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We are carrying out a review of quality at Hawthorne House. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 3 March 2020

During a routine inspection

About the service

Hawthorne House is a residential care home providing personal and nursing care to 92 people at the time of the inspection. The service can support up to 102 people.

This is a care home that provides nursing and residential care to people living with dementia and physical disabilities. The home also offers specialist services for people with acquired brain injuries, including rehabilitation, and Huntington’s disease specialist care.

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

The provider failed to meet regulations to ensure people were safe and had their needs met. Systems to ensure people were safeguarded from abuse had not been addressed by the provider. People were at risk of harm, as systems to protect people were not always followed and were ineffective at identifying and managing risks. People did not always receive their medicines safely. There were not always sufficient staff to ensure people received the support they needed in a timely way.

The policies and systems in the service did not support people to have maximum choice and control of their lives. However, staff did support people in the least restrictive way possible and in their best interests. Staff did not always receive the specialist training they needed to support people. People had a nutritious diet, and they enjoyed the food offered. However, the mealtime experience was not always good for people. There had been improvements made to the environment, and there were plans for further improvement to adapt the environment to meet people’s needs. People had their needs assessed and received the health care they needed.

People and their relatives said they were supported by kind and caring staff. However, the provider did not always show compassion for people by ensuring there were sufficient staff to meet people's needs and spend time with them. Feedback from people living at the home was not always actioned so that improvements could be made.

People did not always receive the support they needed. People’s records did not always guide staff to provide personalised support. People had some access to interesting things to do. The management team were recruiting extra staff to improve people’s social inclusion and provide interesting things to do. People's end of life plans needed additional information to ensure they were up to date. Complaints were investigated and outcomes actioned, although relatives did not always feel listened to.

The service was not well-led. For the second consecutive inspection, the provider continued to lack effective governance systems to identify shortfalls in the quality and safety of the service. The provider's governance systems had failed to ensure people were protected from the risk of harm and agreed safety measures were put in place. Systems to provide an overview of clinical governance were not effective because staff were not given time to complete checks. Actions identified were not consistently addressed and, therefore, there was a lack of continuous learning and improving people's safety and outcomes.

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 16 March 2019).

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

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

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to protecting people from abuse, safe care and treatment, sufficient staffing, consent to care, good governance and failure to notify 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 ap

Inspection carried out on 10 October 2018

During a routine inspection

About the service:

Hawthorne House provides accommodation, nursing and personal care for up to 102 people with a variety of mental health problems combined with physical disabilities or challenges associated with behaviours. Care is provided over seven units. One unit is specifically for those people with an acquired brain injury. The other units support people with high level mental health needs, those living with dementia and those who may have developed mental health conditions as a consequence of other illnesses. When we visited in October 2018 there were 79 people living in the home. In January 2019 there were 87 people living in the home, although three were in hospital on the day of our visit.

People’s experience of using this service:

•Hawthorne House opened in the summer of 2017 and there had been three managers by the time of our first inspection visit in October 2018.

•Whilst we observed some very positive care and support to people, we found the provider’s quality assurance system had not ensured everyone achieved such positive outcomes. For example, people within some of the dementia care units did not receive the same level of person centred care as those on the acquired brain injury unit.

•The provider had systems to identify where there were problems in the service, but managers were not always aware of these. This included incidents involving people which had not always been reported to the managers and therefore had not been considered in the management analysis of accidents and incidents so the provider could have an accurate overview to identify any trends or patterns.

•There were sufficient numbers of nursing and care staff on duty to keep people safe and monitor the communal areas of the home. However, due to high levels of staff sickness, staff were often assigned to work in units they were unfamiliar with, and with people who did not know them.

•There was a programme of activities provided by activities staff. However, improvements were required in understanding and responding to people’s individual interests and need for occupation and engagement on the individual units.

•On some units, especially for those people living with dementia, there was little of interest in the décor, such as pictures, photos, or tactile aids people could touch and hold to stimulate their minds.

•Overall, individual risks to people were managed safely.

•People were confident they received the healthcare support they needed to keep their health conditions stable and knew staff would seek further support if necessary.

•Visiting healthcare professionals spoke positively about the service and people received their medicines from staff who had been trained and assessed as competent to do so safely.

•People's needs were met by staff who were skilled, competent and suitably trained. The provider monitored training to ensure staff skills were kept up to date and they received the training they required.

•Staff worked within the principles of the Mental Capacity Act 2005. People were given day to day choices and this was reflected throughout their care plans and through our observations. Staff sought people’s consent before care interventions.

•People were supported to have enough to eat and drink to maintain their well-being. Nutritional risks were known by staff who monitored people’s food and fluid intake when a need had been identified.

•Staff understood the importance of supporting people with empathy and compassion and provided reassurance when people became anxious.

•Staff were non-judgemental and responded appropriately when people became distressed or agitated. They respected people’s diversity and lifestyle choices.

•People’s relationships with family and friends were encouraged.

•People knew the management team and staff felt motivated by the new registered manager.

•The registered manager worked with external organisations to develop the service they provided.

The registered provider was in breach of Regulations