Hawksbury House

Updated 6 June 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

An inspector carried out this inspection.

Service and service type

Hawksbury House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Hawksbury House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with CQC to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We received feedback from the local authority. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used this information to plan our inspection.

During the inspection

We spoke with 4 people who lived at the service and 2 relatives. We received email feedback from a further 4 relatives. We spoke with 3 staff; the nominated individual, the registered manager and 1 support manager. We received email feedback from 4 care staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of documents relating to the safety and management of the home.

Updated 6 June 2023

About the service

Hawksbury House is a residential care home providing personal to up to 35 people. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 34 people using the service.

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

Although no concerns were raised about staffing levels, management did not always ensure staff were deployed effectively, so people had their needs met in a timely way. Some recruitment checks were not always completed in line with requirements. However, management oversight required improvement to identify and manage potential risks relating to infection prevention and control. This included some PPE not stored correctly, some broken bins in bathrooms and some restricted areas not locked. Health and safety checks were completed regularly.

People were not always supported to have maximum choice and control of their lives and staff did not always 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. Mental Capacity Act (MCA) requirements were not consistently met as MCA assessments and best interest decisions were not consistently decision specific. Some best interest decisions did not follow the requirements of the MCA and in some cases had not been completed.

The provider was reviewing care plans to make them more personalised. The provision of activities to ensure people were engaged and had their social needs met required improvement.

People and most relatives gave positive feedback about the care provided at Hawksbury House. The home was clean throughout.

Safeguarding concerns were referred to the local authority as expected and investigated. Incidents and accidents were logged. The provider was implementing systems to help identify learning. Medicines were managed safely with accurate records kept of the medicines people received.

Staff completed the training they needed and had regular supervisions. People received the support they needed with eating and drinking.

The provider recently implemented a more structured approach to quality assurance. More time was needed to allow these changes to become embedded and evidence sustained improvement. There were opportunities for people relatives and staff to give feedback.

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

Rating at last inspection

The last rating for this service was good (published 19 December 2019).

Why we inspected

We received concerns in relation to inconsistent quality assurance; lack of management visibility; quality of food; lack of response to incidents; medicines management; IPC practices and hygiene; and lack of activities and engagement for people living at the home. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 good to requires improvement based on the findings of 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.

You can see what action we have asked the provider to take at the end 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 Hawksbury House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to good governance. Please see the action we have told the provider to take at the end of this report. We have also made a recommendation about the MCA.

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.