Background to this inspection
Updated
3 December 2022
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 Care Act 2014.
Inspection team
The inspection was completed by 2 inspectors and an Expert by Experience.
Service and service type
Hawthorn House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission.
Notice of inspection
The first day of inspection was unannounced. We informed the registered manager we would be returning for a second day, but not for the third day.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was asked to complete a provider information return prior to this inspection. 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
We spoke with 11 people who used the service, and 3 people's relatives about their experience of the care provided. We spoke with the registered provider and 9 members of staff including the registered manager, deputy manager, and day and night care staff.
We looked around the environment to review the facilities available for people and the cleanliness of the service.
We reviewed a range of records. This included samples of 6 people's care records, and multiple medication records. We looked at 6 staff files in relation to recruitment and training. A variety of records relating to the management of the service, including policies and procedures were reviewed.
Updated
3 December 2022
Hawthorn House is a residential care home providing accommodation and personal care to up to 22 people, some of whom may be living with dementia. At the time of our inspection there were 16 people using the service.
People's experience of using this service and what we found
The service was not well-led. This was the fourth consecutive inspection where the provider had failed to reach a rating of at least good.
Quality assurance systems continued to be ineffective. Lessons had not always been learned as some of the same issues remained from the previous inspections.
Shortfalls had not been identified or promptly addressed which placed people at risk of harm and of receiving a poor-quality service.
People were not always safe and were placed at risk of harm as the provider had not identified, assessed or mitigated risks. This included risks related to people's health and care needs, as well as environmental risks.
Some areas of the service were not clean, and staff and visitors did not continually follow infection control guidance to manage the risk of spread of infection.
Medicines management practice had deteriorated since the last inspection and were unsafe, which put people at risk of harm. We could not be assured people received their medicines as directed, and medicines were not always stored safely.
We could not be assured staff were suitably skilled to ensure people received appropriate care and support to meet their needs. The providers processes could not demonstrate that suitably competent staff were deployed due to a lack of recorded competency and training. Appropriate robust checks were not always completed prior to new staff commencing employment.
There had been some improvements made to the environment, some floorings and furniture had been replaced and a new kitchen had been fitted.
Staffing levels were sufficient during the inspection. Staff were kind and attentive to people. Most feedback from people and their relatives about the care provided was positive.
People were supported to have maximum choice and control of their lives and staff supported did them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was inadequate (published 23 May 2022) and there were 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 the provider remained in breach of regulations.
Why we inspected
We carried out a focused inspection of this service on 8 and 10 March 2022. Breaches of legal requirements were found, and we issued warning notices for the breaches of regulations 12, safe care and treatment and 17, good governance.
The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, and good governance.
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 of safe and well led which contain those requirements.
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 remains inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.
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 COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hawthorn House on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to safe care and treatment, staffing, and good governance 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 appeals have been concluded.
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.
Special Measures
The overall rating for this service is 'Inadequate' and the service is therefore remaining 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.