Hartfield House Care 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

The service was responsive to changing needs and people felt their care was monitored and reviewed to be supported proactively, however they did not recall being actively involved in how their care had been assessed and planned. Assessments did not always capture peoples voice and depth background information which would enhance their experience of care. We saw evidence of staff working with external professionals to support joined up and timely care. People had opportunities to exercise and keep fit and we saw that people had experienced improvements in their health and wellbeing. People were involved in their care with their consent being obtained where necessary.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most people who spoke with us were unsure if they had been assessed prior to moving in to the home. However, they told us their needs were met and the staff knew how they liked their care to be provided. One person told us, “I don’t think it was a big meeting or anything, but they do know what I like.” Another person told us, “I know I went from hospital to hospital then had a telephone interview to ask if I wanted to come here.”

The regional director told us that the service had moved to a new electronic system with improved templates for capturing people’s personal details. The manager told us, “We go into the hospital and do the pre-assessment there and coordinate with a relative for them to be there too.” The regional director told us, “We have a seven day assessment checklist and review what we have in place to ensure it is as robust as it needs to be in those early days.”

Initial assessments were seen to not always capture people’s voice and depth of personal history, character and interests. It was not clear the extent to which people had been involved in their assessments. However, care plans contained detail of people’s day to day interests and preferences. Crucial information about medical conditions and risks had been captured to ensure care could be delivered safely. Care plans were reviewed to ensure the information contained within them remained accurate.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

One person gave us an account of an observation and told us, “I saw the dentist doing a home visit for one of the residents who was in pain. I witnessed a member of staff on the phone to 111 and he did not give up until someone came. He was marvellous.”

The manager told us the GP attended the service weekly. They told us, “The nurses and dementia manager link with relevant professionals directly. We make sure paramedics get tea and coffee and the hospitality helps build relationships.” The manager told us that the general practitioner communicated any updates with them and staff updated people’s records promptly.

Partners told us that there were some communication issues regarding symptoms, changes of medication and between the staff members and sometimes clinical concerns were not shared with the appropriate staff. Staff are accepting of the offer of regular input from health services but there are improvements to be made with working together. Partners felt action was being taken to address this.

We saw daily care notes had recorded staff liaison with other professionals and clearly highlighted handover notes for staff on the next shift to continue to make contact where necessary. Visits from professionals were recorded with a summary of the action taken and any changes to the monitoring or care delivery required by staff. Records showed that nurses had a working relationship with health professionals in supporting people with health needs such as wound care.

People we spoke with told us their health needs were met. They said they felt listened to when they felt unwell and the staff were responsive. They stated they had access to healthcare professionals as needed, such as the GP, who visited weekly or more often if necessary, the dentist or chiropodist. One person said they felt the staff helped them to remain healthy but would like to have access to more exercise.

Staff told us how they monitored and responded to health concerns. One staff member told us, “We record their weight every week to make sure they are not losing more [weight] than they should." Where they were concerned for unexplained weight loss, one staff member told us, "We refer them to the GP and the GP will refer to the dietitian. We try all the possible ways we can to help [people maintain weight], for example with milkshakes. We have some people who have been prescribed supplements." The manager told us there were frequent exercise sessions which people looked forward to. They told us, “Residents go out in the garden and have daily walks. We have a minibus and take people out to the garden centre. We have a salon upstairs and people have foot spas to relax.”

Clinical meetings were held to discuss the safety and health pathways required for people identified to need specific follow up care. For example people whose weight was significantly increasing or decreasing were considered for the most appropriate follow up support.

People told us their care was monitored and reviewed to ensure their needs were met. They felt happy and well looked after.

The regional director told us they had responded to concerns raised by staff that certain roles did not feel respected. They told us, “I was speaking to as many staff as I could, asking staff about why they were here, what they admired about the service, job and colleagues and what was important to them at work. Most said they wanted to be respected and listened to.” The regional director told us that they involved staff in creating a charter of expectations. The manager told us that as a result, “Sickness rate has reduced and retention has improved. We are not using any care assistant agency workers at all. It makes such a difference we are not using agency anymore because people recognise faces and the uniform.”

People’s care and treatment were routinely monitored with tools such as weight, wound and pain charts. The provider completed root cause analyses and took action to improve the lives of people using the service. For example, where the provider had identified a person was losing weight, we saw records that they were supported to discuss the option of dietary supplements with the dietician.

People told us the staff consulted them in all aspects of their care and their needs were respected. We observed the staff asking people for consent. On the first floor, in the dementia unit, we saw the staff asking people what they wanted to drink, or eat, or if they needed anything. They were kind and caring when approaching them and spoke with them with care and respect.

The manager told us, “The dementia manager carries out mental capacity assessments. All staff are trained in mental capacity.” Staff told us they were certain to obtain consent from people before providing care. One staff member told us, “We ask people always what they want. We offer them choices. Do you want a shower or a wash? Or do you want it later on after your breakfast? What to wear, what to eat. We ask, and they tell us what they want. We talk to them constantly." Another staff member told us, “We always ask consent no matter what. This is our job to ask consent, whether they have mental capacity or not. We make sure the staff understand this. We respect their choice even if they do not have capacity."

Consent from people was recorded throughout records. Daily care notes indicated that staff sought consent upon delivering daily care such as supporting with changing continence wear. Care plans indicated consent had been sought to make long term adaptations to care such as installing bed rails. Assessments had been appropriately carried out to establish whether a person had capacity to consent to care if there was reasonable doubt. People who wished to take informed risks were supported in the least restrictive way to do so.