Hawthorne House

Updated 1 February 2024

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

This inspection was carried out by 6 inspectors, a pharmacist specialist, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. On 20 November 2023, 5 inspectors visited the service. One inspector spoke with relatives over the telephone to gather feedback on their experience of working in the service. The Expert by Experience spoke with people living at the service. The pharmacist specialist reviewed medicines at the home.

Service and service type

Hawthorne 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. Hawthorne house is a care home with 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 the Care Quality Commission 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 not a registered manager in post. An experienced manager had transferred from one of the provider’s other care homes and had been in post for 2 months at the time of our visit. They were planning to submit an application to register with us.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 13 November 2023 and ended on 20 November 2023. We visited the home on 20 November 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

During the inspection, we reviewed 17 care plans across all of the units. We reviewed 5 medicine administration records and observed a medicines administration round. We reviewed actions in progress to reduce medicine errors. We spoke to the home manager, regional manager, 4 nurses, and 8 care staff. We spoke with 13 people receiving care and 2 relatives.

Updated 1 February 2024

About the service

Hawthorne House is a residential care home providing personal and nursing care to up to 102 adults across seven separate units. People living at Hawthorne House have various needs which include dementia, physical disabilities, mental health needs and rehabilitation for acquired brain injuries. Each of the units are adapted to meet the needs of the people living there. At the time of our inspection there were 99 people living at the service.

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

Governance systems, management, and provider oversight had not been fully effective, and standards had declined in the home since our last inspection. A new manager had been in post for approximately 2 months when we completed this inspection. They acknowledged improvements were required across the service and had been, and were continuing, to work with the provider to introduce new systems to help improve the service. The service was being supported by the local Integrated Care Board (an NHS organisation) to make the necessary improvements. There was a friendly atmosphere within the service. People and relatives were generally positive in their comments about the staff team.

People told us they felt safe at the home but risks to people's health and well-being had not been consistently identified and assessed. Some of these risks were associated with unclear records, medicine management and staffing arrangements. Staff received training relevant to their roles but staff on some units felt pressured and not able to support people how they would like. People’s medicines had not been managed safely consistently to ensure people received their medicines as prescribed. People had individualised care plans that supported staff to deliver their care. However, some people did not experience person centred care that always met their needs. 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. Staff were recruited safely in line with the providers policy. People told us staff treated them with respect. People had access to healthcare professionals to support their needs when necessary to ensure they remained well.

The prevention and control of infection was managed safely. Good infection prevention and control processes were followed.

We received concerns in relation to the management of risks related to people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe 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 report.

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

Rating at last inspection

The last overall rating for this service was Good (published 1 May 2021)

Why we inspected

The inspection was prompted in part due to concerns received about management of risks associated with people’s care including medicine management. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing and the governance 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 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.