Hawthorns Residential Home

Hawthorns Residential Home is a residential care home providing personal care to up to 15 people, some of whom may be living with a dementia, in one adapted building. At the time of our inspection there were 8 people using the service.

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

People told us they felt safe living at Hawthorns Residential Home. Staff were aware of how to respond and report any safeguarding concerns and were confident this would be dealt with appropriately by the registered manager.

Medicines were managed safely, and people told us they received their medicines as prescribed. Risks to people were assessed and recorded although some records lack person-centred information.

The home was clean and tidy throughout. Some areas of the service were old and worn. A detailed refurbishment plan was not in place. We have made a recommendation about this.

There was enough staff on duty to meet people’s care and support needs. A dependency tool was used to calculate safe staffing levels. Some relatives and staff reported concerns over staffing levels when the number of people living at the service increased. The registered manager assured us staffing levels were regularly reviewed and amended to ensure people’s needs were met.

Audits were used to monitor the quality and safety of the service. Action was taken when shortfalls were found. People, relatives and staff spoke positively of the management team and said they were able to provide feedback on the service provided.

Strong relationships had been built with other professionals to ensure people had access to the support they required.

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.

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

Rating at last inspection

The last rating for this service was good (published 21 November 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

We undertook this 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.

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

Enforcement and Recommendations

We have made a recommendation that the provider implements a robust refurbishment plan to ensure the service is safe and well-maintained.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People were protected from abuse by staff who were trained and knowledgeable about safeguarding adults and understood their responsibilities. The provider had suitable policies and procedures in place for staff to follow to keep people safe.

Where people had been assessed for a risk of harm we found that there were risk assessments in place for staff to follow to minimise that risk for the person.

People lived in premises which the provider maintained safely. The provider carried out a range of health and safety checks including fire safety, water temperatures and hygiene, window restrictors, electrical and gas safety, equipment maintenance and servicing.

Medicines were being administered and managed safely by trained and competent staff. The provider checked that people received their medicines as prescribed.

There was enough staff employed at the service to provide people with safe care. We saw that the provider regularly reviewed the staffing levels to ensure that people had the maximum amount of time with staff.

The provider had recruitment systems in place to ensure that the people they employed were suitable to work with vulnerable people.

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. Staff understood their responsibilities in relation to respecting people’s privacy and dignity.

People enjoyed the food they received and had choice over meals in line with their preferences and cultural needs. People were supported to maintain their health and had regular contract with health professionals.

People received care in line with the Mental Capacity Act 2005 (MCA). The provider appropriately applied for Deprivation of Liberty Safeguards (DoLS) authorisation where it was necessary to deprive a person of their liberty as part of keeping them safe.

People's care needs were assessed and detailed plans were in place to meet their individual needs. People told us that they were cared for by staff who knew them very well, promoted their independence and understood how to support them.

A training programme was in place that enabled staff to provide good standards of person-centred care. New staff also received a suitable induction.

Staff received regular supervision and an annual appraisal which allowed the registered manager to plan further training to support staff development.

Staff had an understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and had received training.

The service had an effective complaints process in place and people were aware of it and understood how to make a complaint should they need to. The service actively encouraged feedback from people and staff.

Leadership was visible and competent with an experienced registered manager in post. The provider was accessible to people and staff. One person told us "I would give the home 10 out of 10, I don't think there's any improvements that could be made." The management team carried out audits of the service to check the quality of care.

Hawthorns Residential Home is situated in Loftus and provides care and accommodation for up to 15 people. The service is adjacent to Hawthorn Lodge, another service operated by the same provider. At the time of the inspection 13 people were using the service, most of who were living with dementia.

There was a registered manager in place. 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. The registered manager managed the service from an office located in Hawthorn Lodge, and also managed that service.

Risks to people across a wide range of areas were assessed and reviewed on a regular basis, and steps were taken to mitigate them. The safety and suitability of the premises was regularly checked, and required test certificates in areas such as gas safety, hoist equipment and PAT electrical testing were in place.

Plans were in place to support people in emergency situations, and these were regularly reviewed.

Medicines were managed safely and people were supported to access them in a safe way. A clear audit trail of medicines was in place, and people’s medicine administration records were accurately completed.

There as a safeguarding policy in place, and staff understood safeguarding issues and were confident to raise any concerns with the appropriate authorities.

Recruitment procedures were robust in ensuring that only suitable staff were employed. Pre-employment checks were undertaken to ensure the suitability of staff.

Staff received the training they needed to effectively support people, and the service was in the process of becoming an accredited training centre.

Staff were supported through regular supervisions and appraisals, and said they would be confident to raise any issues or support needs with the registered manager or provider.

The principles of the Mental Capacity Act and the Deprivation of Liberty Standards were applied when people received care and support. Mental capacity assessments took place in a number of areas, and there was evidence of best interest decisions on people’s care plans.

People received suitable support with food and nutrition and were able to maintain a balanced diet. People had a choice over their meals, and could access food and fluids between mealtimes.

The service worked with outside agencies to support and maintain people’s health, and there was evidence on people’s care plans of frequent visits to people by external professionals.

Staff treated people with dignity, respect and kindness. This contributed to a homely atmosphere at the service, where people seemed relaxed and happy.

Staff knew the people they were supporting well, and had positive and caring relationships with them.

People had access to advocacy services, and one person was using an advocate at the time of the inspection.

Care records were detailed, personalised and focused on individual care needs. People’s preferences and needs were reflected in the support they received. Where people had specialist support needs additional care plans were in place to assist in this.

People had access to a wide range of activities, which were tailored to their preferences and abilities. These were delivered by a committed and motivated activities co-ordinator.

The service had a clear complaints policy that was applied when issues arose, and this was publically advertised at the service.

The provider and registered manager worked together closely to monitor and improve standards, and were a visible presence at the service.

Staff felt supported and included in the service by the registered manager and provider. The service sought feedback from people and their relatives on how the service could be improved.

The registered manager understood their responsibilities in making notifications to the Commission.