Archived: The Hawthorns

We found the following examples of good practice.

People told us that they felt safe during the pandemic and that staff wore Personal Protective Equipment (PPE).

Hearing loops had been purchased to support hearing impaired people to communicate with staff wearing masks. This also supported video calls with loved ones.

The registered manager carried out staff observations of hand hygiene and PPE use. These were documented during staff supervisions.

The layout of the home had been changed to support social distancing. Signs in the dining room reminded people to sit separately during mealtimes.

Staff had completed a risk assessment and health questionnaire to consider their individual needs in response to the risk of COVID-19.

The Hawthorns is registered to provide personal care and accommodation to a maximum of 22 older people. At the time of the inspection 18 people lived at the home.

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

Risks relating to people’s individual circumstances were known and managed in order to minimise the risk of accidents and injury. People were safeguarded from the risk of abuse and safe recruitment processes were in place. Relatives and staff felt that adequate staff were provided to meet people’s needs and to keep them safe. People received their medicines as they had been prescribed. Infection prevention processes reduced the risk of people contracting and spreading infections.

Induction training was in place to introduce new staff to their role and to the people they were to support. Training had been received by staff and was generally refreshed in line with the provider's timeframes. People were supported by staff who knew their personal preferences and individual needs well. People were encouraged, where possible, to make decisions about their care and support. People and their relatives were involved in decision making relating to their family member where this was appropriate. 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. People were offered the food and drink that they liked, and staff encouraged people to take a healthy diet. Referrals were made to healthcare professionals where required to ensure people's health needs were met.

People and their relatives felt staff were kind and caring and treated people with respect and dignity. People were encouraged to develop and maintain their independence skills. Relatives could visit their family member when they wanted to and were welcomed by staff. People were supported and enabled to maintain contact with their families.

Reviews of people’s care and support needs were undertaken regularly. People and their relatives were included in these processes to ensure all needs were determined and addressed. Relatives felt confident and comfortable to raise any complaints they had with the staff or registered manager. Relatives confirmed they were kept up to date with important information relating to their family member.

People and their relatives felt the service worked well and was well-led. Audits were undertaken to determine what the service did well and where corrective action was required. The registered manager was visible within the service and people and their relatives were aware of who they were. The registered manager understood their regulatory responsibilities and their requirement to provide us (CQC) with notifications about important events and incidents that occurred whilst the service was delivering care.

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 01 December 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

At our last inspection in June 2016, we rated this service ‘Requires Improvement’ overall. We had also identified a breach of the regulations because systems had not always been effective to drive the quality and safety of the service. Following the last inspection, the provider told us how they would improve the service. At this inspection, we found improvements had been made to meet all legal requirements and support a rating of ‘Good’ overall.

People were safe using the service. Staff were aware of how to identify and report any safeguarding concerns and how to help manage people’s risks. People were supported by sufficient levels of staff who had been suitably recruited.

People received safe and appropriate support with their medicines. Systems were in place to promote consistently safe medicine management practices.

People were supported by staff who understood their needs. Staff received training and support for their roles. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were supported to have enough food and drink of their choice and preference. People had access to healthcare support as needed to promote their health and wellbeing.

All people and relatives told us staff were kind and caring. People were treated with respect. We observed good, caring interactions from staff and saw people and staff spent time together. People were supported to express their views and make decisions about their care.

People received care that met their needs and wishes. People were encouraged to engage in activities of interest to them. People and relatives felt able to express their views and complain if necessary, although no formal complaints had been raised.

There was a registered manager in place who understood their responsibilities to the Commission. Systems were in place to involve people and relatives in their care and in monitoring the quality of the service. People and relatives consistently expressed satisfaction with their care and staff told us they felt supported in their roles.

People using the service and their relatives told us that the service was safe, however staff were not always clear about how to report safeguarding concerns to help protect people. People’s risks were not always managed effectively.

People felt that they were supported by enough staff to meet their needs. Staff recruitment processes were not always completed suitably. The registered manager was improving medicines management at the home so that people were always supported to receive their medicines safely.

Staff received basic training for safe care practices, however this was not routinely updated to reflect current practice guidelines and ensure that staff knowledge was refreshed. Staff occasionally received supervision and new staff were supported to complete an induction.

Restrictions were in place for some people at the home to help keep them safe and these were applied in a way that promoted their freedom and liberty as far as possible. Not all staff we spoke with could tell us about the Mental Capacity Act, however people told us that they were able to move around the home and fulfil daily tasks as they pleased and our observations confirmed this.

People enjoyed the food available to them at the home, however they were not always supported to have the food and drink they required to stay healthy and well hydrated. People were supported to receive healthcare support as required.

People had mixed views as to whether staff were caring and our observations confirmed that staff did not consistently treat people with respect or engage meaningfully with them outside of group activities or providing their care and support. People told us that staff supported them at a pace that suited their needs and we saw that staff took steps to maintain people’s privacy and dignity.

Residents’ meetings were held regularly and encouraged interaction between people who used the service, however people’s views and preferences that were identified during these meetings were not always acted upon. Most people were aware of how to complain and told us that they had no reason to do so.

People’s care plans were mostly detailed and informative and people were involved in their care plan reviews where possible. People told us that they wanted to be involved in more activities and we found that they had not always been supported to fulfil their own interests.

People who used the service, relatives, visitors and staff were encouraged to share their feedback and views through meetings, surveys and questionnaires.

Staff told us that they felt supported in their roles. The registered manager praised staff for good practice and set expectations for staff in terms of their roles and responsibilities.

Records were not robust and quality monitoring processes had not always led to appropriate follow up action and had failed to identify some concerns in relation to the quality of care that people received. The registered manager did not always fulfil the requirements of their registration.

You can see what action we told the provider to take at the back of the full version of the report.

We spoke with three members of staff, the manager and administrator, five of the people who lived in the home, one visitor to the home, and five relatives. We observed how people were cared for and how staff interacted with them to get a view of the care they experienced.

We considered all of the evidence we had gathered under the outcomes that we inspected. We used that information to answer five key questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We observed the interactions between the people who lived in the home and staff. People looked at ease in their surroundings. Staff spoke with them in a calm and friendly manner. There were enough staff on duty to meet the needs of the people who lived at the home.

We saw there were systems in place to ensure people received their medicines safely and as prescribed.

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes and hospitals. No applications had been made. The manager understood how this legislation applied to people and protected their rights.

We found that equipment was serviced at regular intervals to ensure it was safe to use.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their care plans. Specialist pressure relieving, mobility and equipment needs had been identified in care plans where required.

It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and knew them well. We saw people's care plans and risk assessments were reviewed on a regular basis to ensure their changing needs were planned for.

Visitors and the relatives of people living in the home confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were available at all times, showed patience and gave encouragement when supporting people. One person told us, 'I'm very satisfied, when I ring the buzzer staff come to help.' A relative told us, 'It's a good place to be looked after, staff are very courteous and caring.' Another relative said, 'It's an excellent home, the staff are brilliant.'

People using the service, their relatives, friends and other people involved with the service completed an annual satisfaction survey. The suggestions and ideas voiced by people were followed up.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People's needs had been assessed before they moved into the home and care plans reflected people's assessed needs. We saw people's care plans and risk assessments were reviewed on a regular basis to ensure their changing needs were planned for.

Records confirmed people's preferences, interests, and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People had access to some activities and were able to maintain relationships with their friends and relatives.

Records showed that staff responded quickly to changes in people's health. We saw people had access to a variety of health care providers to ensure their needs could be met.

Is the service well led?

The registered manager had been in post since the home had opened. The manager was experienced and caring and provided good leadership based on how best to meet the needs of people in an individualised way.

There were systems in place so people who lived in the home could share their views about how the home was run. The manager was able to give us examples of actions taken and changes that had been made as a result of listening to the people living in the home.

There were systems in place to ensure the quality of the service was regularly assessed and monitored.

We saw that people were involved in decisions about their care. Care plans and risk assessments were in place and were updated regularly to ensure people received the care they needed.

We saw that staff co-operated effectively with external health providers to ensure people who lived at The Hawthorns received co-ordinated care.

We saw that the equipment used was maintained regularly. This was to ensure people who lived at The Hawthorns were safe.

There were adequate numbers of staff on duty and staff received appropriate support and training to enable them to care for the people who lived at the service. Staff told us they really liked working there and that the provider was very supportive. One person told us, 'The staff are lovely and help me if I need it.'

People experienced good quality care and effective systems for monitoring were in place. There was evidence that people and their families knew how to complain if things were not right. There were a variety of activities designed to meet people's needs and maintain their independence. People told us they liked living at The Hawthorns. One person told us, 'They (the staff) always ask me what I want.'

At this inspection we saw that the provider had a culture which encouraged people to be voice their opinions about the service and their needs. People felt confident to make complaints, knowing there would be no negative repercussions.

Staff were skilled and supported in their roles, they received training to recognise and report abuse, this formed part of their mandatory training.

Staff were able to meet the care and welfare needs of the people using the service. The associated documentation was detailed but the information required to deliver care was well presented, making it easy for staff to find information about people. The provider worked with external healthcare professionals when needed to meet people's needs. One relative when asked about the service said, 'Absolutely brilliant'.

You can see our judgements on the front page of this report.