We inspected Hawthorn House on 10 March 2016. This was an announced inspection. We informed the registered provider at short notice that we would be visiting to inspect. We did this because the location is a small care home for people who are often out during the day and we needed to be sure that someone would be in.
Hawthorn House is a purpose built single storey building which provides a short break service for up to ten adults aged 18 and above who have a learning disability, some of whom may also have a physical disability. It is located on the outskirts of Durham City.
The home had a manager who was not yet registered with the Care Quality Commission. 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 manager told us they were in the process of completing their application to become the registered manager.
The manager and staff showed that they had an understanding on the Mental Capacity Act (MCA) 2005. MCA is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances. Professionals had completed capacity assessments on people who used the service; however decision specific assessments of capacity were not available on care records we looked at. Best interest decisions were not always recorded.
Staff had received regular updates on their training to enable them to carry out the duties within their role; however the training chart needed further development to detail the dates of staff training and all the training staff had completed.
People were protected by the service's approach to safeguarding and whistle blowing. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.
Appropriate checks of the building, equipment and maintenance systems were undertaken to ensure health and safety.
Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as choking, mobility, community participation and behaviour that challenges amongst others. This meant staff had the written guidance they needed to help people to remain safe.
We found that safe recruitment and selection procedures were in place and appropriate checks were completed before staff started work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people. Sufficient staff were on duty to ensure people’s needs were met.
Appropriate systems were in place for the management of medicines so that people received their medicines safely. Regular temperature checks were made of the room in which medicines were stored and on some occasions the room temperature was too warm. This meant that some medicines could deteriorate and be ineffective. The manager said they would monitor temperatures and take action if needed.
Staff told us that they felt supported. There was a programme of staff supervision in place. Records of supervision were detailed and showed that the manager had worked with staff to identify their personal and professional development goals. Staff had received an annual appraisal.
We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met.
People were supported to maintain good health and had access to healthcare professionals and services.
There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, patient and interacted well with people. Observation of the staff showed that they were caring and knew the people very well. Relatives told us that they were happy with the care and service received.
People were assessed and care plans were in place. Relatives told us they were involved with developing the care plans. Care plans described the level of support and care the person needed and likes and dislikes were also recorded. This helped to ensure people received the care and support in the way they wanted. Staff at the service were in the process of reviewing, updating and re-writing all plans of people. At the time of the inspection they had completed 17 of the 72 plans of the people who used the service during the course of the year.
People’s independence was encouraged and their hobbies and leisure interests were individually assessed. There were activities and outings for people.
The registered provider had a system in place for responding to people’s concerns and complaints. Relatives said that they would talk to the manager or staff if they were unhappy or had any concerns.
We looked at the arrangements in place for quality assurance and governance. Quality assurance and governance processes are systems that help providers to assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations. The service manager visited the service on a regular basis and completed audits on a monthly basis. The manager also completed an in house audit of care records, but did not always keep a written record of this.
The service manager told us that commissioners completed an annual survey with people and relatives to seek their views on the care and service provider. Commissioners did not share the result of this audit with participants or staff. This meant the management and staff were unaware if improvements were needed.
The manager provided good leadership who provided an emphasis on teamwork. Morale was good and staff were well supported in carrying out their responsibilities.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.