13 December 2016
During a routine inspection
Hawkesgarth Lodge is a care home with nursing for up to 48 adults living with dementia. There were 27 people living at the service at the time of the inspection.
There was no registered manager employed as they had recently left the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A peripatetic manager was working in the service to provide management support to staff. A peripatetic manager moves from one service to another whenever a need arises.
Risks to people had been identified but the written assessments did not reflect the practice of staff. Risks were not adequately managed. Accidents and incidents were not recorded consistently.
People were at risk of infection. The service was unacceptably dirty.
Staff were recruited safely but there were insufficient numbers of staff on duty to meet people’s needs effectively.
Servicing and maintenance of the environment had been carried out in a timely manner.
Training was up to date but had not been embedded over time into staff practice. Staff had not been supported appropriately but since the arrival of the manager each member of staff had received supervision at least once.
The principles of the Mental Capacity Act (MCA) 2005 were not fully understood by staff and the correct process for making best interest decisions had not been followed.
The chef was knowledgeable about people’s dietary needs and the food we saw was nutritious. The chef was aware of how to fortify diets and provided fortified drinks and finger foods for people. However, care staff practice and supervision was poor when serving and assisting people to eat and drink.
Staff were described by people as being caring and we saw kindness shown to people by staff. However, they did not promote people's dignity or meet people's basic care needs through the care they provided.
Care plans did not reflect the care we observed being provided by staff.
Activities took place over five days and they were not meaningful to people living with dementia. There were no stimulating activities for people and no books or magazines to look at.
The environment was not dementia friendly and did not reflect current good practice guidance.
People knew how to make a complaint and we saw that where complaints had been made they were dealt with in line with company policy.
Notifications had been made to CQC when required.
There had been a lack of effective leadership and management at the service which had led to a significant deterioration in the quality of the service. This was being addressed by the registered provider but there were still areas of concern.
The quality assurance system was not effective. The issues found at the inspection had not been identified through auditing and monitoring. These issues had been identified in an action plan which the manager was using to demonstrate where improvements were being made.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.
Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.
Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded