Enter and view: Hadley Lawns Care Home

Healthwatch Barnet conducted an announced Enter and View visit to Hadley Lawns Care Home on 10 November 2023. The home, operated by Bupa, provides residential, nursing, convalescent and palliative care and was rated Good by the Care Quality Commission across all domains. During the visit, Healthwatch spoke with three residents, four relatives, three staff members and the manager. 

Overall, Healthwatch found evidence of improvement under the manager who had been in post since December 2022. Positive developments included a significant reduction in the use of agency staff, better pressure sore management, increased activity provision and a culture that many residents and relatives described as friendly, caring and welcoming. Several relatives reported that feedback they had provided had led to improvements in the service. 

Residents generally spoke positively about the atmosphere of the home, describing it as calm, friendly and well maintained. Relatives praised many staff members for being attentive, understanding and respectful of residents’ independence. They also noted that the reduction in agency staffing had helped staff become more familiar with residents’ needs and preferences. 

However, concerns were raised about the consistency of personal care. Three relatives reported issues including missed showers, residents being put to bed very early, call bells not always being accessible or answered promptly, and inconsistent standards among some staff. One relative described concerns about hygiene practices, including management of commodes and catheters, inconsistent use of face masks, sharing of slide sheets, and an occasion when a resident was treated roughly by an agency worker during personal care. 

Clinical care received mixed feedback. Relatives praised the home’s honesty in reporting a medication error and also spoke positively about the visiting GP service. The manager reported substantial improvements in pressure sore management, with 95% of category 2 pressure ulcers healing during 2023 and no residents currently experiencing category 3 or 4 pressure ulcers other than those admitted with existing conditions.

Nevertheless, some relatives expressed concerns that access to the visiting GP depended on staff referrals and felt that potential health problems were not always escalated quickly enough. Concerns were also raised about inconsistent oral care and one case where a resident’s previously agreed wishes regarding palliative care appeared to be challenged by a nurse, leading relatives to suggest further staff training around end-of-life care and advance decisions. 

The activities programme was seen as an area of improvement. The home had recently expanded activities from two days per week to six days per week and recruited a second activities coordinator. Residents reported enjoying dominoes, card games, singing and group activities, and Healthwatch observed a lively and well-run game of charades. However, some residents felt there was too much time spent watching television and insufficient social interaction. Relatives also felt that residents with limited mobility, particularly those on the upper floor, were not always included fully in activities that could potentially be delivered in their rooms.

Mealtime observations were generally positive. Staff demonstrated good knowledge of residents’ preferences and offered alternatives where appropriate. The dining room was pleasant, and residents were encouraged to make choices about their meals. However, Healthwatch noted accessibility issues, including menus that were difficult for wheelchair users to read and limited visual contrast between table settings and tablecloths, which could present challenges for visually impaired residents. 

Several concerns were also raised about meal delivery. Relatives described occasions when food arrived cold for less mobile residents eating upstairs, and one relative reported an incident where a resident missed a meal entirely until a complaint was made. Insufficient staffing at mealtimes was identified as a contributing factor.

Staff morale appeared generally positive. Employees described the home as a supportive and friendly workplace and praised the manager's approachable leadership style. Staff reported improvements in teamwork and communication under the current management team. Training compliance was high, with safeguarding training completed by most staff. However, some staff gave different accounts of supervision arrangements and one employee expressed a desire for additional training opportunities. 

The report also highlighted challenges beyond the home's direct control. Staff reported difficulties accessing NHS dental services due to shortages of NHS dentists. They also described occasions when hospitals attempted to discharge residents without providing sufficient information about their care needs, resulting in inappropriate placements and readmissions. To address this, the deputy manager now personally visits hospitals to assess prospective residents before discharge. 

Healthwatch made several recommendations. These included strengthening infection control and hygiene practices, reviewing staffing levels for personal care and mealtimes, ensuring call bells remain accessible, increasing opportunities for less mobile residents to participate in activities, improving dining room accessibility, ensuring hot meals reach residents in their rooms, expanding activities further, and improving staff welfare facilities. The home responded positively to all recommendations and outlined actions already taken or planned to address them. 

Overall, Healthwatch concluded that Hadley Lawns was a caring home that had made notable improvements under its current management. Residents and relatives valued the warm atmosphere, committed staff and expanded activities programme. However, concerns about consistency in personal care, hygiene practices, staffing levels and mealtime support indicated areas where further improvements were needed to ensure consistently high-quality care for all residents.