Archived: Hawkesgarth Lodge

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

This meant that people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We found that staff ensured people who received support were asked for their consent. Where people could not give their consent the provider had followed legal guidelines. Information held in people's care plans identified when someone needed help to make decisions. We observed staff offering choice to people throughout our visit.

We saw the care plans contained detail pertinent to the individual they were about. Staff had taken advice from other professionals in the development of these plans. Relatives had also provided a personal history for people so that staff could look after the whole person and not just manage the condition that had precipitated their admission in to the home.

We found that people were provided with a choice of suitable and nutritious food and drink. Supplements and special diets were provided when necessary. Information about people's dietary needs included input from specialist workers. However, we found the lunch meal to be chaotic and disorganised. This meant people were left for long periods without a meal or with a meal that had gone cold.

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

People were cared for in a clean, hygienic environment.

There was enough equipment to promote the independence and comfort of people who use the service.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

People were made aware of the complaints system. This was provided in a format that met their needs. People could also express their concerns in a regular public meeting.

People's personal records including medical records were accurate and fit for purpose.

We found that a refurbishment programme had started and that carpets and floor coverings had been replaced where malodours had previously been identified.

People we spoke with told us they were satisfied with the cleanliness at the service. One relative of a person who used the service told us 'I have no concerns on that level. It has improved as it had been very smelly. They have just fitted a new carpet. We are very pleased with their room'.

We saw that where issues were identified in audits these had been noted in an action plan with a date set for completion and 'signed off' when done. This meant that identified actions were addressed effectively.

Staff consistently told us that staffing levels had improved and that this had a positive impact on the quality of care and support they were able to provide. One staff member told us 'We are starting to feel like a team'. We saw staff records that showed that staffing levels had increased and the use of agency staff was planned to promote continuity of support for people who used the service.

We found that actions had been taken to make the premises safe and to ensure maintenance checks were completed. We found that the environment did not reflect the needs of people with dementia to support orientation or provide opportunities for purposeful activity.

We found that cleanliness and infection control measures were not implemented to ensure that all areas of the service were free from odour and clean at all times.

We found that people were not always protected from the risk of abuse.

We spoke with one person who used the service who told us "I get my medicines every day and the staff are lovely". We also spoke to relatives visiting two other people in the service. They said that they had no concerns about the way that medicines were handled and had observed medicines being given regularly at the times that they were needed.

On the day of the inspection the manager told us that the kitchen was closed due to a blocked toilet and drains. However, on checking, we found that staff were in the kitchen preparing drinks for the people who lived at the home.

We found that there was poor communication between the manager and staff and that this had led to a lack of clarity regarding whether the kitchen was closed or not. No advice had been sought from the environmental health officer.

We checked the fire safety arrangements at the home, including exits from the property and whether or not they were attached to the fire alarm system. There was a lack of clarity around what action staff should take if the fire alarm sounded.

We checked the risk management assessment for a person who had left the home un-noticed. We saw that the action points related to security of the premises rather than the needs of the person concerned.

Relatives we spoke with, although largely complimentary about the staff also expressed concern about staff numbers. Some people we spoke with explained that they felt they needed to support their relative every day as staff were so busy. During our visit we observed visitors who were left waiting unattended in the reception area for 15 minutes.

We saw care records for people that identified that risk assessments were not always completed or reviewed. Some people who were assessed to have their food and fluid intake monitored had not had this done. Where people were supported using physical intervention appropriate risk assessments and protocols were not in place. Staff told us that they did not have time to familiarise themselves with care plans.

During our visit we identified incidents that should have been referred to the local safeguarding authority. This was done by management following our visit.

Staff we spoke with were able to tell us about the needs of the people who used the service and showed an understanding of how their support needs should be met.

We saw records that identified that there had been periods were there were staff shortages and that this had impacted on the support provided to people who used the service. The staff we spoke with confirmed this was the case.

We spoke with teo who used the services but their feedback did not relate to these standards.

Because of concerns relating to medication issues a pharmacist inspector will also make a separate visit to check on improvements to the medication systems in place.

The people who we met with and whose care we examined in detail were living with dementia which meant it was difficult for us to gain people’s views on the care they received. We observed the care and support offered to people. We saw that staff were attentive and kind when dealing with people and provided supervision and support as needed.