Background to this inspection
Updated
5 May 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by an inspector.
Service and service type
Hawthorne Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Hawthorne Lodge is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
This inspection was unannounced.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to formulate our ‘planning tool’ and plan our inspection.
During the inspection
We spoke with four people who lived at the home and two visiting relatives about their experience of the care provided. We spoke with six members of staff including the registered manager, senior care worker and chef . 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.
We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at recruitment information and quality assurance records.
Updated
5 May 2022
About the service
Hawthorne Lodge is a care home providing personal care. It can accommodate 25 older people. The accommodation is a mock Tudor style building located in the Bootle area of Liverpool. Some people using the service are living with dementia. At the time of the inspection 11 people were living at the home.
People’s experience of using this service and what we found
Risks assessments were not always in place for people to keep them safe from harm. Some fire doors were not operating correctly and some smoke seals had been painted over. Medication was mostly safe. However, we saw an example of where medication was not given correctly. Incidents and accidents were not being routinely analysed for patterns and trends, and there were some missed opportunities to identify and explore potential risks. There were some concerns regarding IPC and visiting arrangements. People told us they felt safe, and there was enough staff to support people safely. Staff were recruited safely, following robust checks on their character and suitability for the role.
We sought assurances from the registered manager and provider at the end of day one of our inspection to ensure that all immediate risks were mitigated, and they responded promptly to our concerns.
People were not always supported to have maximum choice and control of their lives and staff did not always 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.
Staff were supervised and had completed all mandatory training. People told us they were having their assessed needs met. However, care records did not always reflect this due to a lack of information. People said they liked the food and the chef was knowledgeable about people’s diets and likes and dislikes.
Governance systems were not robust enough to highlight some of the concerns we raised with regards to care records, medication, Mental Capacity, and the environment, such as the fire doors. We saw that despite some audits and reviews being completed, there was no additional oversight from the provider, so we could not be sure adequate governance systems were in place. We have received assurances from the provider and the registered manager that all of our feedback has been actioned. The registered manager understood their role and they were honest and transparent with us on the days of our inspection regarding some improvements required at the home to systems and processes. Notifications had been sent as requested. However due to limited oversight of incidents and accidents, notifications were not always being send in a timely manner. People said they liked the registered manager, and staff told us they felt well supported and able to raise any concerns.
We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services across Merseyside. To understand the experience of social care Providers and people who use social care services, we asked a range of questions in relation to accessing urgent and emergency care. The responses we received have been used to inform and support system wide feedback.
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 good (published February 2019).
Why we inspected
We received concerns in relation to records, and infection control procedures. As a result, we undertook a focused inspection to review the key questions of safe, effective 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, effective and well – led sections of this full report.
The provider took action during and after the inspection in response to our feedback to ensure risks were mitigated.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hawthorne Lodge on our website at www.cqc.org.uk.
Enforcement and Recommendations
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 monitor the service and will take further action if needed.
We have identified breaches in relation to safe care and treatment, consent and governance 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.