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Hawthorn House Requires improvement

Reports


Inspection carried out on 7 August 2019

During a routine inspection

About the service

Hawthorn House is a care home that was providing personal care to nine people with a learning disability or mental health needs at the time of the inspection. The service accommodates up to nine people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was registered for the support of up to nine people, which is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size.

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

Overall we found improvements had been made since our last inspection; people had access to more structured activities and there was better staff consistency. Care plans also contained clearer information about how staff should support people safely when they were distressed. However, we continued to find some inconsistency in the reporting of safeguarding concerns to the local authority and notifying the Care Quality Commission (CQC) of certain incidents as required. Therefore, the service continues to require improvement.

People were satisfied with the service and told us they were happy living at Hawthorn House. Staff were aware of risks to people’s safety and wellbeing. Systems were in place to ensure people received their medicines as prescribed, but there were minor recording issues with certain types of medicines. The provider agreed to address this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported with their nutritional and health needs. They had access to a range of health professionals, an annual health check and regular medication reviews.

People and visitors spoke positively about staff. Staff were respectful and responsive to people’s needs. People were encouraged to be as independent as possible and were involved in some aspects of running the home, such as cooking.

Staff morale had improved since our last inspection and staff felt supported. Systems were in place to check the quality and safety of the service. Audits were completed more consistently than at our last inspection, however the quality assurance systems had not been effective in addressing the inconsistent practice in relation to safeguarding referrals and CQC notifications, which had reoccurred since our last inspection. Issues in the provider's training department had resulted in delays with the completion of staff induction processes.

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

Rating at last inspection

At the last inspection the service was rated requires improvement overall (published 7 August 2018). This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a scheduled inspection based on the service’s previous rating.

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 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.

Inspection carried out on 28 June 2018

During a routine inspection

This inspection took place on 28 June, 5 and 11 July 2018 and was unannounced.

Hawthorn House is a care home, registered for up to nine people with a mental health need, learning disability or autistic spectrum disorder. It is a detached property and is situated in the village of Strensall, near to the city of York. At the time of our inspection eight people were using the service.

At our last inspection in July 2016 the service was rated Good overall, but we asked the provider to take action to make improvements to their record keeping and quality assurance systems. After the inspection in July 2016 the provider wrote to us to say what they would do to meet the legal requirements in relation to this breach of regulation. At this inspection we found that the provider had made sufficient improvement to meet legal requirements, but there were still aspects of record keeping which could be improved further. We also identified some additional issues related to the safety of the service. Therefore, the service is now rated Requires Improvement overall.

The service is required to have a registered manager as a condition of their registration. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Since our last inspection a new manager had been appointed and they were registered with CQC in October 2017.

The provider had an infection control policy and schedules for cleaning. We found the home was clean and generally well maintained. There had been improvements to the environment and décor since our last inspection. The provider conducted checks of environmental safety, but we found the annual gas safety check certificate was out of date. The registered manager made arrangements for this check to be completed shortly after the inspection.

People’s needs were assessed and risk assessments were in place to reduce risks and prevent avoidable harm. Plans were in place to guide staff how to respond to any incidents of behaviour which was challenging, but one we viewed needed updating to reflect current physical interventions used. We found the provider’s policy to record a de-brief meeting with staff after any significant incidents that occurred was not being consistently followed. This showed that opportunities to learn from incidents and effectively support staff were not being maximised.

Staff received training in how to safeguard vulnerable adults from abuse, and staff we spoke with understood the different types of abuse that could occur and how to respond to any concerns. The provider usually referred all relevant incidents to the local authority safeguarding team as required, but we identified an incident where there was a delay in reporting an incident that had occurred.

There were systems in place for the safe management of medicines.

The provider had a safe system for the recruitment of staff and appropriate checks were conducted prior to staff starting work, to ensure their suitability for the role. There were sufficient staff on duty to keep people safe and meet their needs, but there had continued to be staff vacancies and turnover since our last inspection. New staff were due to start work within a month of our visit.

Staff received an induction and refresher training to help them carry out their roles effectively. There were gaps in supervision records and the provider was working to improve the consistency and regularity of supervisions.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Care plans contained information about people’s nutritional needs and preferences. People we spok

Inspection carried out on 12 July 2016

During a routine inspection

This inspection took place on 12 July 2016 and was unannounced.

Hawthorn House is registered to provide personal care and accommodation for up to nine people with a mental health need, learning disability or autistic spectrum disorder. It is a detached property and is situated in the village of Strensall, near to the city of York. At the time of our inspection there were nine people using the service.

At our last inspection on 15 and 16 April 2015 we asked the registered provider to take action to make improvements to their medication administration, recording and disposal systems. After the comprehensive inspection on 15 and 16 April 2015 the registered provider wrote to us to say what they would do to meet the legal requirements in relation to this breach of regulation. These actions have now been completed and at this inspection we found that systems were in place to ensure people received their medicines safely.

The service is required to have a registered manager as a condition of their registration. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of our inspection there was no registered manager in post and as such, the registered provider was not meeting their conditions of registration. Two area managers had joint oversight of the service until a new manager was recruited, and they were supported by two senior care staff who provided day to day leadership at the service on shifts.

Quality assurances systems were in place and a range of audits were conducted and acted on. However, we found examples during our inspection of inconsistencies in record keeping, which were not identified in audits. We found that the absence of a manager for the service had impacted on the monitoring and consistency of record keeping, including incident records, training records and supervision. This was a breach of Regulation 17 (2)(a)(c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

The registered provider had an infection control policy and cleaning schedules were in place. Most of the home was clean, but we did note the standards of hygiene in some areas were not appropriately maintained and we have made a recommendation in our report about this.

We found that people’s needs were assessed and risk assessments were in place to reduce risks and prevent avoidable harm.

The registered provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse, and staff we spoke with understood the different types of abuse that could occur and were able to explain what they would do if they had any concerns.

The registered provider had a safe system for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers. There were sufficient numbers of suitable staff to keep people safe and meet their needs, but there had been some staff sickness and turnover in recent months so the provider was taking action to recruit more permanent staff in order to address staff consistency.

Staff received an induction and completed a range of training to help them carry out their roles effectively. Staff we spoke with were knowledgeable and told us they received sufficient training and support.

The registered provider sought consent to provide care in line with legislation and guidance. Staff were able to demonstrate an understanding of the principles of the MCA and we saw evidence of people’s agreement to their care plans.

People who used the service told us they were happy with the quality and variety of food available, and that

Inspection carried out on 15 & 16 April 2015

During a routine inspection

Hawthorn House is registered to provide accommodation for persons who require nursing or personal care. The service can support up to nine people who may have a learning disability. It is a detached property and is situated in the village of Strensall, near to the city of York.

The inspection took place over two days on 15 and 16 April 2015. The inspection was unannounced.

At the last inspection on 8 and 15 July 2014 we asked the registered provider to take action to make improvements to their quality assurance system and to the respecting and involving of people who used their service. After the comprehensive inspection on 8 and 15 July 2014 the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches of regulation. Their action plan stated that the service would be compliant by 31 January 2015. These actions have now been completed.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager in post whose application to register was being processed by the Care Quality Commission (CQC); their registration was completed on 23 April 2015. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found unsafe practices around the administration, recording and disposal of medicines. You can see what action we told the provider to take at the back of the full version of this report.

We found that people were protected from the risks of harm or abuse because the provider had effective systems in place to manage issues of a safeguarding nature. Staff were trained in safeguarding adults from abuse and the majority of staff understood their responsibilities, but some staff would benefit from further training. We have made a recommendation in the report about this.

We found the premises to be safe and well maintained; people had their own bedrooms and access to a garden area.

There were sufficient numbers of trained, skilled and competent staff on duty although the manager was relying on bank staff and staff from other homes to fill staff vacancies until new staff were recruited. The registered provider did have robust staff recruitment procedures in place.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes. People who used the service received additional care and treatment from health professionals based in the community.

People spoken with said staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided in the service.

Staff received a range of training opportunities and told us they were supported so they could deliver effective care; this included staff supervision, appraisals and staff meetings.

The manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. Improvements were needed to ensure the progress being made by the service was documented appropriately.

We found that there was a need to develop the use of advocates within the service to help people to become more aware of their own rights, to exercise those rights and be involved in and influence decisions that are being made about their future. The provider had made some progress with this, but further improvement was needed.

Inspection carried out on 8 & 15 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014. 

This was an unannounced inspection. During the visit we spoke with six people living at the home, two care staff, the manager and the Commercial Director.

Hawthorn House provides accommodation for persons who require nursing or personal care. The service can support up to nine people who may have a learning disability. The service does not provide nursing care to those accommodated. There were seven people living at the home on the day of our visit.

The home has recently employed a new manager but they have not yet applied to be registered with the Care Quality Commission. ‘A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider.’

People told us that generally they felt safe living at Hawthorn House. On occasions incidents had occurred which had resulted in people feeling unsafe or unhappy. We were told that these incidents rarely occurred and in the main were well managed.

Staff were trained in safeguarding vulnerable adults and discussions with staff confirmed that they were clear of what to do should an allegation be made. Recruitment records viewed contained the required information. This helped to protect people living at the home.

Training had not yet been provided in The Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) although any limitations on what people could do were recorded and were signed by people living at the home. This training will help to ensure that staff are clear of the processes to follow and can continue working within formal legal safeguards.

People said they knew how to complain and we saw information displayed to support them in doing so. Information about advocacy was also available.

The service had policies, procedures and systems in place which supported staff to deliver care effectively. People told us they were able to make choices and decisions although some people did tell us they had been unable to read their care records.

People were positive about their rooms and we saw that these were individually furnished and decorated. People also expressed positive comments about the food but felt that more choice could be offered. Menus were devised on a weekly basis with people living at the home.

We received mixed views about people’s social and leisure opportunities and the manager confirmed that this was an area that she hoped to develop further. Relatives also felt that this was an area which could be further improved.

Staff received training and supervision to support them in their roles. Although not all of the training was up to date we did see evidence that training courses had been booked and staff confirmed that the training they received supported them in caring for people appropriately.

All of the people living at Hawthorn House told us they were well cared for. They were positive about the staff who supported them. They confirmed that they were treated with privacy and dignity and we observed this throughout our visit.

Some people expressed concerns regarding their spiritual needs being met and some people said that they would like a key to their door. This was rectified during our visit.

We found that people’s health needs were responded to. Appropriate guidance and support was accessed where required. People were involved in daily living tasks at the home to promote their independence and they told us they could have family and friends to visit anytime.

Although people told us that they could express their views and opinions they did say that resident meetings were not held. Most people told us they would like to have these meetings and the manager commenced these during our visit.

People expressed concerns regarding the number of staff who had left and the management arrangements in place prior to our visit. We were told that the previous manager of the home had been absent and although senior managers had spent time in the service relatives felt that this had impacted as issues raised had not been responded to quickly.

The home has employed a new manager and additional care staff and said that they hoped this would provide stability for the home. As the manager was new to the post some of the quality management systems had not been fully implemented. Some of the records seen were in need of update and were poorly organised.

Systems to seek the views and opinions of relatives, people living at the home and key stakeholders also required development. This will help to ensure that people’s views and wishes can be taken into account in regards to the way the service is delivered and run.

Inspection carried out on 12 July 2013

During a routine inspection

People were asked for their consent and everybody worked together to assist people to learn how to manage risks associated with everyday living. We met three people who used the service. One person who used the service told us �Staff do a good job here.� Another person said �They look after me very well.�

We saw that there were opportunities for people using the service to make choices and have a say in how their treatment or care was delivered. We found that care and treatment was personalised and people took part in range of activities in the community.

We found appropriate arrangements were in place in relation to obtaining, recording, handling, and administration of medicine.

People were supported by suitably qualified, skilled and experienced staff. Throughout our inspection we observed good interactions and found people who used the service were relaxed in the care of the staff. A healthcare professional told us staff had worked with them so that people who used the service received the right support.

Effective systems were in place to monitor the quality of the service and promote people�s safety and wellbeing

Inspection carried out on 20 February 2013

During a routine inspection

People were supported in promoting their independence and community involvement. People contributed their views as far as they were able to do so and everybody worked together to assist people to learn how to manage risks associated with everyday living.

People who used the service told us "Staff are ok they let me do my own thing� and another said "Staff are doing a very good job here�.

During our inspection we spoke with a relative and they told us that staff worked with them to ensure that the person who used the service was properly supported. They appreciated the effort staff made to ensure their relative�s had the best support possible.

Staff were aware of the different types of abuse and said they were confident they would be able to identify the signs of abuse in people who used the service.

People told us that if they had a complaint they would tell a member of staff or the manager. They also told us that there were regular house meetings where they could all discuss any concerns they had. One person said "The staff take time to talk to you and I tell them if I am unhappy" and "Staff talk to you about what you want."

Inspection carried out on 2, 7 February 2011

During a routine inspection

People told us that 'staff are always available to help ' and staff let me choose what I do and help me when I need it'. They also said that the staff were nice and they can get on with them. They said that staff help them and always knock on their door before entering. They enjoy living at Hawthorne House as they can choose how they live several people said �this is my home�

Reports under our old system of regulation (including those from before CQC was created)