Background to this inspection
Updated
21 February 2019
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.
The inspection took place on 17 and 18 December 2018. The inspection team consisted of two inspectors, a specialist advisor and a pharmacy inspector. The first day of our inspection was unannounced, but we told the provider we would be returning for the second day.
Prior to the inspection we reviewed the information we held about the service. We spoke with the service GP and communicated with a representative from the local authority to obtain their feedback.
During the inspection we spoke with 13 people using the service. Some people could not let us know what they thought about the home because they could not always communicate with us verbally. We therefore used the Short Observational Framework for Inspection (SOFI), which is a specific way of observing care to help us to understand the experience of people who could not talk with us.
We spoke with 10 care workers, one team leader, three nurses, the clinical lead, two activities coordinators, the deputy chef, the registered manager of the service and regional manager for the provider. We looked at a sample of 11 people’s care records, ten staff records and records related to the management of the service.
Updated
21 February 2019
We conducted an inspection of Hawthorne Green on 17 and 18 December 2018. The first day of the inspection was unannounced. We told the provider we would be returning on the second day.
At the last inspection on 30 and 31 October and 1 November 2017, we found breaches of regulations relating to the provision of safe care and treatment, maintaining good staffing levels and good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. The provider sent us their action plan detailing their planned actions to improve the service. At this inspection we found improvements had not been made in relation to the provision of safe care and treatment or good governance. We found improvements had been made in ensuring safe staffing levels. This is the sixth time the service has been rated Requires Improvement.
Hawthorne Green is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Hawthorne Green provides care and support for up to 90 people who require nursing and personal care. There were 71 people using the service when we visited. There are three floors within the building and each floor consisted of two units. Four of the home’s units are for people who have nursing needs and two of the units are for people with residential care needs, some of whom have early onset dementia.
There was a registered manager at the service. 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 a 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 had been registered with the CQC for one day at the time of our inspection and had been managing the service for approximately one month.
Medicines were not always managed safely. We found one team leader was administering medicines without having the training to do so safely. We found medicines care plans were not always up to date.
The provider did not consistently assess and mitigate risks to people’s safety. We identified some examples of people without clear, written risk management guidelines in place for care staff.
There were enough suitably trained staff scheduled to work during our inspection. The provider conducted safer recruitment practices through appropriate pre-employment checks. However, we found that they did not renew their criminal record checks every three years after appointment as per best practice.
Both permanent and agency staff received an effective induction to the service. Care staff received supervisions and appraisals of their performance, however, we found these were not conducted regularly as some people had not received a supervision in the nine months prior to our inspection.
Care records contained insufficient information about people’s mental health needs and care staff had limited understanding about how to support people with these. People received appropriate support with their physical healthcare needs and care staff assisted them to access external healthcare professionals when needed.
People told us care staff were caring but we observed varying levels of kindness and attentiveness towards people using the service. Care staff had a good understanding of people’s preferences in relation to how they wanted their care delivered. People told us care staff respected their privacy
People told us they felt safe within the home and the provider had an appropriate safeguarding policy and procedure in place which care staff were aware of. However, we found safeguarding investigations were not conducted in a timely way to manage potential risks to people’s safety.
The building was clean and tidy at the time of our inspection and care staff practised good infection control practices. There was a dedicated sluice on each unit for the hygienic removal of disposables such as incontinence pads.
People were supported with their nutritional needs. Care records contained sufficient information about people’s needs and included their likes and dislikes in relation to food. Kitchen staff were aware of people’s needs and people gave good feedback about the food provided.
People using the service and their relatives were involved in decisions about their care and how their needs were met.
Care staff had a good understanding of their responsibilities under the Mental Capacity Act 2005. Mental capacity assessments were completed when needed and we saw these in people’s care files. The provider made applications to the local authority for authorisation where it needed to restrict someone’s liberty for their safety.
People told us they knew how to make complaints and there was a complaints policy and procedure in place.
The provider operated a varied activities programme which included a range of activities both inside and outside the home and people told us they enjoyed these.