was able to explain the audits and checks they, and other key staff, completed which were designed to enable them to monitor and improve the quality of people’s care. However, the provider had not taken consistent or timely action in response to identified risks to the quality and safety of people’s care, which had been escalated to them. In addition, there was no evidence of any additional systems or processes the provider relied on to identify where quality and safety may be compromised, beyond these audits and checks. Staff told us that they understood their respective roles and responsibilities; however, we found this was not always demonstrated through the consistent performance of key duties. For example, timely updates had not always been made to people’s support plans and risk assessments, to ensure these remained effective, accurate and up to date. This placed people using the service at increased risk of harm. Staff told us the registered manager and clinical lead were approachable and supportive. Feedback from health professionals and relatives was, overall, positive and they were happy with the service and support provided.

The provider’s governance and quality assurance systems and processes were not sufficiently robust or effective. For example, these had not enabled them to identify and address the significant concerns we found in relation to safety of the premises and care equipment in use. Where audits and checks completed by the registered manager and other key staff had identified risks to the quality and safety of people’s care, and these had been escalated to the provider, they had not made timely improvements, including necessary repairs. For example, replacement flooring and an accessible bath requested by management in September 2023 still had not been authorised when we assessed the service on 20 November 2024. The fire risk assessment which was carried out in November 2023 still had actions outstanding. There was no evidence that the progress of this had been checked by the provider. This meant people, staff and visitors were at increased risk of avoidable harm. Audits of care plans and risk assessments had not enabled the provider to consistently identify incomplete or conflicting information and guidance for staff. Care plans reviews needed to be more inclusive. There was a service action plan in place which the registered manager was working through to make improvements. Improvement was required in the oversight of the completion of monitoring charts, including fluids and food intake, to ensure these were effective. Oversight of staff training had not enabled the provider to identify and address the concerns we found relating to the need for training to better reflect some people’s individual health and care needs.

We were told by people, relatives and staff that improved links and access to the community would benefit people using the service. This included day trips to places of interest and local clubs and cafes. People and relatives told us, and we saw, that local schools and entertainers came into the home. We saw evidence and were told that people saw health professionals in a timely way. Referrals were made to other health professionals, as appropriate.

Staff and leaders told us how they worked with other health professionals to ensure the best outcomes for people using the service and we saw evidence of this occurring.

Feedback from health professionals we spoke with was positive and indicated there were good working relationships.

The provider’s processes required improvement to ensure they more fully involved people using the service in their care. This included involving people in their care planning when first moving into the service and when carrying out care reviews and risk assessments to enable independence.

The registered manager and clinical lead told us they were aware of where further improvements were needed in the service. The registered manager explained how they took lessons learnt from incidents and identified shortfalls within the service. However, this process required further work to ensure this learning was used robustly to help drive improvements for people using the service.

At this assessment, and over the course of our previous 3 inspections of the service, we have identified significant concerns in the safety and quality of people’s care, a number of which represent repeated failings. This includes concerns regarding the safety of the physical environment in which care was delivered and the care equipment in use. This did not demonstrate a clear commitment to continuous learning and improvement on the part of the provider, or an understanding of how to make improvement happen. Although the registered manager had been proactive in driving some improvements in the service, and the care environment, since our last inspection, this was limited due to the lack of timely action on the part of the provider, including delays in approving replacement furniture, fixtures and equipment. Further work was needed to more fully involve people and their relatives in improvements to the service, including, for example, more inclusive care reviews. The lack of structured supervision and appraisal for the registered manager did not demonstrate a commitment to developing their skills around improvement and innovation.