Hawthorne Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this service under the current provider.

This key question has been rated requires improvement.

This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

This service scored 54 (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 did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

On day 1 of inspection, we saw the potential emergence of a closed culture within the service. This was demonstrated by staff feeling they could not approach their managers to inform them there was an inspection in process as they felt the manager did not approve of such contact. However, between day 1 and day 2 of inspection there was a change in the management structure and staff appeared more relaxed and receptive. The provider said they had appointed an interim manager and were providing additional support. This change in culture needed to be embedded and monitored by the provider to ensure everyone had a shared direction.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

External professionals told us communication was sometimes inconsistent and that the previous changes in leadership had affected the stability of the service. We raised our concerns with the provider and the provider demonstrated a willingness to improve.

There was a marked difference between day 1 and day 2 of the inspection. On day 1 of inspection the management team was lacking oversight and they did not ensure there was an inclusive environment, and some aspects of care did not focus on compassion. On the second day of inspection staff described leaders as approachable, supportive and visible within the service. Leaders demonstrated an understanding of the complexity of people’s needs and the pressures this placed on staff, and spoke about supporting staff wellbeing through teamwork, flexible approaches and open communication. Staff felt listened to and said leaders responded appropriately when concerns were raised, contributing to an inclusive culture where staff felt valued, supported and able to carry out their roles effectively. This is inconsistent with the findings on the first day of inspection.

The provider had a policy in place around whistleblowing however, at the commencement of this inspection staff could not freely express themselves due to fear of repercussion.

On the second day of inspection the current leaders were described as approachable and said concerns were listened to, treated seriously and handled sensitively, with attention to confidentiality. This supported an open and transparent culture where staff felt safe to raise issues and contribute to learning and improvement. This was inconsistent with the findings on the first day of inspection. The service was committed to embedding these improvements.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider employed a diverse workforce from varying backgrounds and cultures. Cultural backgrounds were celebrated at the service and incorporated into the home through the celebration and acknowledgement of cultural and religious celebrations.

Staff spoke positively about working at the service, describing a strong sense of mutual support. While staff acknowledged that workloads could be demanding due to the high dependency and complexity of people’s needs, they felt supported by colleagues and team leaders.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The provider had governance systems in place including audits, incident reviews and safeguarding logs. However, some audits were ineffective. For example, the monthly and weekly medicines audits had failed to identify the concerns we found. Environmental audits had also failed to detect issues around infection prevention and control and damaged equipment. On the first day of inspection leaders responded when concerns were raised and began taking immediate action including contacting external fire assessors. However, their systems had not identified the issues and the manager stated they had not walked any evacuation routes or gone out of any fire exits so had not picked up on any issues. Leaders did not always promote a positive culture where staff felt able to speak up or confident their views would be heard. Leaders did not always demonstrate a clear understanding of the providers processes and systems, for example on our first day of inspection many records were not made available despite asking for on multiple occasions. This lack of clarity further demonstrated that oversite of the leadership was not always effective. Between the onsite inspections there had been a change in leadership which had created a period of unsettledness. The service subsequently appointed a new interim manager to stabilise the service whilst improvements are being made.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

The service worked with a range of health and social care professionals including GPs, advanced practitioners and local authority teams. There was also engagement within the wider community such as the local church. However, feedback from health professionals demonstrated communication with the service required further development. They described ongoing concerns about the consistency and timeliness of care. They told us there had been variable responsiveness from previous managers and communication and follow up had been more difficult during periods of leadership change.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

Discussions with leaders demonstrated they recognised the importance of learning lessons and continuous improvement to ensure people received care that was consistently safe and effective. However, we identified leaders and staff that had not always been proactive at driving improvements and maintaining documentation. Systems were in place however the appointed person wasn’t using these on our first day of inspection. Action plans were in place however, these did not contain all our findings throughout this inspection. This demonstrated quality performance had not always been effectively assessed which meant opportunities to learn lessons and drive lasting improvements had been missed. The provider committed to improve and embed these systems and to monitor the location more effectively moving forward.