Archived: Hawthorns

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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.' Registering the Right Support CQC policy

People’s experience of using this service:

¿ Actions taken to always ensure risks to promote people’s safety in the home environment were not always effective.

¿ The providers quality checks were not fully effective in identifying potential risks to people living at the service.

¿ Not all fire doors were effective in their ability to reduce the risk of fire spreading.

¿ Testing of the fire alarm system was not taking place on a regular basis

¿ A required service of the stair lift had not taken place.

¿ Checking of water temperatures had not taken place for four months and no action had been taken regarding the lack of water supply to one bedroom

¿ Gaps were identified on staff training

¿ Care documents were not always up to date to reflect the care and support provided to people.

¿ Records were not always secured to prevent unauthorised access.

¿ Improvements were needed to ensure people’s personal care records were completed showing the care provided.

¿ Care records needed to be secured to prevent unauthorised access.

¿ The registered provider had not achieved a rating above Requires Improvement for the second consecutive inspection.

¿ People indicated they felt safe living at the home.

¿ Staff were aware of the responsibility regarding safeguarding

¿ Risks to people’s personal care needs were assessed, reviewed and equipment was in place..

¿ People received their medicines.

¿ People were supported by staff who were kind and caring.

¿ People had fun and interesting things to do including trips out and holidays

¿ Relatives were confident they could raise concerns and they would be acted upon

¿ Staff found the registered manager to be supportive

Rating at last inspection: Requires Improvement (report published May 2018 with a supplementary report published January 2019)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found improvement was required.

Enforcement: Action we told provider

We found the service met the requirements for ‘Requires Improvement’ in all five areas. The overall raring of the service was ‘Requires Improvement’. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Follow up: We will continue to monitor intelligence we received about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We previously inspected Hawthorns on 02 November 2015 and rated the provider to be Good overall with a Requires Improvement rating in the effective question. At this inspection, we have rated the key questions Caring, Responsive and Well led as Requires Improvement. As a result, the overall rating has changed to Requires Improvement.

Hawthorns 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.

Hawthorns accommodates four people in one adapted building. Adaptions in place were to assist people with their physical disabilities such as a stair lift. The home has areas where people can spend time together as well as people having their own personalised bedroom. People have access to a garden. There were four people living at the home when we carried out our inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the last inspection on 02 November 2015, we asked the provider to take action to make improvements. This was in relation to a consistent approach being undertaken when people did not have the mental capacity to make their own specific decisions. We saw action had been completed following the previous inspection.

During this inspection, we found that the registered provider had failed to display their current inspection rating. It is a legal requirement for people to have access to the rating to inform their judgement about the service. You can see what action we told the provider to take at the back of the full version of the report

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Applications were made to the local authority when people had restrictions on their freedom as individuals. When applications had been approved, the Care Quality Commission were not notified as required by law. You can see what action we told the provider to take at the back of the full version of the report

People who lived at the home had done so for a number of years. As a result, people’s needs had changed. The registered manager was aware of the need to increase staffing levels to meet people’s needs and was working to achieve this. We heard conflicting accounts from staff as to how care needs were meet while providing personal care. The registered manager was not aware of the inconsistency in people’s personal care until brought to their attention as part of this inspection.

Systems to access and monitor the quality of the service provided needed to be improved. This was so any shortfalls in standards were identified and actioned. You can see what action we told the provider to take at the back of the full version of the report

People and their relatives felt they were safe living at the home. Staff had received training on recognising and reporting abuse. People were positive about their care and about the staff who cared for them. People were supported to be independent were possible.

Medicines were administered to people by staff who were trained to do this to ensure people received them correctly. People’s healthcare needs were identified and professionals were involved in their care as needed to promote wellbeing. People were supported as needed while eating and drinking and had a choice of meal. Staff knew how to reduce the risk of cross infection within the home.

People were supported to have maximum choice and control of their life and staff supported them in the least restrictive way possible.

Relatives spoke positively about the registered manager and felt any concerns they had would be listened to and addressed. The registered manager was responsive to the concerns identified during the inspection.

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

Prior to our visit we reviewed all the information we had received from the provider. During the inspection we spoke with the four people living at the home. We spoke by telephone with two relatives and asked them for their views. We also spoke with the staff present at the time of the inspection. These were one senior care worker and three care workers. We also spoke with the provider by telephone. We looked at some of the records held in the service including the care files for the four people. We observed the care and support people who used the service received from staff and carried out a tour of the building.

The summary below describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found that people's needs had been assessed and individual care plans drawn up to meet people's needs. These assessments and plans included consideration of risks to the person and how these could be managed to keep the person safe.

There were arrangements in place to deal with foreseeable emergencies. We were told by staff members we spoke with that they were able to contact a manager when they needed to. We were told the owner rings each day to ensure people are well.

The provider carried out checks on staff prior to them starting work to ensure they were suitable to work with people. The provider ensured there was enough staff to meet people's needs.

Two people supported had received training on safeguarding. Staff had been trained in safeguarding and knew what to do in the event of abuse being suspected, witnessed or alleged. People were protected from the risk of abuse because the provider had ensured that safeguarding policies and procedures were in place and available to staff.

We found the home was clean and hygienic providing a safe environment for people.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The provider had not submitted any applications, however relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. Relatives told us they were happy with the care and support people received. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. Staff had received training to meet the needs of the people living at the home.

We saw in care plans that risk assessments had been completed that promoted people's independence. We found staff worked in accordance with these assessments with moving and handling.

Is the service caring?

We found that people were supported by kind and attentive staff. We saw staff talking with people in a respectful manner and using non-verbal communication consistent with people's individual care plans. We saw staff took care to ensure people had enough to eat and drink. We saw that activities were planned and that people's involvement was monitored.

Family representatives we spoke with told us they were now happy with the service and found the manager approachable.

Is the service responsive?

We found that each person's needs were regularly reviewed with care plans updated if needed. Records showed that people were supported in line with these plans.

People had access to activities and had been supported to maintain relationships with their relatives. Activities and holidays people had requested had been provided. We found that relatives were encouraged to visit whenever they wished.

We found that people's own rooms had been personalised and reflected their own interests and things they liked.

Is the service well-led?

The provider had quality assurance processes in place. People's views had been obtained by the provider along with the views of family representatives and staff. The provider had taken action as a result.

People supported and their relatives told us they would feel able to raise any concerns they had with the provider and were confident their concerns would be dealt with.

We found that quality checks were carried out by the provider and that the health and safety of people was monitored.

People supported, relatives and staff all commented that the manager of the home was approachable and supportive.

On the day of the inspection the service was a member of staff short which was covered by the registered manager. We spoke with the registered manager. We looked at care records for two people and other supporting documents for the service.

We saw that people were respected by staff. Staff asked people if they were happy with them giving care before they gave it.

People's needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. We saw that staff were aware of each person's needs and how to give care and support to meet those needs. People told us they: 'Liked' the staff who worked at the home. We saw that staff were kind and caring in their approach to people who lived in the home.

We saw that medicines in the home were managed safely and given to people as they had been prescribed.

Recruitment procedures were in place and followed to make sure that suitable people were employed to work at the home.

There was a complaints procedure in place at the home. We found people knew how to make a complaint and felt supported in that process.

Records showed that people's needs had been assessed and care and treatment was planned and delivered in line with their individual care plan.

We found that people who used the service were protected from the risk of abuse. People told us they liked living at Hawthorns and that they felt the staff gave them the help they needed. We saw that staff had a kind and caring approach towards people they supported.

Staff received regular training and support so that they were able to give people the care they needed. Staff told us they were given many opportunities to do training and were well supported by the registered manager.

The registered manager told us that a full review of the quality of service they provided was being carried out and a report of this review would be produced in February 2013.