CQC report explained · a nursing home
What the CQC found at Hartwell Lodge Residential Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff, safe recruitment, effective risk management, appropriate safeguarding and good infection control. Some medicines and water-safety checks still needed improvement.
- Effective?
- Good
- This area was not inspected during this focused visit. Its previous rating was carried forward when calculating the overall rating.
- Caring?
- Good
- This area was not inspected during this focused visit. Its previous rating was carried forward when calculating the overall rating.
- Responsive?
- Good
- This area was not inspected during this focused visit. Its previous rating was carried forward when calculating the overall rating.
- Well-led?
- Requires improvement
- Management systems had improved and the previous breach had been resolved. However, audits did not fully identify or address problems with topical medicines and Legionnaires' disease controls.
What inspectors found, August 2023
Hartwell Lodge Residential Home rated Good overall, but inspectors found further work was needed on medicines and safety audits.
This was an unannounced focused inspection on 11 and 25 July 2023. Inspectors spoke with people, relatives and staff, and reviewed care, medicines, recruitment and management records.
The home was rated Good for Safe. Inspectors found enough staff, safe recruitment, well-managed risks, suitable infection control and proper safeguarding arrangements. People were described as safe and protected from avoidable harm.
The home was rated Requires Improvement for Well-led. Quality checks had improved and the previous legal breach had been resolved, but audits did not always identify problems with topical medicines or Legionnaires' disease controls. The overall rating improved from Requires Improvement to Good.
This was a focused inspection of Safe and Well-led only. The ratings for the other areas were carried forward from the previous inspection.
Good safety arrangements
Inspectors found that risks were assessed and managed, with appropriate measures to keep people safe.
“Risks to people's safety were well managed. Risk assessments were completed and there were appropriate measures in place to reduce risks for people.” from the report
Enough staff
There were enough staff to support people in a timely way, and recruitment checks had been completed.
“There were enough staff on duty and the provider had a system to work out safe staffing numbers according to the needs of people living at the home.” from the report
People felt happy and safe
People and relatives gave positive feedback. Inspectors saw people relaxed and happy when interacting with staff.
“People and their relatives were happy with the service.” from the report
Previous breach resolved
The provider improved its governance systems enough that it was no longer in breach of the regulation identified at the last inspection.
“At this inspection, enough improvement had been made and the provider was no longer in breach of this regulation.” from the report
Topical medicines records
needs fixingRecords did not always clearly explain which creams people needed and how often. Not all staff knew what creams had been prescribed, although inspectors found no evidence of harm.
“Records did not always provide clear guidance about the type and frequency of creams people required.” from the report
Water safety checks
needs fixingAn issue with water temperatures increased the risk of Legionnaires' disease. The provider acted promptly, and a recent water sample showed no Legionnaires' disease.
“We did identify an issue with water temperatures which increased the risk of legionella.” from the report
Audits needed to improve
needs fixingThe home's quality checks had not found all the problems with topical medicines, and some Legionnaires' disease controls were not included in the checking system.
“We found audit processes relating to topical medicines and legionella needed further improvement.” from the report
- 01How do you now record which topical creams each person needs and how often they should be used?
- 02How do you make sure all staff know about each person's prescribed creams?
- 03What checks are now in place for water temperatures and Legionnaires' disease risks?
- 04How will you show that the new medicines and water-safety systems are being monitored and kept in practice?
- 05What were the ratings for Effective, Caring and Responsive at the previous comprehensive inspection?
This was a focused inspection of Safe and Well-led only; the other ratings were carried forward from the previous inspection. This explanation was written from the published report of 9 August 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, May 2022
Rated Requires Improvement; inspectors found kind, responsive care but weaknesses in infection control, medicines records and quality checks.
This was an unannounced inspection on 5 and 6 April 2022. Inspectors reviewed all five areas of care, spoke with people, relatives, staff and health professionals, and checked care, medicines, recruitment and management records.
People were generally happy and said staff were kind, respectful and knew them well. Staffing was sufficient. The home provided personalised care, activities, good food and support with healthcare and end-of-life care.
However, inspectors found risks in infection control and medicines management. Some risk and care records were incomplete. The home's checks had not always found these problems, so the overall rating remained Requires Improvement. Safe and Well-led were Requires Improvement. Effective, Caring and Responsive were Good.
Kind and respectful care
People and relatives spoke positively about the staff. Inspectors observed kindness, compassion, dignity and respect in daily interactions.
“Our observations of staff interactions with people showed that people were treated with kindness, compassion, dignity and respect.” from the report
Enough staff
Inspectors found enough staff to meet people's needs. Recruitment checks had been completed before staff started work.
“There were sufficient staff to meet people's needs and staff knew people very well.” from the report
Personalised activities
Activities reflected people's hobbies, past work and interests. Inspectors found these activities gave people meaningful experiences.
“People's past occupations and hobbies had also been taken into account when planning activities. This meant they were meaningful for people.” from the report
Good links with health professionals
The home worked with health professionals and acted when people's health changed. External professionals gave positive feedback about this partnership.
“Concerns are raised appropriately about [people], changes in [people's] condition tend to be picked up promptly as staff know them well.” from the report
Infection control
seriousSome staff were not wearing masks correctly when inspectors arrived. Visitors were not screened or asked for test evidence and some people entering the home did not use hand sanitiser.
“We were not assured personal protective equipment (PPE) was used effectively to safeguard people.” from the report
Medicines records
seriousThe number of tablets recorded as in stock did not match the number counted. Records for as-required medicines and creams also needed improvement, creating a risk of errors.
“We identified discrepancies between the number of tablets recorded as in stock on the Medication Administration Records (MAR) and the number of tablets counted.” from the report
Incomplete risk records
needs fixingWritten guidance about dehydration and constipation risks was not detailed enough. Staff knew people's needs, but records did not consistently explain how risks should be monitored and reduced.
“Records relating to risks associated with dehydration and constipation needed to be improved.” from the report
Weak quality checks
seriousThe home's audits had not identified the problems found during the inspection. This led to a breach relating to governance and accurate records.
“Quality assurance systems had not always been effective in identifying the concerns we found at this inspection.” from the report
- 01What has changed in the medicines system since inspectors found differences between tablet stock records and the tablets counted?
- 02How do you now check that staff wear the correct protective equipment and that visitors are screened and use hand sanitiser?
- 03What written guidance is now in place for monitoring and reducing dehydration and constipation risks?
- 04How do your quality checks now identify problems with medicines, infection control and care records?
- 05How are incidents and any duty of candour discussions recorded and reviewed?
This was an unannounced inspection of all five key questions, including infection prevention and control; the previous targeted inspections in 2019 and 2020 covered narrower areas and did not change the rating. This explanation was written from the published report of 25 May 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Hartwell Lodge Residential Home
9 rated inspections over 7 years: the service has improved, from Inadequate to Good.
- August 2023Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Hartwell Lodge Residential Home →
- May 2022Requires improvementSafe: Requires improvementWell-led: Requires improvement
Read what inspectors found at Hartwell Lodge Residential Home →
- December 2020Inspected but not ratedSafe: Inspected but not rated
- September 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- June 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- January 2018Requires improvementup from InadequateSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2018Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- October 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Inadequate
- April 2017Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Inadequate
- June 2016InadequateSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- July 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 18 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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