Background to this inspection
Updated
6 April 2024
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.
Inspection team
The inspection was carried out by 2 inspectors and 1 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.
Service and service type
Hawthorns 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. Hawthorns 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.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
During the inspection we spoke with 5 people who used the service and 7 relatives about their experience of the care provided. Not everyone who used the service communicated verbally or wished to speak, therefore they gave us permission to speak with their relatives on the telephone. We spoke with 6 members of staff including the registered manager, 1 deputy manager, 3 care workers, including 1 senior care worker and 1 domestic staff member.
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 4 people’s care records and multiple medicines records. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including training information and policies and procedures were reviewed.
Updated
6 April 2024
About the service
Hawthorns Lodge is a care home providing accommodation and personal care to up to 20 people in one purpose-built building. The service provides support to older people, including people who may live with dementia or a dementia related condition. At the time of our inspection there were 16 people using the service.
People’s experience of using this service and what we found
A quality assurance system was in place, but it needed to become more robust to assess the standards of care in the service. Improvements were needed to the running of the service to ensure people were encouraged to be involved and they received person-centred care.
Care was task-centred rather than person-centred. Due to staff being busy they did not have time to spend with people. Throughout our observations some people sat silently or were not engaged or stimulated. There were limited activities and entertainment. A relative commented, “There is nothing to do, no entertainment, apart from at Christmas.”
Improvements were required to records to ensure people received safe and person-centred care. Risks were not always assessed and mitigated to keep people safe. Staff recruitment was carried out safely and effectively. Medicines were mostly managed safely. Medicines records required more information for the use of ‘when required’ medicines. There was evidence of collaborative working and communication with other professionals to help meet people's needs.
Improvements were needed to the environment to ensure it was appropriately designed to meet people's needs, to keep people orientated as they moved around.
People and relatives were complimentary about the direct care provided by support staff. They trusted the workers who supported them. They said staff were kind, caring and supportive of people and their families.
Improvements were needed to give people control in their lives and involve them in decision making. People were not supported to have maximum choice and control of their lives and staff had not supported them in the least restrictive way possible and in their best interests; the policies and systems in the service had not supported this practice.
Improvements to systems and accessible information was needed to promote people’s involvement in decision making about their lives.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was good (published 16 December 2023).
Why we inspected
The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk. This inspection examined those risks.
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, responsive, well-led sections of this report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hawthorns Lodge on our website at www.cqc.org.uk
Enforcement and Recommendations
We have identified breaches in relation to safe care and treatment, person-centred care and good governance at this inspection.
We have made the following recommendations:
Staffing levels and staff deployment to be kept under review.
Information should be made accessible to meet people's needs.
Systems to communicate with relatives to be strengthened to ensure people and relatives are involved in the running of the home and to gather their feedback.
Improvements to be made to people's dining experience.
Improvements to be made to activities and outings to keep people engaged and occupied, as they choose.
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.