Archived: Hawkesgarth Lodge

Updated 23 February 2017

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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 13 and 14 December 2016 and was unannounced. The inspection team on day one comprised one adult social care inspector, one inspection manager, a pharmacy inspector, one specialist advisor whose specialism was mental health nursing and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. They had experience of both health and social care services. On day two the adult social care inspector returned alone.

Prior to the inspection we reviewed all the information we held about the service. The registered provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. In addition we looked at all the statutory notifications we had received. Statutory notifications are documents that the registered provider submits to the Care Quality Commission (CQC) to inform us of important events that happen in the service.

During the inspection we case tracked three people, looking at their care plans, medicine records and other documentation in relation to their care. In addition we looked at a further three care plans. We also inspected the way in which medicines were managed by reviewing six medicine records and reconciling them with the prescription and stock, observing how medicines were administered and checking the storage of medicines. We observed a lunchtime period and people being given assistance to eat and drink. We reviewed other documents relating to the running of the service such as accident and incident records, general risk assessments and servicing and maintenance documents.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. There were very few people who could speak with us and give feedback.

We spoke with six people who used the service and four relatives during the inspection and a further five relatives and friends following the inspection. We also spoke with a chiropodist and a social worker during the inspection. We interviewed the clinical lead nurse and a registered nurse who were on duty during the inspection as well as speaking with an agency care worker, a domestic worker, a maintenance person, a chef and a kitchen assistant.

The peripatetic manager made themselves available throughout the inspection answering our questions and providing information promptly.

Following the inspection we spoke with a community mental health nurse, community mental health team manager, a palliative care clinical nurse specialist, a practice nurse from one of the surgeries used by people at the service and an independent mental capacity advocate. We contacted a further 14 care workers after the inspection as staff were very busy on both days of the inspection. We left them a message with our contact details and three staff gave us feedback.

The provider readily agreed to an early meeting following the inspection in order to discuss our findings. We met them on 4 January 2017 which was the earliest mutually convenient time.

Updated 23 February 2017

The inspection took place on 13 and 14 of December 2016 and was unannounced. The service was meeting all regulations at our last inspection in April 2015. At this inspection we found breaches of Regulation 10 Dignity and Respect, Regulation 11 Need for consent, Regulation 12 Safe care and treatment, Regulation 14 Meeting hydration and nutritional needs, Regulation 15 Premises and equipment, Regulation 17 Good Governance and Regulation 18 Staffing. You can see what action we told the provider to take at the back of the full version of the report.

Hawkesgarth Lodge is a care home with nursing for up to 48 adults living with dementia. There were 27 people living at the service at the time of the inspection.

There was no registered manager employed as they had recently left the service. 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. A peripatetic manager was working in the service to provide management support to staff. A peripatetic manager moves from one service to another whenever a need arises.

Risks to people had been identified but the written assessments did not reflect the practice of staff. Risks were not adequately managed. Accidents and incidents were not recorded consistently.

People were at risk of infection. The service was unacceptably dirty.

Staff were recruited safely but there were insufficient numbers of staff on duty to meet people’s needs effectively.

Servicing and maintenance of the environment had been carried out in a timely manner.

Training was up to date but had not been embedded over time into staff practice. Staff had not been supported appropriately but since the arrival of the manager each member of staff had received supervision at least once.

The principles of the Mental Capacity Act (MCA) 2005 were not fully understood by staff and the correct process for making best interest decisions had not been followed.

The chef was knowledgeable about people’s dietary needs and the food we saw was nutritious. The chef was aware of how to fortify diets and provided fortified drinks and finger foods for people. However, care staff practice and supervision was poor when serving and assisting people to eat and drink.

Staff were described by people as being caring and we saw kindness shown to people by staff. However, they did not promote people's dignity or meet people's basic care needs through the care they provided.

Care plans did not reflect the care we observed being provided by staff.

Activities took place over five days and they were not meaningful to people living with dementia. There were no stimulating activities for people and no books or magazines to look at.

The environment was not dementia friendly and did not reflect current good practice guidance.

People knew how to make a complaint and we saw that where complaints had been made they were dealt with in line with company policy.

Notifications had been made to CQC when required.

There had been a lack of effective leadership and management at the service which had led to a significant deterioration in the quality of the service. This was being addressed by the registered provider but there were still areas of concern.

The quality assurance system was not effective. The issues found at the inspection had not been identified through auditing and monitoring. These issues had been identified in an action plan which the manager was using to demonstrate where improvements were being made.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded