22 February 2023
During an inspection looking at part of the service
Hawksbury House is a residential care home providing personal to up to 35 people. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 34 people using the service.
People’s experience of using this service and what we found
Although no concerns were raised about staffing levels, management did not always ensure staff were deployed effectively, so people had their needs met in a timely way. Some recruitment checks were not always completed in line with requirements. However, management oversight required improvement to identify and manage potential risks relating to infection prevention and control. This included some PPE not stored correctly, some broken bins in bathrooms and some restricted areas not locked. Health and safety checks were completed regularly.
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. Mental Capacity Act (MCA) requirements were not consistently met as MCA assessments and best interest decisions were not consistently decision specific. Some best interest decisions did not follow the requirements of the MCA and in some cases had not been completed.
The provider was reviewing care plans to make them more personalised. The provision of activities to ensure people were engaged and had their social needs met required improvement.
People and most relatives gave positive feedback about the care provided at Hawksbury House. The home was clean throughout.
Safeguarding concerns were referred to the local authority as expected and investigated. Incidents and accidents were logged. The provider was implementing systems to help identify learning. Medicines were managed safely with accurate records kept of the medicines people received.
Staff completed the training they needed and had regular supervisions. People received the support they needed with eating and drinking.
The provider recently implemented a more structured approach to quality assurance. More time was needed to allow these changes to become embedded and evidence sustained improvement. There were opportunities for people relatives and staff to give feedback.
For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 19 December 2019).
Why we inspected
We received concerns in relation to inconsistent quality assurance; lack of management visibility; quality of food; lack of response to incidents; medicines management; IPC practices and hygiene; and lack of activities and engagement for people living at the home. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.
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 has changed from good to requires improvement based on the findings of 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.
You can see what action we have asked the provider to take at the end 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 Hawksbury House on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified a breach in relation to good governance. Please see the action we have told the provider to take at the end of this report. We have also made a recommendation about the MCA.
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.