Hawksbury House

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.

We found the following examples of good practice.

The provider was facilitating visits for people who used the service safely. A visiting pod was available accessed via the garden. People were admitted to the service safely in line with government guidance.

People were encouraged to be socially distant from each other when in communal areas. During the outbreak people with COVID-19, that were unable to isolate, were able to use a lounge separate from other people living at the service. Staff were observed wearing PPE correctly during the inspection.

Risk assessments and policies were in place to help keep people safe, the infection control policy had recently been updated in line with latest guidance.

Hawksbury House accommodates 35 older people across two floors in one adapted building. Some of the people were living with dementia. At the time of our inspection visit there were 34 people using the service.

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

People felt at home, comfortable, safe and well cared for by staff who knew them well. There was a welcoming atmosphere and a person-centred approach to care evident at all levels of staffing. People, relatives and long-term volunteers were involved in the planning of activities and the running of the home.

Medicines, the premises, utilities and safety equipment were all managed safely. There was a focus and commitment to learn lessons when incidents occurred, and to be an adopter of best practice across a range of contexts.

Feedback about the registered manager and staff from a range of external professionals was positive. All had confidence in their ability to ensure the service continued providing a high standard of care. There was clear oversight of all aspects of the service, with the registered manager and deputy manager providing hands-on support to staff. Training was comprehensive and had regard to best practice.

People’s capacity was assumed unless there were reasons to consider otherwise, and staff acted in line with the Mental Capacity Act 2005. 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.

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

Rating at last inspection

The last rating for this service was good (published 3 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Hawksbury House is a care home for older people, some of whom have a dementia-related condition. It does not provide nursing care. It has 35 beds and 34 people were living there at the time of this inspection.

The service had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Without exception, people we spoke with during the inspection were highly complimentary about the kind and caring nature of the staff who supported them.

The majority of staff members had been employed by the service for a significant period of time. As a result they had built up very strong, positive, caring relationships with the people they supported and were very knowledgeable about their individual needs and preferences.

The ethos of the home was to care for people in a way that met their individual needs. People’s individuality was respected and staff went out of their way to ensure people felt comfortable and at ease in their surroundings. Whether this be through ensuring people were provided with the food of their choice or making adaptations to their rooms.

Care staff were very attentive to people’s needs and relatives we spoke with told us they were exceptionally good at picking up any changes in people’s health or well-being. This meant people received prompt medical intervention where required and as such were actively supported to maintain good health.

Staff encouraged people to maintain their independence. People were actively encouraged to socialise and engage in activities or outings into the local community. A varied activities programme was provided, both within the home and in the local community, to prevent people from being socially isolated.

People’s wishes were respected and their privacy and dignity maintained. All staff were aware of the importance of maintaining people’s privacy and dignity and had received appropriate training to enable them to do this.

Systems were in place to ensure people’s wishes in relation to their end of life care were captured and acted upon. People were supported to be comfortable and pain free when receiving end of life care. An external healthcare professional we spoke with described the end of life care provided by the service as exceptional. They told us the staff team provided very high levels of care to both people and their friends and family members during this time. One relative told us after the inspection, "The end of life care is second to none. It was very important to me that my mother was not moved to hospital or nursing care. She was cared for by all staff as if she was their own mother. Who could ask for more?"

Measures were in place to protect people using the service from abuse. Staff received safeguarding training which was refreshed on a regular basis and were aware of their roles and responsibilities for ensuring people’s safety. Risks to people, staff and visitors were assessed and monitored. Action was taken to manage and mitigate risks in order to keep people safe.

Robust recruitment processes were in place to ensure staff members were suitable to work with vulnerable people. People and their relatives were encouraged to take an active part in the recruitment of new staff members. Works trials were undertaken to enable the provider to better assess applicants suitability for employment within the service. Staffing levels were based on people’s dependency levels and were subject to regular review. People told us staff responded to their requests promptly and they felt safe and well cared for.

People were supported to receive their medicines safely and appropriate arrangements were in place for the ordering, recording, storage and administration of medicines. Although “best interest” decisions had been made to administer two people’s medicines covertly (without their knowledge), this was used as a last resort.

Staff were provided with a comprehensive training and induction programme which included completion of the Care Certificate, a standardised approach to training staff in health and social care. Staff were encouraged to undertake additional training and qualifications relevant to their roles and were provided with support through regular supervision sessions.

The service worked within the principles of the Mental Capacity Act 2005. People’s capacity to make decisions about their care and treatment was assessed and where appropriate, “best interest” decisions were made on people’s behalf. These involved relevant healthcare professionals as well as people’s friends and family members.

People’s nutritional needs were assessed when they first joined the service. The service monitored people’s food and fluid intake and their weight and where there were concerns about a person’s health referrals were made to appropriate healthcare professionals. Healthcare professionals we spoke with confirmed the service made appropriate and timely referrals to them and acted upon any advice or guidance provided.

People’s needs were assessed prior to them joining the service. People had extensive plans in place which detailed the different aspects of how staff should support them with privacy and dignity to promote individualised care. People were also encouraged to maintain their independence and to be involved in the care planning and review.

The service encouraged feedback from people using the service. Any form of dissatisfaction was taken seriously and action taken promptly to investigate and rectify issues. Detailed records were maintained and any lessons learnt were shared with the staff team. People and relatives we spoke with told us they had no complaints about the service but felt if they did they would be able to raise these and they would be dealt with accordingly.

The provider had a range of systems in place for monitoring and reviewing the effectiveness of the service. During the inspection we found action was taken to address issues or areas for improvement, although documentation did not always support this. The registered manager accepted this and assured us action would be taken to ensure documentation was updated to reflect the actions undertaken by the service to resolve areas for improvement.

People, visitors and staff we spoke with were all complimentary about the registered manager and the owners. We were informed they were a visible presence within the service and people, staff and visitors all felt they were approachable and took issues seriously. One relative told us following the inspection "The care is consistently good, but the staff are constantly seeking to make improvement. Each person matters and they are treated with respectful diligence. Nothing is too much trouble and any issues that do arise are immediately dealt with."