Archived: Hawthorns Residential Care Home

Our inspection took place on 18 July 2016, and was unannounced.

The service did not have a registered manager. An application had been made by the manager of the service to register with the Care Quality Commission (CQC). 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.

People felt safe in the service. Staff understood the importance of safeguarding them and had been trained to recognise signs of potential abuse and neglect. They were aware of the systems in place to report or raise concerns. Processes were in place to manage identifiable risks for people and to enable them to remain as independent as possible using control measures. Risk assessments had been carried out to guide staff to manage and reduce the level of harm to which people may be exposed.

There were sufficient numbers of staff who had the right skills and knowledge to meet people’s needs. Safe and effective recruitment practices were followed to ensure that people remained safe.

People’s medicines were administered safely in line with prescribed guidance. There were suitable arrangements for the safe management of medicines.

Staff received on-going training to enable them to perform their roles and responsibilities appropriately. New staff had been provided with induction training to give them the right skills and knowledge to support people appropriately.

People’s consent was sought by staff on a daily basis and their decisions respected. Where people lacked capacity to make their own decisions, consent had been obtained in line with the Mental Capacity Act (MCA) 2005.

People enjoyed a balanced dietary intake, in line with their specific preferences and dietary requirements. They were provided with a balanced diet and adequate amounts of food and drinks of their choice. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to ensure their general health and well-being was maintained.

People experienced care from staff that were kind, caring and compassionate and who understood their needs well because they had involved people in the care planning process. Staff worked hard to promote people’s privacy and dignity and respect their equality and diversity.

Staff understood how people preferred to be supported because they were guided by information contained within person centred care plans. There were effective systems in place for responding to complaints and people and their relatives were made aware of the complaints processes. People and where appropriate, their family, were given regular opportunities to express their views on the service they received.

The service was led by a team of established staff and as a result experienced good leadership. This positive ethos meant that staff were motivated and positive in their desire to provide good quality care for people. Quality assurance systems were in place and were used to monitor service performance and drive future improvement.

At the time of our inspection five people lived at The Hawthorns. We met with three people who used the service. Staff told us that the remaining two people had decided to have tea at one of the providers other services after they had attended the day centre. Because of the nature of their disabilities, people were not able to tell us in detail about their experiences. Our summary is based on our observations during the inspection, speaking with staff supporting people who used the service, the deputy manager, the provider and from looking at records. If you want to see the evidence supporting our summary please read the full report.

During the inspection we sought answers the five key questions below:

Is the service safe?

Staff had received training in safeguarding vulnerable adults, understood the different types of abuse and their responsibilities for reporting any concerns about the treatment of people who used the service.

People had been placed at significant risk as a result of two night staff who worked alone not being trained to administer medication. The provider gave us immediate assurances that a trained member of staff would be available on each shift.

Is the service effective?

People's health and care needs were assessed and plans of care developed according to their needs which helped staff to deliver appropriate care. From our observations and discussions with staff, we concluded that staff had a good knowledge of each person's care needs and preferences. This meant that staff were able to support people effectively.

Is the service caring?

We saw that people were treated with dignity and respect by the staff. People who used the service were relaxed in the presence of staff and responded positively to them.

Is the service responsive?

We saw that staff were available to support people who used the service and that they were responsive to signs that they may need assistance. Staff had responded to the changes in one person's behaviours by seeking advice and support from the community learning disability team.

Is the service well-led?

We found that the service was well organised. The provider had taken action since our last inspection to make the improvements required in relation to considering people's capacity to consent and safeguarding them from financial abuse.

We were satisfied that the provider responded quickly and appropriately to concerns raised by the inspector that people who used the service were left at night without staff trained to administer their medication. However, the fact that this had been allowed to occur raised concerns about the management and their oversight of the service.

As part of our inspection we looked at some care plans and we talked to the people who lived at the home, their family members and staff who worked at the home.

We found that people who lived in the home were happy with how they were treated in the home. One person was watching television, whilst another returned from time at a day centre.

A family member told us, 'They treat X well and look after him.'

Another person told us, 'We are fortunate to have her there.'

Although we had positive feedback from family members about the care and support provided at The Hawthorns we found that care plans did not provide clear evidence about how decision about obtaining consent to care and treatment had been made.

We also found that the Provider had inconsistent arrangements in place for the management of financial arrangements for the people who lived in the home. We have judged that the Provider should take action on these matters.

We reviewed how the safety and suitability of the premises and found that the home had been adapted to meet the needs of the people who lived there.