Background to this inspection
Updated
7 October 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection team consisted of two inspectors.
Service and service type
Hawthorns is a ‘care home’ without nursing. People in a care home receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, both looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we have received about this service since the last inspection. We received information of concern from two local authorities and other professionals who work with the service. In addition, we identified further concerns as result of the Emergency Support Framework (ESF) which was undertaken with the registered manager.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all of this information to plan our inspection.
During the inspection
We were unable to speak with people who use the service. We spent time to see how people were cared for by staff, before everyone went out for their planned activity for the day. We spoke with four members of staff including the registered manager who is also the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. The other staff members spoken with were members of care staff who are also responsible for cleaning the home and cooking people’s food.
We reviewed a range of records these included two peoples care records and multiple medication records. We looked at the file of a newly appointed member of staff in relation to their recruitment. We looked at a variety of records related to the management of the service including body maps, records of incidents and the management and review of people’s risks as well as policies and procedures.
After the inspection
We continued to seek clarification from the registered provider to validate evidence found. We viewed the records and additional information we requested sent to us via email and held further discussions with the registered manager. We discussed our findings with other professionals so they were aware of risks at the home and the safety concerns we identified.
Updated
7 October 2020
About the service
Hawthorns is a residential care home providing accommodation and personal care to three people with learning disabilities at the time of the inspection. The service can support up to four people. Hawthorns accommodates people in one modern domestic detached building. Bedrooms were located on the first and ground floor of the property. A communal lounge/dining room, kitchen and conservatory room were on the ground floor.
The service has been developed taking into account best practice guidance and the principles and values underpinning Registering the Right Support. The home is located close to communal facilities.
People’s experience of using this service and what we found
People living at Hawthorns did not receive a safe, effective and well led service. The registered provider had not ensured oversight was in place to maintain people’s safety and welfare. Shortfalls identified as part of previous inspections regarding the service were not always actioned to prevent further or similar occurrences.
People’s rights were not always promoted regarding where they spent their time within their own home. Terminology used by staff when caring for people and in recording people’s care was not always in line with person-cantered care.
Care plans and risk assessments did not contain up to date and accurate information to provide safe care and support people required to keep them safe. Body maps were used in the event of a person having bruising. However, no follow up action was recorded to prevent reoccurrences. Specialist nursing advice was not always sought if people’s care needs changed.
The provider and registered manager had not taken appropriate action to protect people. Where people experiencing unexplained bruising, the provider had not informed key agencies with responsibilities for protecting people, to ensure investigations were undertaken and plans put in place to keep people safe.
Environmental risks were not acted upon and systems in operation failed to identify where people could be at risk of harm. Risks regarding the building were not always identified and were not always acted upon in line with the provider’s procedures.
Accurate records regarding people’s medicines and prescribed creams were not always maintained placing people at risk.
The dependency needs of people were not considered to establish the required staffing levels to meet these needs.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
The service didn’t always apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people did not fully reflect the principles and values of Registering the Right Support. Terminology used in recording and while supporting people was not always in line with person-centred care.
Staff had received training in line with the provider’s procedures. Staff were not always applying their skills and knowledge from the training they had received in areas such as consent and record management. Management had not provided an oversight to ensure staff training was used effectively.
The governance of the service had not ensured people received the care and support required to meet their individual need. Systems in operation had not identify shortfalls and had not driven improvements in peoples care.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
The service didn’t always apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons. Best interests decision involving appropriate people were not undertaken prior to people having tests for Covid-19. There was a lack of person-centred care for example in terms of language used by staff within records and staff actions if people did not comply with requests.
The provider had failed to notify the Care Quality Commission of certain events which had occurred within the home as required by law.
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 04 September 2019). There were two breaches of regulation. The provider told us what they had done after the last inspection to show how they had improved. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
The service was rated Requires Improvement at the last two consecutive inspections.
Why we inspected
We received concerns in relation to the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. We were also aware of the death of a person. This is potentially subject to a police investigation. As a result, this inspection did not examine the circumstances surrounding this.
We reviewed the information we held about the service including information supplied to us before the inspection was undertaken. We did not inspect the other key questions as part of this inspection. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hawthorns on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and people’s treatment, staffing, personalised care, best interests decisions, safeguarding, management of a safe environment and the governance of the service.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Special Measures:
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.