Hawthorns Lodge Limited

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.

Hawthorn Lodge is a care home that provides accommodation and personal care to a maximum of 20 older people, some of whom are living with dementia. At the time of inspection 13 people were using the service.

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

People and their relatives were very positive about the care provided. People told us they felt safe and staff had the skills to support them. Relatives provided positive examples of how staff had helped improve people’s lives since moving to the home.

Staff were safely recruited and received an induction followed by training from the provider. Training was monitored and staff were supported with regular meetings and supervisions. Staffing capacity was enough to meet people's needs.

People and relatives were involved in every stage of care planning. Systems and records were in place to ensure people received person-centered, safe care.

The registered manager had an effective quality assurance system in place. Regular audits and checks were done. These were used to identify relevant action and lessons learnt. People, relatives, staff and professionals were offered opportunities to provide feedback about the care provided at the home.

All staff ensured people living in the service were happy with the environment and found ways to promote their independence; their passions and interests maintained wherever possible.

The service was following safe infection prevention and control procedures to keep people safe.

Medicines were managed safely. Risks to people were assessed and action taken to reduce the chances of them occurring. The registered manager acted on feedback immediately. People were safeguarded from abuse.

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 CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 2 December 2020).

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice

• The service had identified a dedicated unit within the home so they could safely admit people who were positive for Covid-19. Access to and from this unit was separate from the rest of the home. A cohort of staff would work in this unit to minimise the risk of transmission.

•At the time of the inspection people using the service were not receiving face to face visitors. However, other methods of contact were encouraged, for example, video and telephone calls and window visits.

• Enhanced cleaning schedules included regular cleaning of touch areas such as handrails and door handles. This reduced the risk of cross infection.

• To reduce the risk of infection transmission, staff no longer worked across different units and when they arrived at work, they then changed into their uniforms. Staff had received additional training in infection prevent and control and the use of PPE.

• Staff and people living in the service accessed regular testing for Covid-19. This meant action could be taken swiftly if anyone developed symptoms or had a positive test result.

• Management ensured people and staffs mental health and well-being was supported at all times.

• The infection prevention and control policy was up to date. People and staff had risk assessments in place to identify their individual risks associated with Covid-19. This meant protective measures could be put in place to keep people and staff safe.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

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.

Hawthorn Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Hawthorn Lodge provides personal care for up to 20 older people and people living with dementia type illnesses. At the time of our inspection there were 19 people living at the home.

The service had a registered manager in post. A registered manager is a person who has registered with the 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.

The atmosphere of the service was homely, warm and welcoming. People who used the service were relaxed in their own home environment.

People were supported to have choice and control from being supported by person centred approaches. Person centred care is when the person is central to their support and their preferences are respected.

People were always respected by staff and treated with kindness. We saw staff being discrete and considerate.

People’s support plans were person centred. They included details of peoples care needs and a ‘one page profile’ that described their individual support needs. These were regularly reviewed.

Support plans contained risk assessments that were individualised. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. This supported people do the things they wanted to live their lives fully.

The support plans we viewed also showed us that people’s health was monitored and referrals were made to other health support professionals where necessary, for example; the falls team or community nurse.

Staff understood safeguarding issues and procedures were in place to minimise the risk of abuse occurring. Where concerns had been raised we saw they had been referred to the relevant safeguarding department for investigation. Robust recruitment processes were in place.

Staff understood the importance of equality, diversity and protecting peoples’ rights.

Information was provided in accessible formats and access to advocacy services was available.

People were supported to have maximum choice and control of their lives and we saw staff supporting them in the least restrictive way possible; the policies and systems in place supported this practice.

Where people lacked the mental capacity to make decisions about aspects of their care, staff were guided by the principles of the Mental Capacity Act 2005 (MCA) to make decisions in the person’s best interest. For those people that did not always have capacity, mental capacity assessments and best interest decisions had been completed for them. Records of best interest decisions showed involvement from people’s family and staff.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs.

People were supported to maintain their independence on a daily basis.

Support staff told us they felt supported to carry out their role and to develop further and that the registered manager led by example. They were supportive and always approachable.

When we looked at the staff training records, they showed us staff were supported and able to maintain and develop their skills through training. Development opportunities were available. People were supported by enough staff to meet their needs.

Medicines were stored, managed and administered safely. We looked at how records were kept and spoke with the registered manager about how senior staff were trained to administer medicines and how this was monitored.

We found an effective quality assurance survey took place regularly when we looked at the results. The service delivered had been regularly reviewed through a varied range of internal audits.

We found people who used the service and their representatives were regularly asked for their views about the support and service they received.

The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

Hawthorns Lodge provides accommodation and care for up to 20 older people who may be living with dementia. The home is a purpose built bungalow style accommodation. It is situated on the same site as Hawthorns Residential Home.

The home is recorded as not having had a registered manager in post since June 2014. 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 lack of registered manager was found to be an administrative error. The registered manager for Hawthorns Residential Home covers both locations and had expected that they would be registered for both locations. The manager had noted this discrepancy and submitted the relevant forms to ensure this location is added to their registration.

People told us that staff worked with them and supported them to continue to lead fulfilling lifestyles. Staff outlined how they supported people to continue to lead independent lives. We found that a range of stimulating and engaging activities were provided at the home. We found that people were encouraged and supported to take responsible risks and positive risk-taking practices were followed. Those people who were able to were encouraged and supported to go out independently, and others routinely went out with staff.

People we spoke with told us they felt safe in the home and that staff made sure they were kept safe. We saw there were systems and processes in place to protect people from the risk of harm.

People who used the service and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. The registered provider and manager had closely considered people’s needs and by using rolling cover ensured that for the 20 people using the service from 6am until 10 pm there was a senior carer and three to four care staff were on duty during the day and a senior carer and a care staff member on duty overnight.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff received a wide range of training, which covered mandatory courses such as fire safety as well as condition specific training such as dementia care.

Where people had difficulty making decisions we saw that staff gently worked with them to work out what they felt was best. Staff understood the requirements of the Mental Capacity Act 2005 and had appropriately requested Deprivation of Liberty Safeguard (DoLS) authorisations. Staff had been working hard to ensure capacity assessments were completed in line with the Mental Capacity Act 2005 code of practice. They and the manager recognised that they were still developing the skills needed to always complete these accurately and they needed more space on the sections relating to people’s ability to take on board information to write their analysis.

We observed that staff had developed very positive relationships with the people who used the service. The interactions between people and staff were jovial and supportive. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity. Staff also sensitively supported people to deal with their personal care needs.

People told us they were offered plenty to eat and we observed staff to assist individuals to have sufficient healthy food and drinks to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained detailed information about how each person should be supported. We found that risk assessments were very detailed. They contained person specific actions to reduce or prevent the highlighted risk.

We saw that the registered provider had a system in place for dealing with people’s concerns and complaints. The manager had ensured people were supported to access independent advocate.

s when needed. People and relatives we spoke with told us that they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We found that all relevant infection control procedures were followed by the staff at the home and saw that audits of infection control practices were completed.

The registered provider had a range of systems to monitor and improve the quality of the service provided. We saw that the registered provider was enhancing these systems with the introduction of a computerised quality assurance system. The manager had systems in place to oversee the performance of the home and to identify any areas that needed to be developed.

People told us that they were happy and there was plenty to do in the home. One person said, "I like all the staff, they are always kind to me."

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect.

We saw that people had their needs assessed and that care plans were in place.

The care records examined showed that people and their families were involved in making decisions about their care and treatment.

People were safe and their health and welfare needs were met by sufficient numbers of appropriate staff.