Hawthorn Manor Residential Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Accident and incidents were recorded well by staff. These included where people had fallen, were found to have an unexplained bruise, or had experienced periods of distressed behaviour. All accidents and incidents were closely monitored with ongoing analysis to check for trends and causes, in order to learn lessons. The analysis was comprehensive, including visual reports such as tables and graphs of the number of falls, time of the day and most frequent location.

Records showed action taken, for example, people who had fallen regularly had been referred to a healthcare professional such as the falls team or occupational therapy. Care plans and risk assessments were reviewed and updated following an incident to prevent further re-occurrence.
A person told us, “I did have a fall in the kitchen and bumped my head, but the staff were around to help me. I saw the Doctor after my fall, and I must be more careful when walking around by myself.”
 

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

An initial assessment was completed with people before they moved into the service to support their safety and transition. Staff liaised with other relevant partners if they required further information to support a smooth move.
Relatives told us they were involved in providing personal information about their loved one to support the initial assessment and ongoing review. A relative said, “Yes, they did do an assessment and we as a family have been involved with risk assessments and care plans as her health needs are always changing.”

People’s care plans provided sufficient detail about their wishes and needs so that if they needed to go into hospital or move to another care facility, their health and care requirements could be shared.
 

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People and their relatives told us they felt safe with the care and support they received. Comments included, “Yes very safe, the staff look after me very well”, “Yes, the people are always around”, “We are very happy with (relative) care here, very well looked after, no problems at all” and “I feel she is safe here, the carers are lovely, always around for a chat and will call if they have any concerns about (relative).”

Incidents had been referred to the local authority in line with safeguarding vulnerable adults’ protocols. Staff had raised concerns when they should, and these had been raised externally.
Investigations had been undertaken to understand what had happened and to determine the action needed to learn lessons. Appropriate action had been taken when necessary.

Where relevant, a Deprivation of Liberty Safeguards (DoLS) application had been made when people had been assessed as lacking the capacity to consent to their care and treatment.
 

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People had individual risk assessments in place that were detailed and provided safe guidance for staff to follow when delivering their care. However, records used to detail the care people received each day was not always accurate or up to date, and there were some inconsistencies in the information provided.

One person who had difficulty chewing had been advised by a healthcare professional to have an international dysphagia diet standards initiative (IDDSI) level 4 diet, which means their food should be pureed. They had previously been on a level 6, which meant their food had been in soft and bite sized pieces. However, their records were inconsistent, with some part of their care plan detailing a level 4 diet and other parts a level 6. Staff knew the consistency of food the person should have, so we found no impact arising from the inconsistencies, but we identified a potential risk, particularly if new or agency staff were providing support.
Some people’s daily records were not accurately recorded, close attention had not been paid to records by staff, and this had not been picked up by the management team. These included people’s bowel records, fluid records and repositioning charts. On discussion with the registered manager, and our own observations, people were getting the appropriate care but there were clear potential risks. The registered manager shared their plans for improvement during the inspection which included a more robust handover between staff and more targeted oversight of care records by senior staff. This is an area for improvement and will be checked at the next inspection.

Guidance for staff in relation to people’s individual risks were comprehensive and provided staff with the information they needed to provide safe care that was individual to the person’s needs and wishes. For example, a person’s mobility assessment provided a detailed step by step description of how staff should approach supporting them to use a hoist, ensuring the person’s comfort and safety.
People were assessed by healthcare professionals such as dieticians, speech and language therapists and district nurses to make sure the care they received was safe and using best practice techniques.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The property was old and required some refurbishment to improve the environment. However, this did not impact people’s safety, and the registered manager told us plans were in place to carry out some refurbishments. This included plans to replace all carpeted areas with new flooring.

Staff told us the service would benefit from a lift, although they knew the provider had looked into the possibility, but it was not a viable option. The registered manager told us the provider had seriously considered the option of adding a lift, which had been investigated and a feasibility study had been undertaken but the option was not possible within the configuration of the premises.

Doors were locked that should be, such as those that stored cleaning products or equipment that may be a risk to people’s safety. Equipment was serviced at appropriate intervals, and the premises were regularly checked for risks, including fire safety.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There were enough staff to meet people’s needs. There was mixed feedback about staffing levels from people and relatives. However, people also said they did not have to wait long to get the support they needed and that staff never rushed them when assisting them. Comments included, “I get help when I need it, everyone is friendly and nice”, “I am quite unsteady so need lots of support, so they always take their time with me”, “Sometimes they can be short staffed at night, they sometimes have patients that need more care” and “I would like there to be more staff as the changing needs of all residents puts more demands on the staff time available.”

Staff received the training they needed. There was a comprehensive list of training available for staff to complete, including the specific needs of people living in the service, such as catheter care, epilepsy and Parkinson’s disease. Staff received regular supervision to assess and feed back on their performance and look at development opportunities.

Staff had been recruited safely; the required checks had been completed to make sure staff were of good character.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service was generally clean, and we found it to be free from odours. People told us the home was always kept clean. Comments included, “A lady comes in and cleans my room every day and changes my bed if it needs changing” and “They hoover every day, bed changed and surfaces cleaned, very efficient.”

Staff had access to Personal Protective Equipment (PPE) when needed to support the prevention of infection spreading. Staff had received training to increase their understanding and put this into practice. People and relatives confirmed staff wore PPE. Comments included, “They always wear gloves and aprons when they wash me” and “Yes, the staff always wear appropriate PPE when caring for mum.”

Regular audits were undertaken to check the effectiveness of infection control procedures. Actions were taken when areas to improve were found. These included the lack of availability of large gloves in one area of the home, which was recorded and rectified.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

People’s medicines were not always managed safely. Some people had been prescribed medicines to take only when required (PRN), such as painkillers. Guidance was not always in place for staff to make sure the medicines were administered safely, such as when to give the medicine and the safe dosage. This issue had previously been picked up during the provider’s medicines audits, however, this continued. The registered manager checked all PRN medicines during our visit and made sure the correct guidance was in place for all relevant medicines. Measures were put in place to prevent this happening again.

We found an error when sample checking people’s medicines. The registered manager investigated this, found the cause and put measures in place to prevent it happening again.

Staff who had responsibility for administering people’s medicines had the appropriate training and competency checks to make sure people received their medicines safely.