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Reports


Inspection carried out on 6 February 2020

During a routine inspection

About the service

The Hawthorns is a residential care home that was providing personal care to 37 people at the time of the inspection. The service can support up to 39 people. Most of the people living at the service had age related conditions many of whom were also living with dementia.

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

The service had not been well managed. The governance of the service was insufficient to ensure that people received support to keep them safe and maintain their wellbeing. Audits had not always been completed or used to develop improvements in the quality and safety of the service people received. Records had not been fully or accurately completed and were disorganised. People were not asked to give their views of the service so that shortfalls could be identified, and improvements made.

People had not always been protected from the risk of potential abuse and risks to people's health and safety had not been consistently assessed and mitigated. Medicine were not always safely managed and the competencies of some staff that administered medicines had not been assessed. The recruitment of some staff had not been robust and the relevant checks had not always been completed. The staffing levels were not based on an assessment of people’s needs and sometimes people had to wait for assistance. Some areas of the service were not clean and cleaning products had not always been kept in a locked cupboard.

People's needs had not always been adequately assessed and planned for. Care plans provided little detail or guidance for staff to follow when delivering care. Some people’s care was not being effectively monitored because staff had not been provided with the relevant guidance. 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.

Staff had not always received the induction, training and support they needed to provide safe and effective care. Many staff had not completed the training the provider considered to be mandatory before they worked unsupervised.

We have made a recommendation about the design and adaptation of the building to meet people's needs.

People had not always been treated well. Personal valuable items being kept by the provider had not been all been named so it was not possible to identify who they belonged to. Although people who could move independently were able to move freely about the service others were not always supported to remain independent. Most people felt that staff were kind and caring.

People did not always receive care that was personalised to meet their individual needs. Care plan contained little information about people's preferences for how they wanted their care to be delivered or how they like to spend their time. The opportunities for people to engage in activities, hobbies and pastimes that interested them were limited and staff did not always have the time to spend time talking to people. People told us they did enjoy the activities that were on offer, but most people spent much of their time in their rooms. People had not always been asked about their wishes on their end of life care and complaints people had made had not always been recorded.

We have made a recommendation about the management of complaints.

People were supported to access the support of healthcare professionals. We received mixed feedback about meals. People told us they could ask for an alternative if they did not like the food on offer.

Regular staff knew people well and had a good understanding of their needs. People felt staff were kind and caring and treated people with respect. Although limited, people did enjoy the activities that were on offer.

Two experienced managers had been deployed to work at the service and were developing an action plan to address

Inspection carried out on 24 June 2019

During a routine inspection

About the service:

The Hawthorns is a ‘care home’ and is located in a residential area of Wilmslow. The Hawthorns provides accommodation and personal care for up to 39 people. Accommodation was found over two floors; bedrooms were spacious, there was an accessible passenger lift and a communal garden area for people to enjoy. At the time of the inspection 32 people were living at The Hawthorns.

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

Quality assurance measures were not always effectively in place. Although we received positive feedback about the newly recruited manager, areas of governance required improvement as a measure of monitoring and reviewing the quality and safety of care people received.

Medicine management procedures were in place. However, we did note that some areas of practice did not comply with the providers medication administration policy. We have made a recommendation regarding this.

People’s level of risk was assessed from the outset. Support measures were implemented although we did note that some areas of risk were not always being reviewed or monitored accordingly.

Safeguarding and whistleblowing procedures were in place; staff knew how to raise their concerns and the importance of keeping people safe.

Staff were appropriately recruited, and staffing levels were routinely analysed. People told us that staff were responsive to their needs and provided support in a timely and effective manner.

Staff were observed providing person-centred care. It was evident during the inspection that staff knew people well and provided the tailored level of care that was needed.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We received positive feedback about the variety of different activities that were scheduled. We were told that the area of ‘activities’ had improved, and people were encouraged to participate in activities that were fun, stimulating and engaging.

The provider had an up to date complaints policy in place. Complaints were monitored and reviewed and responded to in line with company policy.

People had the opportunity to share their thoughts, views and opinions about the provision of care being delivered during regular ‘resident meetings’. New quality questionnaires were being devised and circulated as a measure of establishing feedback from people, staff, external professionals and relatives.

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 17 August 2017). Since this rating was awarded the registered provider of the service has changed. We have used the previous ratings to inform our planning and decisions about the rating at this inspection. At this inspection, the service has been rated ‘requires improvement.’

Why we inspected

The inspection was prompted in part due to concerns received about risk management, staffing levels and overall governance of the service. A decision was made for us to inspect earlier and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the ‘safe’ and ‘well-led’ sections of this full report.

Enforcement

We have identified a breach in relation to ‘good governance' 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.