The Hawthorns

The Hawthorns is a residential care home providing personal care to 20 people aged 65 and over at the time of the inspection. The service can support up to 39 with age related conditions, some of whom were also living with dementia.

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

We looked at infection prevention and control measures under the Safe key question. Overall, we were assured that people were being kept safe.

The registered manager was aware of current PPE guidance and staff had received infection control training. However, we observed two staff were not always wearing PPE during interactions with people. The registered manager took prompt action to address this.

Safe recruitment procedures were in place. The training matrix clearly showed all training undertaken. Staff told us they attended regular staff meetings and felt well supported by the manager.

Governance systems were used to identify areas for development and improvement. Audits were regularly and consistently completed in all key areas of the service. The staff and management team worked closely with health and social care professionals to ensure good outcomes for people.

Medication was managed safely by trained and competent staff. Medication administration records (MARs) were fully completed and regularly reviewed. Medicines policies and procedures were available for staff along with best practice guidance.

People were protected from the risk of abuse. Safeguarding policies and procedures were in place and staff had received training on how to keep people safe. Staff told us they felt confident to identify and raise any concerns they had about people's safety. They believed prompt action would be taken.

Family members told us they felt their relatives were safe living at the home and felt confident they would be contacted if staff had any concerns. People appeared happy with the home and the staff that provided their care.

Staff assessed and reduced risks as much as possible, and there was equipment in place to help people remain as independent as possible.

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 Requires Improvement (published 7 December 2020).

Why we inspected

We received concerns in relation to staff conduct, moving and handling training, and the procedure for admitting people in to the home during the pandemic. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Hawthorns on our website at www.cqc.org.uk

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Hawthorns is a residential care home providing personal care to 17 people aged 65 and over 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, some of whom were also living with dementia.

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

People and their relatives were very positive about the care and support they received. They told us improvements had been made at the home since the current manager had been in post. The management team had engaged and were focused on developing the culture of person-centred care. Communication throughout the home had improved.

Systems were now in place to monitor the quality and safety of care people received. Quality audits had been implemented and were carried out to identify and act on any shortfalls in the service. These required ongoing development to demonstrate actions had always been completed and addressed. The management were responsive to any feedback given during the inspection and took action straight away.

We looked at infection prevention and control measures under the Safe key question. Overall, we were assured that people were being kept safe. We have also signposted the provider to resources to develop their approach. This relates to aspects of the cleanliness of the environment and equipment, along with the use of personal protective equipment (PPE).

Improvements had been made in relation to the safe administration of medicines. Care records had greatly improved and any potential risks to people were now being assessed. Feedback from health colleagues confirmed positive changes in responding to people’s changing health needs.

People were supported by enough staff to meet their needs, staffing levels were kept under review. New staff had been recruited and were now recruited safely. There had been a focus on staff training and new staff were undertaking an induction. There was ongoing recruitment and further plans to roll out staff appraisals.

Systems were in place to safeguard people from the risk of abuse. People told us they felt comfortable and safe living at the home. However, one person raised a concern about the approach of one staff member which was dealt with appropriately when raised with the registered manager.

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. Mental capacity assessments and best interest decisions could be developed further to ensure assessments considered each specific decision being made.

The management team acknowledged that improvements were ongoing. They had worked hard on making improvements, also working within a Covid-19 pandemic, which had created new challenges. The positive changes now need to be sustained and fully embedded.

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 inadequate (published 4 April 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 3 April 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned focused inspection based on the previous rating and to examine any risks.

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 coronavirus and other infection outbreaks effectively.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe, Effective and Well-led.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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

Follow up

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

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 the shortfalls and bring about improvements.

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 20/07/2019) where we identified one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the administration of medicines and the safety of the service A decision was made for us to inspect and examine those risks.

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

Enforcement

We have identified breaches in relation to the safety of the service people receive, staffing levels, staff training, protecting people from the risk of potential abuse, gaining lawful consent, providing people with person centred care and the governance of the service. Please see the action we have told the provider to take at the end of this report.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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.