This inspection was carried out on 23 October 2018 and was unannounced. At their last inspection on 15 August 2017, they were found to be meeting the standards we inspected, however they were rated as requires improvement. At this inspection we found that they had continued to meet all the standards and had improved their rating to Good. However, consistently promoting people’s dignity was an area that required improvement.

Hatfield Residential and Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hatfield Residential and Nursing Home provides accommodation for up to 118 older people, this included people with nursing care needs and some people living with dementia. At the time of the inspection there were 102 people living there.

The service had a manager who was registered 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.

People told us that staff were kind and caring. However, we found that people’s dignity was not always promoted by staff. This related to a lack of ironing of people’s clothes and ensuring beds were made properly.

Confidentially and privacy were promoted. Visitors were made welcome.

People were supported by staff who knew how to recognise and report any risks to people’s wellbeing. Accidents and incidents were reviewed to reduce a reoccurrence and there were effective infection control practices in place. Medicines were managed safely and people received them promptly.

People were supported by enough staff who were recruited safely. Staff received a robust induction, regular training and felt supported.

People enjoyed a variety of food and drink, and there was appropriate access to external health and social care professionals. Staff had a good understanding of the Mental Capacity Act 2005 and adhered to its principles.

People said the care met their needs and people’s care plans included information to guide staff. People were supported at the end of their life with compassion and care.

The activities plan would benefit from further development to ensure activities reached everyone but people were happy with what was offered.

People and staff were positive about the registered manager and how the service was run. The management team kept an overview of the service and addressed any issues. The quality assurance systems were effective and complaints were responded to and people’s views were sought.

This inspection was carried out on 15 August 2017 and was unannounced. At the last inspection carried out on 17 January 2017, the service was found to not be meeting all the standards we inspected. These were in relation to staffing, records and medicines. We also found that there was a continued breach of regulation in relation to person centred care.

At this inspection we found that there had been improvements in the service and was no longer in breach of regulation; however there were still areas in need of improvement.

Hatfield Residential and Nursing Home is registered to provide accommodation for up to 118 older people who require nursing or personal care and may also be living with dementia, physical disabilities and sensory impairment. At the time of the inspection there were 106 people living in the service. A number of bedrooms were in use by a local hospice which was undergoing refurbishment. This service was not inspected.

There was a registered manager in post. 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.

There were consistent numbers of staff on duty to meet people's needs however people told us that they experienced some delays at times in receiving their care. The registered manager monitored staffing levels across the service and staff recruitment was a work in progress. Robust recruitment processes were in place and the required recruitment checks had been completed to ensure that staff were suitable for the role they had been appointed to prior to commencing work.

People felt safe in the service. Staff understood their responsibilities with regards to safeguarding people and they had received effective training. Referrals to the local authority safeguarding team had been made appropriately when concerns had been raised.

There were personalised risk assessments in place that offered guidance to staff on how individual risks to people could be minimised. Medicines were stored appropriately, managed safely and audits completed.

Staff received training to ensure they had the skills and knowledge to support the people living in the service. Staff felt supported in their roles and received regular supervision and appraisals. New members of staff received an induction.

People had been in involved in deciding the way in which they wished to receive care. People’s consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS) were met.

People were provided with a varied, balanced diet and were supported to make choices in relation to their food and drink. People's health care needs were being met and they received support from health and medical professionals when required.

Staff were kind, caring and respectful. People's privacy and dignity was promoted throughout their care.

Care plans and risk assessments took account of people’s individual needs, preferences and choices. They had been regularly reviewed and were reflective of people's current needs and wishes.

People gave us mixed views regarding activities. There was an activities programme available however people felt it did not meet their needs and provided little stimulation.

There was an effective complaints system in place. People and staff knew who to raise concerns with and there were clear lines of accountability amongst senior staff.

People, relatives and staff spoke positively about the registered manager. The management team were approachable and were a visible presence in the service.

There was an effective quality assurance system in place. The registered manager completed a range of quality monitoring audits and these were used to identify wh

This inspection was carried out on 17 January 2017 and was unannounced. At their last inspection on 12 and 13 July 2016, they were found to not be meeting the standards we inspected. These were in relation to person centred care, nutrition and meals, staffing and management systems. At this inspection we found that although there had been improvements, there were still areas that needed to be improved further. These were in relation to staffing, records and medicines. We also found that there was a continued breach in relation to person centred care.

Hatfield Residential and Nursing Home is registered to provide accommodation for up to 118 older people who require nursing or personal care and may also be living with dementia, physical disability and sensory impairment. At the time of the inspection there were 103 people living there. This was because eight of their beds were in use from a hospice which was undergoing refurbishment. This service was not inspected.

The service had a manager who was registered 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.

People told us that staffing could at times be an issue. Medicines required further development to ensure they were consistently managed safely. People were supported by staff who were recruited through a robust process. Accidents were reviewed to ensure all action to reduce a reoccurrence was taken, we saw that people were supported safely.

People were supported in accordance with the principles of the Mental Capacity Act. Staff received the appropriate training and felt supported. People had enough to eat and drink but they did not always enjoy their food and they had access to health and social care professionals when needed.

While we found that most staff were attentive and communicated well with people, people’s dignity was not consistently respected by some staff. This was raised with the management team at the time of the inspection who set about addressing these concerns and provided us with a prompt response detailing the actions they were taking to address this with the staff involved.

People were involved in the planning of their care and we found that people had access to advocacy. Care plans were clear and gave staff enough information to meet people’s needs. People did not yet have access to a range of hobbies and interests that they enjoyed, this was still in progress.

People, relatives and staff were positive about the registered manager and we found that systems had been developed to help identify and address issues in the home.

There were still areas that needed further improvement. There was a plan in place to address some of these issues, but not all of the issues arising from people’s voice. People’s voice was not always sought and heard completely. However, complaints were responded to.

The inspection took place on 12 and 13 July 2016 and was unannounced. When we last inspected the service on 2 and 20 March 2015 we found it was not meeting the required standards. We found breaches of the Regulations in relation to safe care and treatment, staffing and person centred care. At this inspection we found that the provider had made some improvements, however further improvement was needed to meet 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 has separate nursing, residential and dementia care units spread over five floors where staff support people with varying needs and levels of dependency. At the time of our inspection there were 110 people living at the home.

There was a manager in post who was registered 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.

At the previous inspection we found that there were not enough staff to meet people`s needs at all times. At this inspection we found that this was still an area of concern. The registered manager had a permanent recruitment drive to try and build up a permanent staff team and the majority of the agency staff they used were mainly the same to maintain continuity for people. However, people who lived at the home told us staff were not always attending to their needs in a timely way and the care was not always delivered as they preferred due to lack of staff. Staff told us they found the workload to be overwhelming and that the care they delivered at times was adapted around the tasks they had to do and not around people’s preferences.

There was a lack of monitoring tools available for the registered manager to effectively monitor people’s dependency levels to inform staffing in the home. Call monitoring log reports were not available due to a dated call system used which could not generate reports. The provider was in the process of implementing a new tool to help monitor people’s dependency levels and inform staffing ratios. The call system was being changed at the time of the inspection to a more effective one. This allowed the registered manager to monitor the length of time taken for people to have their call bells answered and identify times of the day when staff needed more support in meeting people`s needs effectively.

People had mixed views about the quality of the food provided. Although there were sufficient quantities people told us the quality of the food was not always good. Risks associated with people’s daily living were recognised and risk assessments were in place with clear instructions and guidance for staff how to mitigate these risks.

People told us they felt safe at the home. Staff received training in how to safeguard people against the risks of abuse and they were knowledgeable in how to report any concerns internally and externally. Recruitment processes were safe and helped to ensure staff employed to work at the service were of good character, physically and mentally fit for the roles they performed and able to meet people’s needs.

At the last inspection we found that people had not been supported to take their medicines on time or as intended by the prescriber. At this inspection we found that improvements were made and systems were implemented to help ensure people received their medicines safely. The nursing staff were working closely with a local clinical commissioning group (CCG) and GP`s to review and manage people`s medicines effectively.

Staff obtained people’s consent before providing the day to day care they required. We found that processes to establish if people

We carried out an unannounced inspection of the service on 07 May 2014. This is a summary of what we found.

We considered our inspection findings to answer the five key questions we ask.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found during our inspection of Hatfield Nursing Home.

Is the service safe?

The people we spoke with said that they and their relatives had been involved in the decisions about their care. They said that their privacy and dignity had been respected. One person said “Staff are very helpful. People knock on the door before they are asked to come in and, they tell me what they are doing.” Another person said “The staff support me to have my bath. They provide a good care and they are respectful.”

People’s needs had been assessed, reviewed regularly and met appropriately. Risk assessments had been carried out with clear instructions on how to manage and reduce the risks so that people were safe and protected from any injuries or harm.

People had been cared for in a clean, hygienic and clean environment. Staff had attended training in infection control and there were procedures were in place to minimise the risk of cross infection.

There were sufficient numbers of staff rostered on duty to meet the needs of people so that their health and wellbeing was maintained.

Is the service effective?

The people we spoke with said that they were well looked after and cared for. One person said “The staff are helpful. They ask me how I would like to be helped and I can say no if I don’t want to.” People were able to make choices in relation to food, activities, clothes they would like to wear and whether they would like a bath, shower or a strip wash. Staff were aware of people’s needs and supported them in accordance with their individual care plan.

Is the service caring?

We observed that people were treated with respect and in a dignified manner. People we spoke with said that staff were caring, kind and helpful. We noted that a variety of activities had been provided and people had been engaged in, and participating in, the activities. We observed that there was good interaction between people and staff.

Is the service responsive?

People's care plans included their preferences, likes and dislikes so that staff would be aware when supporting them in meeting their needs. The care plans had been reviewed regularly and kept up to date to reflect the changing needs of the person. A variety of activities had been planned and provided for people so that their day would be varied and stimulating.

Is the service well-led?

The provider had a system to regularly assess and monitor the quality of service. People and their relatives had been invited to attend meetings where they could discuss any concerns. A range of audits had been carried out to check and monitor the service provision with action plan and timescales to address any issues identified.

The people we spoke with said that they were happy with the care they received from permanent staff, however two people had told us that the agency staff were impatient. One person said that they had been left on the commode for a long time during the night. Another person said “Most staff are nice except for one who comes in the morning and is rough with me. The food is quite nice. I like sitting by the window.” A third person said “The staff looked after me. The food is good. Sometimes I have to wait a long time to be out of bed and ready for the day. I do not like any activities."

We found that the provider had not ensured that people's dignity, privacy and independence had been respected and promoted. They had not taken proper steps to ensure that people’s needs had been met appropriately and that their welfare and wellbeing had been maintained. There was not an effective system in place to control the spread of infection which put people at risk of cross infection. The provider had not ensured that sufficient numbers of staff were on duty to meet the needs of people appropriately. They did not have an effective system to regularly assess and monitor the quality of service that people received.

However, people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

During our visit, we spoke with a number of people using the service and their relatives. We were also accompanied by an expert-by-experience, who assisted us with the inspection by seeking the views of people using the service. One person said, “The food is wonderful. I have no problems sleeping and can get up when I like.” Another person said, “I like my room and the food is very good. The place is nice and kept clean and tidy. The staff are good to us and we can have a laugh.” One relative said, “The home provides an excellent service. The staff keep me informed when my relative has a fall. We are happy with the care and treatment my relative is receiving and we have no concerns.”

We found that people’s care and treatment were satisfactory. However, insufficient activities were provided for people to participate in. There was a policy and procedure in place to control the spread of infection. However, not all procedures had been followed. There was a safe system in place for the management and administration of medicines. There was a sufficient number and skill mix of staff to meet the needs of people. The home had a system in place to assess and monitor the quality of service by seeking the views of people, relatives and staff

During our visit on 24 September 2012, we spoke with a number of people using the service, their relatives and staff. We also reviewed eight care plans, staff training files and other records associated with the day to day running of the home.

The people we spoke with told us that they had been well looked after and that the staff were good, caring and approachable. They said that they were happy with the care and treatment they were receiving and did not have any concerns. However, one person raised their concerns about the lack of choices at breakfast and the call bells being disconnected from the wall at night, thus making it impossible for people to call for help.

A person's relatives said, "It was a very good home and we could not have asked for anything better. My relative is well looked after and we could not speak highly enough the care provided by the staff". Another relative said, "We visit the home regularly and we find that the staff are friendly and helpful and they provide a good quality of care".

We found that although the provider was meeting the standards we had inspected, there were areas for improvement and those areas have been highlighted in this report.

The people we spoke to during our visit on 23rd December 2010 said that the service they received was good and that staff were aware of their needs.

The people who use the service told us that the staff are ‘very good, helpful, caring and are able to support them in meeting their needs’. People said that staff were competent and looked after them well during cold weather and holiday period.

People we spoke to said that they found the food was ‘good and plenty of it’. They also said that they are provided with a choice of meals from the menu and drinks are available at all times.

The people we spoke to told us that they were happy with the home that is well maintained, kept clean, warm and it was a comfortable and pleasant place to live.

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.