Hatfield Peverel Lodge Care Home

Hatfield Peverel Lodge Care Home provides personal and nursing care to up to 68 people aged 65 and over. There were two areas, Kingfisher in the main building and Mallard, which specialises in support for people with dementia. At the time of our visit there were 63 people using the service.

People’s experience of using this service and what we found

People were protected from the risk of harm. There were adequate numbers of suitably trained staff to provide quality care and meet people’s needs. People received their medicines in a safe and appropriate way. Staff within the service were recruited safely and received suitable training to fulfil their role. The service had implemented good infection control practices, protecting people from the risk of infections.

The management of the service maintained good oversight through regular reviews and audits. Management were quick to respond to emerging concerns and investigated incidents thoroughly. Staff and relatives spoke highly of the deputy manager, who provided visibility and stability throughout a period of management change. The service worked well with external professionals to monitor and maintain people’s health.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (Published 22 April 2021)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hatfield Peverel Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hatfield Peverel Lodge Care Home provides personal and nursing care to up to 68 people aged 65 and over. The service is set in large grounds in a rural location close to Hatfield Peverel. There are two units, Kingfisher House in the main building and Mallard, which specialises in support for people with dementia. At the time of our visit there were 44 people using the service.

People’s experience of using this service and what we found

Feedback from people and families was largely positive as there was a core staff team who knew people well. However, risk had not been well managed, in particular, there was not always enough information for temporary staff to support people safely if they had to cover in an emergency, such as an outbreak of COVID-19.

The registered manager and deputy manager had concentrated on managing risk over the last 12 months. They had often provided frontline care to ensure people’s needs were met. As a result, some management tasks had not been completed effectively. This included ensuring care plans and other records were accurate and current, staff received regular supervision and quality checks were acted on.

Staff morale was low, and they told us they did not always feel supported or able to speak out. The provider had temporarily cut the number of nursing staff, which had impacted negatively on the service and had led to staff raising concerns with us. By the time of our inspection staffing levels had been reinstated and there were enough staff to support people safely. The provider was beginning to address concerns with morale. However, retention of nursing staff remained an issue.

The provider was aware the registered manager needed support and an area manager was spending time at the service providing practical assistance. The registered manager was positive and open to learning.

Staff worked well with external professionals to meet people’s health needs. People received support to take their medicines as prescribed.

We found the provider and registered manager investigated safeguards effectively. Professionals told us the registered manager was open and transparent when there were concerns. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were processes in place to reduce the risk of infection from COVID-19. Gaps in audits and delayed repairs were being addressed following the end of the recent COVID-19 outbreak. The provider recognised the need to support people and staff affected by the pandemic.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 27 November 2018).

Why we inspected

The inspection was prompted in part due to concerns received about management of the service and staffing issues. A decision was made for us to inspect and examine how well risk was being managed.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection took place on 9 October and was unannounced.

At our last inspection in July 2017, the service was rated requires improvement overall. We had concerns staff did not have the necessary skills to meet people’s needs, care plans were not person centred and people being cared for in bed lacked stimulation and access to activities. There had been some improvements however, the service was rated requires improvement overall. This was because previous inspections had highlighted that the provider struggled to maintain good care standards over time, with overall ratings of requires improvement in 2015 and 2016 and an inadequate rating in February 2017.

At this inspection we found the provider had addressed our concerns and improvements were being implemented in a positive and sustainable manner. As a result, the rating improved to good.

There was a new registered manager and deputy manager in place. 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 new management team worked very effectively together, with the deputy manager taking on the role of clinical lead. There was an open culture which focused on the people who lived there. Checks on the quality of the service were robust and improved the wellbeing of the people receiving care. The registered manager worked well with outside organisations to drive improvements.

People received the support they needed to remain safe. Staff demonstrated an enabling attitude to risk, ensuring people were not restricted unnecessarily. Learning from incidents and accidents was used to improve safety at the service.

Staff supported people to take their medicines safely and as prescribed. There were plans to improve the administration of medicines to ensure the task did not disrupt people’s enjoyment at meal times. Staff worked hard to minimise the spread of infection, despite the challenges posed by the age of the property.

Staff across the service had been supported to improve their skills when working with people with dementia. Care plans were being revised to provide more detailed guidance about people’s needs. Staff continued to be well supported and functioned well as a team.

People received the necessary support to eat and drink enough, to ensure they maintained a balanced diet. People were supported to access health and social care professionals when necessary. There was a positive focus on enhancing people’s quality of life through promoting their right to make choices about their daily routines. The registered manager ensured decisions were made in line with the Mental Capacity Act 2005.

There was a calm atmosphere at the service, which promoted a caring environment. Staff took time to support people in a dignified manner, encouraging their independence and respecting their right to privacy. Support to people being cared for in their rooms had become more person-centred. People engaged in varied activities, in line with their choice and preferences. Care plans were being adapted to become more person-centred and there was an effective system to make sure reviews of the support provided took place as required.

Support to people at the end of their lives was compassionate and caring. Care plans were being improved to ensure this support was consistent and in line with people’s preferences. People felt able to raise concerns and be confident that these would be used to improve the quality of the service.

On the 27 February 2017 we returned to assess whether improvements had been made, carrying out an unannounced inspection. We carried out an announced inspection for a second day on the 28 February 2017. On the 9 March 2017 we returned to the service to meet with the manager, the area director and the management team to gather additional information and discuss our findings.

During this inspection we found that significant improvements had been made at the service, and where issues remained, the service was being proactive in making the necessary improvements. Consequently, we found that the service was no longer in breach of any legal requirements. The provider now needs to sustain those improvements.

Care provided at Hatfield Peverel Nursing and Residential Home is carried out over two separate units (Houses), caring for older adults who have nursing and residential care needs, and who may or may not be living with dementia. They can accommodate up to 70 people over these two houses, but at the time of inspection, only 40 people were residing at the service.

It is a requirement that the service has a registered manager, but at the time of the inspection an acting home care manager was in place, supported by additional managing staff in training to become the manager and seek registration with CQC.

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.

Since the inspection in June 2016, the service had worked hard to improve all safety concerns raised. We found that the service was safe and appropriate processes and systems were in place to identify and act on potential risks.

Staff were recruited and managed well. Safe systems were in place for monitoring, storing, and dispensing medicines.

Staff adhered to principles of the Mental Capacity Act (MCA), 2005 and Deprivation of Liberty Safeguards (DoLS). People were only deprived of their liberty if this was in their best interests, by the least restrictive option.

Staff had received training in a number of areas, however, still required additional knowledge in caring for people with behaviours that could challenge and those living with dementia. The service had plans to improve this area going forward.

There was a good choice of food and drink to meet people’s preferences and nutritional needs, and the monitoring of people at risk of malnutrition had been improved.

Managers, nursing, and care staff were caring and treated people with dignity and respect.

Care plans were not always responsive and did not always provide an accurate representation of needs, and how staff should support people with complex needs.

Care note entries did not reflect the person centred care provided. However, audit systems had identified these issues and following the inspection the manager was able to demonstrate that training was being accessed in response to these audits.

People who used the service, their, relatives, and staff felt able to make their needs and concerns known and these were received well and acted upon.

The culture of the service had significantly improved and managers and staff were cohesively working together to bring around positive changes. They acknowledged areas where improvements were still needed, but had identified how they would make these changes a reality.

People who used the service, staff and relatives told us that managers were visible, and that they were transparent, open and honest, willing to investigate concerns and make changes when these were needed.

The inspection was completed on 21 and 22 June 2016 and there were 61 people living at the service when we inspected.

A home manager had been seconded into the post with daily telephone support from the registered manager who had been deployed elsewhere within the organisation, but who had retained overall responsibility for the home. 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 service has been inspected at regular intervals over the last two years due to concerns that people were not receiving care that was safe, effective, caring, responsive, and well led. We identified a number of concerns during the inspection on 19 March 2015 and 17 April 2015 where we found that the provider was not meeting the requirements of the law in relation to consent to care and treatment, staffing levels and the arrangements for quality assurance were not effective and improvements were required. An additional inspection in October 2015 identified that some improvements had been made, however there were still areas of improvement needed in medicine management, staff supervision, and quality assurance systems. The plan provided by the service had not insured that all improvements were made.

During this inspection, we found that improvements that had been made had not been sustained and that issues that remained had not been addressed effectively for the safety of people using the service. We found that quality assurance systems in place did not identify that people nursed in bed were not receiving timely care and treatment and that records to document care needs were not filled in at the time of care provided. We found that there were not sufficient systems in place to identify the safe level of staff needed to manage the dependency needs of people at the service.

We identified a number of concerns about the care, safety, and welfare of people who received care from the provider. We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking further action in relation to this provider and will report on this when it is completed.

We found that staffing was not sufficiently employed to meet peoples individual needs to promote independence and physical and mental well being and safety. We found lounge areas on Mallard unit at times unattended in spite high risk activity, and people nursed in bedrooms went without regular meaningful interaction for long periods.

When risks to people were identified, interventions to manage these risks were not always in place.

Systems in place to monitor and accurately record peoples dietary and nutritional intake were not always followed correctly. Consequently, in was difficult to ensure accuracy and consequently individual's level of risk and need.

Some staff we spoke to had a poor understanding of people's rights under the Mental Capacity Act. People told us that due to the restraints on staff time they did not always have care provided in a way that respected their capacity to make decisions or their wishes.

Whilst we observed a number of positive and caring interactions between staff and people at the service, we observed some interactions from staff and people were not caring or dignified.

Some care plans were task orientated and did not focus on the individual person they were designed for.

Staff told us that they did not record all complaints made to them, for example the loss of sensory aids. We found that in some cases it took considerable time to address these issues, leaving people sensory deprived for longer than necessary, even when this had been highlighted in risk assessments as a potential risk factor for falls, mental ill health and loss of independence.

Where internal audits had identified areas of improvement were needed, action plans did not include how changes would be implemented or when they should be completed by. A number of issues identified by the provider had still not been addressed at the time of inspection.

Consequently, 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. If we have not taken immediate action to propose to cancel the provider’s registration of the service, they will be inspected again within six months. You can see what action we told the provider to take at the back of the full version of the report.

The expectation is that providers found to be 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.

We looked at ten people’s care records. We also looked at the provider’s arrangements for obtaining, and acting in accordance with, the consent to care and treatment for people who used the service. In addition, we looked at the provider’s arrangements for the management of medicines, staffing the service to meet peoples care and support needs and the provider's arrangements to monitor the quality of the service provided.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

We looked at staffing levels at the service. On the day of our inspection we found that there were sufficient staff available to meet people’s care and support needs. We also found that since our last inspection in February 2014, the staffing levels at the service had been increased.

CQC monitors the operation of the Deprivation of Liberty Safeguards [DoLS] which apply to care homes. At the time of our inspection no DoLS applications had been submitted to the Local Authority, where people were considered as being deprived of their liberty. This was despite two people who used the service being subject to continuous supervision and control and not being free to leave the service. Not everyone had had their capacity to make day-to-day decisions assessed and where these assessments were in place the records were not robust. We found that information was not recorded and people had not been consulted about the use of a sensor mat or where their medication was covertly administered. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the Mental Capacity Act [MCA] 2005 and DoLS.

We found that improvements had been made to ensure that people who used the service were protected against the risks associated with the unsafe use and management of medicines.

Is the service effective?

Appropriate arrangements were in place to ensure that people who used the service received regular support and access from a variety of health and social care services and professionals.

Is the service caring?

People told us that they were happy with the care and support they received. We found that staff relationships with people who used the service were seen to be caring, kind and considerate. Staff we spoke with were able to demonstrate a good understanding and knowledge of people's individual care needs.

People who used the service had a care plan in place detailing their specific care needs and the support to be provided by staff.

Is the service responsive?

The provider did not have an effective system in place to deal with comments and complaints received from people who used the service, those acting on their behalf and other third parties. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to complaints management.

Our observations showed that people who used the service were supported to participate in a range of meaningful daytime activities.

People who used the service were supported to maintain important relationships that mattered to them.

Is the service well-led?

The provider was able to demonstrate that there were suitable arrangements in place to assess and monitor the quality of the service provided. Our findings showed that lessons had been learned from previous inspections.

Our observations suggested that the majority of people living at the service liked living at Hatfield Peverel Lodge Nursing Home; and that they felt safe and were well cared for. It was evident that people who used the service had a good relationship and rapport with the staff who supported them. We spoke with eight people who used the service. People told us that they liked living at Hatfield Peverel Lodge Nursing Home and found the staff to be kind and caring. Comments included, "The girls are very nice and I am looked after very well", "The girls are all very nice and lovely" and, "They are so kind and considerate. Nothing seems to be too much bother."

People's health and personal care needs were assessed and there were care plans in place for care staff to follow so as to ensure that people were supported safely and in accordance with people's individual preferences and wishes. Improvements were required so as to ensure that these were robust and recorded each person's care needs.

Areas for further improvement related to the management of medicines and ensuring that appropriate arrangements were in place so as to ensure that staffing levels were appropriate for the numbers and needs of people living at the service.

We found that people's capacity to consent was recognised and where appropriate, they were able to exercise consent in most daily activities. For those people who lacked capacity, this was clearly documented within their records.

One person told us, "I love living here and the staff are kind." We observed that care plans were person centred, with risk factors being appropriately assessed.

We noted that there was a policy for the management of medication and saw that staff had received training before administering medication.

Staff generally felt well supported at work and said they found the home manager to be approachable. They received supervision and were supported with appropriate training and development to assist them in their roles.

We observed a robust complaints policy prominently displayed. Both staff and people told us they would feel able to raise any concerns or issues that they had.