Hawthorne Nursing 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.

This is the first assessment for this service under the current provider. This key question has been rated requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 56 (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.

The provider completed investigations where required in response to complaints, accidents or incidents. This included looking at the concern raised, recording the action taken and highlighting lessons learnt. Internally staff communicated through daily flash meetings and handovers. We saw evidence of referrals to other agencies being made in a timely manner to ensure people received safe care. Staff were encouraged to come forward with ideas around improvements in the service to help improve the quality of life for people.

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.

The provider worked with other healthcare professionals making referrals where necessary. This included the dementia outreach team, tissue viability nurses and dieticians. The provider had documented admission processes. This ensured relevant information about people’s needs, risks and preferences were obtained and shared with staff in a timely manner. There were systems in place to share information with partners when people’s needs changed.

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.

The service had generally effective systems in place to safeguard people from abuse and improper treatment. Safeguarding concerns were reported to the local authority and CQC as required, and external partners told us there was a good process for safeguarding and regulatory referrals in place. Leaders maintained oversight of safeguarding activity. Staff understood their safeguarding responsibilities and felt able to raise concerns. Staff had received recent safeguarding training. The provider had policies in place around safeguarding and whistleblowing.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found appropriate assessments and applications had been made in line with the recommended procedures whilst still supporting people to live the lives they wanted. Any restrictions in place were authorised, proportionate and the least restrictive.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The service worked with people, and where appropriate their representatives, to understand and manage risks in a way that balanced safety with people’s rights and choices. Risk assessments and care plans generally reflected known risks and the actions staff needed to take to keep people safe. Referrals were made when required and were made in a timely manner.

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

Inspectors found hazards across the home including fire safety risks, unsafe equipment and poor maintenance. Door frames had sharp plastic guards that posed a risk of injury to people. A stair gate installed at the bottom of the stairs had not been risk assessed regarding its height and this increased the risk of toppling to people using the stairs. We also observed exposed hot water pipes that were hot to the touch, this increasing the risk of burns. Unsafe equipment was found throughout the home for example wheelchairs were missing heel straps with 1 observed dragging on the floor as the person was being moved. This increased the risk of entrapment under the chair and the risk of injury.

The fire escape route from the first floor was not clearly signposted and was obstructed externally by a locked gate at the time of inspection meaning people would be unable to assemble in the assembly area. The provider has since changed the locking mechanism on the gate and sought further professional advice. At the time of inspection another fire exit led into an enclosed outdoor area with no means of exit. After we identified concerns regarding the potential unsafe exits routes from the building the provider made changes to ensure people had a safe means of evacuation.

We returned onsite after a short period and observed that new wheelchairs had been ordered, the fire escape route had been addressed and the door surrounds had been removed. This reducing the risk of harm to people living at the service.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support,

supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Staff were recruited safely. Recruitment files showed the required pre-employment checks were completed. There were gaps in training compliance with some mandatory training not being completed however, this is scheduled to be completed in the near future. Staff were supported with regular supervisions.

People, relatives and professionals gave mixed feedback about staffing levels. One person told us ‘I guess there’s enough [staff] to look after everyone, but not to take us anywhere as they say there’s no one spare. Weekends are quieter but they still seem ok staffed.’ During inspection we noted at least 1 staff member was present in each lounge, and if one was called away, the remaining staff would monitor both rooms. People told us call bells responses were usually timely. Another person told us how ‘sometimes there’s not enough staff, [staff member] is amazing, but a lot of staff don’t know people’s needs.’

The provider did not effectively assess or manage the risk of infection. They did not detect and control the risk of it spreading.

Inspectors observed widespread infection prevention and control issues. Numerous handrails were chipped exposing porous wood that could not be effectively cleaned. Several pressure cushions were soiled and some covers were torn, this preventing appropriate decontamination. Inspectors observed poor infection prevention and control practice with regards to the drinks trolley and utensils used.

We observed other areas of poor infection prevention and control practice for example, rusty table legs that would hamper effective cleaning. The provider did not have effective infection prevention and control measures in place to identify or rectify potential issues within the home.

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.

Prescribed topical creams were not always labelled with the date of opening and some prescribed creams were found in communal bathrooms. This created a risk that expired or contaminated creams could be used, increasing the risk of infection or ineffective treatment. PRN (when required medicines) protocols were not always person centred and lacked sufficient detail. For example, a person prescribed medication to support bowel movements did not have guidance on when the medicine should be administered or what action staff should take if it was not effective. This put the person at the risk of receiving delayed treatment, discomfort or pain for a prolonged period. The service made immediate improvements to all PRN protocols once brought to their attention.

We also identified several people were prescribed transdermal patches and whilst staff were recording the site of application at the time of administration, there were no documented daily checks recorded to ensure the patches remained in place. This could leave people at risk of ineffective pain management. Another person was on an anticoagulant however there was no associated risk assessment in place. This meant risks associated with anticoagulant therapy, including bleeding, could increase the risk of harm to the person after a fall or injury.