Hawthorn Lodge Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Most people and relatives we spoke with couldn’t remember if they had an assessment completed prior to moving into the service. Guidance documents written by health and social care staff had not been used effectively, to create meaningful care plans for people. People and their relatives had not always been fully consulted in care planning.

People living with specific clinical conditions did not always have updated care plans and risk assessments in place for these. For example, one person was described as requiring repositioning every 2 hours, as they were at a high risk of pressure sores. However, different parts of their care plan stated positional changes should be every 4 hours. This left people exposed to the risk of staff not understanding their specific needs.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The management team had not ensured people and those close to them were involved in regular assessments and reviews. This left a shortfall in ensuring people’s opinions were respected, listened to and implemented as part of their care planning.

One person said, “I’ve never heard of such a thing, and I’d be interested.” A relative told us, “I’ve no knowledge about any care plan or information held.” We raised the lack of involvement in care planning with the management team, who advised they were making review meetings a priority moving forwards.

Feedback on mealtimes was mixed, with people generally feeling food provision was adequate, but more choice at mealtimes would be appreciated. One person who chose to eat in their bedroom said they were asked on a Monday for their meal preferences for the week. Other people told us they were asked at the table for their choice for that meal, which would limit the availability of alternative options if requested. One person said, “It varies - good and bad meals. They ask us our choice once we’re sat at the table. It can be a bit cold if you’re one of the last to be served. We have nice puddings but usually with cream, rarely custard which is a shame. The ‘diabetics’ get fresh fruit but no one else. I’d like a bowl of fruit salad now and then.”

Snacks, fruit or biscuits were offered from the tea trolley mid-morning and mid-afternoon. One person told us they could ask for a sandwich or crisps between meals, if staff had time to prepare this. Another person said, “On the whole it’s 8/10, we get a choice at mealtimes. It’s adequate food and on a 4-week cycle of menus. I like to go down for my meals and it’s hot enough when it arrives. You can ask for less or a bigger portion.”

People and their relatives were concerned about the lack of oversight of their hydration needs. One person said, “I asked for a jug of water today as usual, as I’m supposed to have one all the time, and got squash instead. Twice I’ve asked carers to change it and they say of course, but then they forgot and never came back. The trolley comes round at about 11am and 3pm.”

Another person said, “They give me bottles of water but I have to get them to loosen the caps, with my arthritis. We get juice with our meals and can have tea and coffee between times.”

The management team did not ensure best practice in dementia care was being followed. For example, one person was described in their dependency assessment as displaying distress behaviours. The records for this person showed a lack of exploration of the antecedent, behaviour and consequences records, (ABC) of each event. This structured approach allows care staff to understand potential triggers and impacts and can support effective interventions.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Where people had been assessed by an external team prior to moving into the service, we saw this information had not always been incorporated into their care plans and risk management records. For example, a person living with diabetes and a history of dysphasia had contradictory information in their nutrition and hydration support plan. The plan referred to provision of a low blood sugar diet, but then stated the person was to be given a normal diet, as they were not at risk of choking. The plan referred to hypo and hyperglycaemia but did not provide guidance for staff of what signs of these would be. These inconsistencies in care plans and risk management left the staff team unclear as to what the support needs of this person would be, and how to recognise any changes which might require external review.

People and their relatives did not feel fully engaged in reviews of their care. One relative told us, “I’ve never heard of or seen anything like a care plan. We don’t get told anything unless there’s been an incident or [name] is ill.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Changes in people’s presentation, emotional state or distress, which might indicate a deterioration in their health or wellbeing were not always being recognised. For example, there was a lack of personalised information on pain scales for people who were unable to communicate this.

People were supported to access their GP, dentist or optician regularly. Feedback from people and relatives was positive regarding this being accessible for them when required. One person said, “I have the chiropodist monthly and the hairdresser comes twice a month on Wednesdays. An optician comes once in a while if you want a checkup.” A relative told us, “The doctor has been today and is happy with my family member. An Admiral nurse comes in once a month also.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Feedback we received from people indicated the service worked in partnership with external agencies. However, we found the care plans, risk assessments and daily records for people had not always been regularly updated when a review had taken place. This left people living at Hawthorn Lodge with potential unmet needs.

We found a lack of consistency in the therapeutic activities available for people. People and relatives gave mixed feedback about the structured activities which were offered. In the main, people were observed to be seated in the communal lounge for extended periods of time with a lack of interaction with staff. On the day of our visit there were yoga and music exercise sessions in the morning for residents with some mobility. In the afternoon board games were played by several people.

We saw no activity provision in the other lounges, the TV was the only entertainment, with a semi-circle of chairs facing the TV. Chairs in other parts of the room had no sight of the TV, just sound across the background noise.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

People were not always supported to understand consent, what being safe meant to them, and how to raise concerns when they did not feel safe, or they had concerns about the safety of other people. People were not always supported to make choices about their day and night routines. Information on this was not clearly recorded in their care plans and it was unclear if people’s preferences were known or being respected by staff. Therefore, we could not be confident that people were not being unnecessarily restricted. Care records did not include how either through verbal or non-verbal means people were able to refuse or give consent for specific decisions.

We saw staff asking people for their consent prior to entering their bedrooms, or before providing personal care. One person said, “They’re quite good and ask if I’m ready for a wash and dressing.” However, we observed some drinks being taken away from the side tables next to people, without staff asking if people had finished their drink. We raised this staff approach with the management team to review.