Hawthorne House

Hawthorne House is a residential care home providing personal and nursing care to up to 102 adults across seven separate units. People living at Hawthorne House have various needs which include dementia, physical disabilities, mental health needs and rehabilitation for acquired brain injuries. Each of the units are adapted to meet the needs of the people living there. At the time of our inspection there were 99 people living at the service.

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

Governance systems, management, and provider oversight had not been fully effective, and standards had declined in the home since our last inspection. A new manager had been in post for approximately 2 months when we completed this inspection. They acknowledged improvements were required across the service and had been, and were continuing, to work with the provider to introduce new systems to help improve the service. The service was being supported by the local Integrated Care Board (an NHS organisation) to make the necessary improvements. There was a friendly atmosphere within the service. People and relatives were generally positive in their comments about the staff team.

People told us they felt safe at the home but risks to people's health and well-being had not been consistently identified and assessed. Some of these risks were associated with unclear records, medicine management and staffing arrangements. Staff received training relevant to their roles but staff on some units felt pressured and not able to support people how they would like. People’s medicines had not been managed safely consistently to ensure people received their medicines as prescribed. People had individualised care plans that supported staff to deliver their care. However, some people did not experience person centred care that always met their needs. 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. Staff were recruited safely in line with the providers policy. People told us staff treated them with respect. People had access to healthcare professionals to support their needs when necessary to ensure they remained well.

The prevention and control of infection was managed safely. Good infection prevention and control processes were followed.

We received concerns in relation to the management of risks related to people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe and well led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hawthorne House on our website at www.cqc.org.uk.

Rating at last inspection

The last overall rating for this service was Good (published 1 May 2021)

Why we inspected

The inspection was prompted in part due to concerns received about management of risks associated with people’s care including medicine management. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing and the governance of the service at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Hawthorne House is a residential care home providing personal and nursing care to up to 102 adults across seven separate wings. People living at Hawthorne House have various needs which include dementia, physical disabilities, mental health needs and rehabilitation for acquired brain injuries. Each of the wings is adapted to meet the needs of the people living there. At the time of our inspection there were 72 people were living at the service.

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

People felt safe living at Hawthorne House and relatives told us improvements had been made since our last inspection. Risks to people's health and well-being had been identified and assessed. However, we identified that locks in two cabinets which contained powder to thicken fluids were not effective and the rubber feet of three walking frames were worn which could increase the risk of falls. The registered manager arranged for these to be corrected immediately. Care records contained guidance to inform staff how to manage risks to keep people safe.

There were enough staff to support people safely and staff knew about people’s individual risks and how to minimise these. There was a robust recruitment procedure which prevented unsuitable staff from working with vulnerable adults.

People received their medicines as prescribed. Medicines were ordered, stored, administered and disposed of safely. Good infection prevention and control processes were followed.

People's needs, and preferences had been assessed before they moved into the service. People’s care and support was planned in partnership with them, those closest to them and appropriate health professionals. Records showed referrals had been made to other healthcare professionals when necessary to ensure people remained well.

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 had enough to eat and drink and gave positive feedback about the food. Guidance was provided in care plans for staff about how to encourage people to maintain a healthy diet and their nutritional needs had been assessed.

Staff received training relevant to their roles and people told us staff were kind and treated them with respect. Staff told us they took pleasure in their role and enjoyed working at the service. We saw warm and friendly interactions between people and staff, and there was a friendly atmosphere within the service.

Following our last inspection in March 2020 the previous manager left the service and the new manager took over management of the service in April 2020. The new manager is referred to throughout the report as the registered manager.

The registered manager completed regular checks to ensure the service was meeting their legal requirements. This included checks on the environment, people’s health care and the quality of care provided. Where improvements were identified, action had been taken or was planned. People knew how to complain and were confident they would be listened too. People, relatives, staff and health professionals provided positive feedback about the management of the service.

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

Rating at last inspection and update

The last rating for this service was Inadequate (13 May 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. The registered manager and provider attended regular meetings with an CQC inspector to monitor the actions they took to make improvement. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 13 May 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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.

Hawthorne House is a residential care home providing personal and nursing care to 92 people at the time of the inspection. The service can support up to 102 people.

This is a care home that provides nursing and residential care to people living with dementia and physical disabilities. The home also offers specialist services for people with acquired brain injuries, including rehabilitation, and Huntington’s disease specialist care.

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

The provider failed to meet regulations to ensure people were safe and had their needs met. Systems to ensure people were safeguarded from abuse had not been addressed by the provider. People were at risk of harm, as systems to protect people were not always followed and were ineffective at identifying and managing risks. People did not always receive their medicines safely. There were not always sufficient staff to ensure people received the support they needed in a timely way.

The policies and systems in the service did not support people to have maximum choice and control of their lives. However, staff did support people in the least restrictive way possible and in their best interests. Staff did not always receive the specialist training they needed to support people. People had a nutritious diet, and they enjoyed the food offered. However, the mealtime experience was not always good for people. There had been improvements made to the environment, and there were plans for further improvement to adapt the environment to meet people’s needs. People had their needs assessed and received the health care they needed.

People and their relatives said they were supported by kind and caring staff. However, the provider did not always show compassion for people by ensuring there were sufficient staff to meet people's needs and spend time with them. Feedback from people living at the home was not always actioned so that improvements could be made.

People did not always receive the support they needed. People’s records did not always guide staff to provide personalised support. People had some access to interesting things to do. The management team were recruiting extra staff to improve people’s social inclusion and provide interesting things to do. People's end of life plans needed additional information to ensure they were up to date. Complaints were investigated and outcomes actioned, although relatives did not always feel listened to.

The service was not well-led. For the second consecutive inspection, the provider continued to lack effective governance systems to identify shortfalls in the quality and safety of the service. The provider's governance systems had failed to ensure people were protected from the risk of harm and agreed safety measures were put in place. Systems to provide an overview of clinical governance were not effective because staff were not given time to complete checks. Actions identified were not consistently addressed and, therefore, there was a lack of continuous learning and improving people's safety and outcomes.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 March 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection not enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to protecting people from abuse, safe care and treatment, sufficient staffing, consent to care, good governance and failure to notify at this inspection.

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.

We are mindful of the impact of 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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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 with the 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.

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.

Hawthorne House provides accommodation, nursing and personal care for up to 102 people with a variety of mental health problems combined with physical disabilities or challenges associated with behaviours. Care is provided over seven units. One unit is specifically for those people with an acquired brain injury. The other units support people with high level mental health needs, those living with dementia and those who may have developed mental health conditions as a consequence of other illnesses. When we visited in October 2018 there were 79 people living in the home. In January 2019 there were 87 people living in the home, although three were in hospital on the day of our visit.

People’s experience of using this service:

•Hawthorne House opened in the summer of 2017 and there had been three managers by the time of our first inspection visit in October 2018.

•Whilst we observed some very positive care and support to people, we found the provider’s quality assurance system had not ensured everyone achieved such positive outcomes. For example, people within some of the dementia care units did not receive the same level of person centred care as those on the acquired brain injury unit.

•The provider had systems to identify where there were problems in the service, but managers were not always aware of these. This included incidents involving people which had not always been reported to the managers and therefore had not been considered in the management analysis of accidents and incidents so the provider could have an accurate overview to identify any trends or patterns.

•There were sufficient numbers of nursing and care staff on duty to keep people safe and monitor the communal areas of the home. However, due to high levels of staff sickness, staff were often assigned to work in units they were unfamiliar with, and with people who did not know them.

•There was a programme of activities provided by activities staff. However, improvements were required in understanding and responding to people’s individual interests and need for occupation and engagement on the individual units.

•On some units, especially for those people living with dementia, there was little of interest in the décor, such as pictures, photos, or tactile aids people could touch and hold to stimulate their minds.

•Overall, individual risks to people were managed safely.

•People were confident they received the healthcare support they needed to keep their health conditions stable and knew staff would seek further support if necessary.

•Visiting healthcare professionals spoke positively about the service and people received their medicines from staff who had been trained and assessed as competent to do so safely.

•People's needs were met by staff who were skilled, competent and suitably trained. The provider monitored training to ensure staff skills were kept up to date and they received the training they required.

•Staff worked within the principles of the Mental Capacity Act 2005. People were given day to day choices and this was reflected throughout their care plans and through our observations. Staff sought people’s consent before care interventions.

•People were supported to have enough to eat and drink to maintain their well-being. Nutritional risks were known by staff who monitored people’s food and fluid intake when a need had been identified.

•Staff understood the importance of supporting people with empathy and compassion and provided reassurance when people became anxious.

•Staff were non-judgemental and responded appropriately when people became distressed or agitated. They respected people’s diversity and lifestyle choices.

•People’s relationships with family and friends were encouraged.

•People knew the management team and staff felt motivated by the new registered manager.

•The registered manager worked with external organisations to develop the service they provided.

The registered provider was in breach of Regulations 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Rating at last inspection:

This was the first rating inspection of this service.

Why we inspected:

This was a planned inspection based on the date of registration of the service.

Enforcement:

Action provider needs to take (refer to end of report).

Follow up:

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