Archived: Hawthorn House

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

The service was not well-led. This was the fourth consecutive inspection where the provider had failed to reach a rating of at least good.

Quality assurance systems continued to be ineffective. Lessons had not always been learned as some of the same issues remained from the previous inspections.

Shortfalls had not been identified or promptly addressed which placed people at risk of harm and of receiving a poor-quality service.

People were not always safe and were placed at risk of harm as the provider had not identified, assessed or mitigated risks. This included risks related to people's health and care needs, as well as environmental risks.

Some areas of the service were not clean, and staff and visitors did not continually follow infection control guidance to manage the risk of spread of infection.

Medicines management practice had deteriorated since the last inspection and were unsafe, which put people at risk of harm. We could not be assured people received their medicines as directed, and medicines were not always stored safely.

We could not be assured staff were suitably skilled to ensure people received appropriate care and support to meet their needs. The providers processes could not demonstrate that suitably competent staff were deployed due to a lack of recorded competency and training. Appropriate robust checks were not always completed prior to new staff commencing employment.

There had been some improvements made to the environment, some floorings and furniture had been replaced and a new kitchen had been fitted.

Staffing levels were sufficient during the inspection. Staff were kind and attentive to people. Most feedback from people and their relatives about the care provided was positive.

People were supported to have maximum choice and control of their lives and staff supported did 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 Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 23 May 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out a focused inspection of this service on 8 and 10 March 2022. Breaches of legal requirements were found, and we issued warning notices for the breaches of regulations 12, safe care and treatment and 17, good governance.

The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of safe and well led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service remains inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hawthorn House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, and good governance at this inspection.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore remaining in 'special measures'.

This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service.

This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as

inadequate for any of the five key questions it will no longer be in special measures.

Hawthorn House provides accommodation and support with personal care for up to 22 older people, some of whom may be living with dementia. At the time of this inspection there were 18 people using the service.

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

The service was not well led. People's safety and welfare was compromised, and governance arrangements continued to be ineffective and could not demonstrate how people were safe. This was the third consecutive inspection where the provider had not achieved a rating of good.

Risks to people were not effectively identified and mitigated. Work was required to ensure current government guidance for working safely in care homes during the COVID-19 pandemic was implemented, adhered to, and appropriately monitored. Good infection control practice had not been effectively implemented.

Work was required to improve the administration, recording and auditing of medicines. We have made a recommendation about the management of some medicines.

Where incidents and accidents had happened it was not clear that lessons had been learnt and action to reduce future risk had been taken.

Systems for oversight and checks of environmental and equipment related risk management were not being identified and documented and there were a number of shortfalls identified over the course of the inspection.

Systems to ensure people's needs were met were not effective as records were not always accurate.

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 Care Quality Commission’s (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 9 November 2020). There were breaches of regulations 11 (Need for consent), 12 (Safe care and treatment), and 17 (Good governance).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

At a previous inspection published on 9 November 2020 we recommended the provider reviewed their systems and processes in line with current legislation and guidance for determining safe staffing levels and training. The provider had made improvements.

Why we inspected

We carried out an announced focused inspection of this service on 6 October 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Need for consent, Safe care and treatment, and Good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of safe, and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hawthorn House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Hawthorn House is a residential care home providing personal and nursing care to people aged 65 and over. At the time of the inspection there were 19 people living in the service. The service can support up to 22 people.

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

We found ongoing shortfalls in the management of the safety and quality of the service. Checks in place were not effective which had led to new and continued breaches of regulations.

The provider’s approach to assessing and managing environmental and equipment-related risks was inconsistent and identified risks were not always addressed. Action had not been taken to address longstanding risk associated with Legionella’s.

Staff were not up to date in safety-related training including medicines and there were no systems in place to assess their competency in this area.

The registered manager did not adopt a systematic approach to determining staffing levels based on people’s changing needs.

We have made a recommendation about safe staffing levels.

People’s consent had not always been appropriately sought and staff were unclear about the levels of restrictions in place for some people. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not support this practice.

Despite our concerns, the culture in the service was warm and welcoming. We received positive feedback from people and their relatives about the care they received.

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 requires improvement (published 04 July 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made in some areas and not enough in others and the provider was still in breach of some regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 30 May and 03 June 2019. Breaches of legal requirements were found. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hawthorn House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to managing risks and the safe management of medicines, consent and the running of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hawthorne House is a residential care home that was providing personal care to 21 people at the time of the inspection. The service can support up to 22 people.

People’s experience of using this service

Since our last inspection the provider had failed to maintain high quality standards of practice within the service. The provider demonstrated their willingness to improve by working with us during and after the inspection.

The quality of the record keeping varied and some care records we looked at did not have the right information in them to manage people’s care safely. The assessment and monitoring of risk for people was ineffective.

Care plans and risk assessments had not been reviewed on a regular basis or when people’s care needs had altered.

Staff were not recruited safely. The provider had failed to assure themselves that staff were suitable to work with vulnerable people.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

Complaints were not recorded or responded to in line with the provider’s policy. Improvements were needed to provide information to people in an accessible format.

People told us they felt safe and well cared for and staff treated people with respect and dignity.

Staff were proud to work at the service and were self-motivated to provide person centred care for people. Staff were trained appropriately to meet people’s needs and received regular supervision meetings.

The provider had taken appropriate action when concerns had been raised regarding the registered manager’s practice, subsequently they were not present during this inspection. Quality assurance systems were ineffective at identifying improvements required at the service.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around safe recruitment of staff, consent and good governance. Details of action we have asked the provider to take can be found at the end of this report.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

At the last inspection the service was rated as good (published November 2017).

Why we inspected

This inspection was prompted by information of concern.

Follow up

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

The service is located in Hedon, a market town in the East Riding of Yorkshire. Accommodation is provided across two floors. There are gardens which are accessible to people and car parking is available at the front of the property. At the time of our inspection there were 20 people living at Hawthorn House.

At the last inspection in August 2016 the provider was rated as required improvement. The service was in breach of one regulation under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach was in Regulation 19, Fit and proper persons employed. We asked the provider to submit an action plan regarding the breach and during this inspection we saw these actions were met. The service was no longer in breach of this regulation.

There was a manager who had been registered with CQC on the 8 November 2016. 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.

Staff knew how to keep people safe and understood their duty to protect people from the risk of abuse. Risks were managed so that people were protected, as far as reasonably practicable, from avoidable harm.

Sufficient staff were on duty to meet people's needs. Safe recruitment procedures were followed and appropriate pre-employment checks had been made including satisfactory written references. Appropriate background checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely and people received them as prescribed. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People received care and support from staff who had the skills and knowledge to understand their role. Staff received documented supervision to ensure they were supported in their role and development.

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

People were supported to eat and drink sufficiently. Any specific dietary needs were recorded in their care plan and staff confirmed they requested support from other health professionals where it was required.

We saw people were supported with kindness, patience and consideration. Peoples privacy and dignity was respected.

People's needs were assessed and their care plans provided staff with guidance about how they wanted their individual needs to be met. Care plans were person centred and contained appropriate risk assessments. They were reviewed and amended as necessary to ensure they reflected people's changing support needs.

There was a complaints procedure for people to follow when they raised their concerns.

The service was clean, well maintained and accessible. There were systems of audit in place to check, monitor and improve the quality of the service. Associated actions were recorded with timely outcomes and these were reviewed for their effectiveness.

The registered manager had an understanding of their role and responsibilities and requirements in regards to their registration with CQC.

The home is registered to provide accommodation and care for up to 22 older people, including people who are living with dementia. On the day of the inspection there were 21 people living at the home. The home is situated in the centre of the town of Hedon, a market town in the East Riding of Yorkshire, and also close to the city of Hull. There are various communal areas where people can spend the day and an enclosed garden. The second floor of the home is accessed by either a stair lift or a passenger lift, and there are ramps to the premises to enable wheelchair access.

The registered provider is required to have a registered manager in post and on the day of the inspection there was no manager registered with the Care Quality Commission (CQC). 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. However, a manager had been appointed and was due to commence work in September 2016. They had previously been registered as a manager with the Care Quality Commission.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs. There were recruitment policies and procedures in place but there needed to be more evidence that these had always being followed when new staff were employed. The records for one new employee contained only one employment reference and the Disclosure and Barring Service (DBS) check had been received after they had commenced work. The records for another new employee did not include an up to date DBS check. This meant that there was a lack of evidence that the people were suitable to be employed at the home.

This was a breach of Regulation 19 (3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People told us that they felt safe living at the home. People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Staff told us that they were well supported by the previous registered manager and the deputy manager, and felt that they were valued. They confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them and that they felt it equipped them to carry out their roles effectively. The training records needed to be more robust to evidence that staff had completed induction and on-going training. The deputy manager told us they were in the process of compiling a new and up to date training matrix.

There was evidence that the registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

We checked medication systems and saw that medicines were stored, recorded and administered safely. Staff who had responsibility for the administration of medication had received appropriate training.

People who lived at the home and relatives told us that staff were caring and that they respected people’s privacy and dignity. We saw that there were positive relationships between people who lived at the home, relatives and staff, and that staff had a good understanding of people’s individual care and support needs.

People told us that they were very happy with the food provided and people's nutritional needs had been assessed. We observed that people’s individual food and drink requirements were met.

A variety of activities were provided and people were encouraged to take part. People’s family and friends were made welcome at the home, and people were supported to take part in the local community.

There were systems in place to seek feedback from people who lived at the home, relatives and staff but it was not always clear when the feedback had been collected as it was not dated. People told us that they had not needed to make a complaint, but they knew who to speak to and were confident their complaints and concerns would be listened to. Staff told us that, on occasions, feedback received at the home was used as a learning opportunity and to make improvements to the service provided.

Staff, people who lived at the home and relatives told us that the home was well managed. However, some notifications that needed to be submitted to the CQC in respect of serious injuries incurred by people who lived at the home had not been submitted. We have made a recommendation about this in the report.

Quality audits undertaken by the registered provider and previous registered manager were designed to identify any areas of improvement to staff practice that would promote people’s safety and well-being. Numerous audits were being carried out and any areas that required action had been recorded, although more care needed to be taken to record when identified improvements had been carried out.