Hawthorn Lodge Care Home

Updated 7 December 2023

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 Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and an Expert by Experience.

An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Hawthorn Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Hawthorn Lodge s a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We also reviewed information shared with us by the local authority. We used all this information to plan our inspection.

During the inspection

We spoke with 3 people and 13 relatives. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with 7 staff members. This included kitchen, housekeeping, maintenance, and care staff. We spoke with three external professionals visiting the service. We also spoke with the registered manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We completed observations of people being supported by staff and the service environment. We reviewed a range of documentation including people’s care plans, medicine records, staff recruitment files, training records and manager audits.

Updated 7 December 2023

About the service

Hawthorn Lodge is a residential care home providing accommodation and personal care. The service is registered for up to 60 people. The service provides support to people aged 65 and over. The building is on two floors containing people's rooms and flats as well as a shared dining room and several lounge areas. At the time of inspection the service was supporting 42 people.

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

Governance systems and processes had failed to make sustained improvements since the last inspection. Quality assurance systems failed to identify and mitigate risks and left people at risk of harm.

People were not protected from environmental risks. Risks to people were not documented or mitigated effectively. The provider took action to mitigate risks highlighted once raised by inspectors.

Medicines were not managed in line with best practice. People who smoked and were prescribed flammable creams were not protected from the risk of severe burns or fatal harm. Action was taken by the provider to mitigate risks to these people once raised by inspectors.

People were not protected from the risk of infection. Areas of the service were not clean, had damage and wear and required repair.

Professional advice was not always sought or followed in a timely manner.

Potential safeguarding incidents were not consistently documented or reported to the local safeguarding authority for further review. Action was taken to improve these processes following discussion with the inspector and local authority.

People were not always supported to have maximum choice and control of their lives as they were not always supported in the least restrictive way possible and in their best interests. Systems in the service did not always support this practice. Relevant legal authorisations for Deprivations of Liberty for people were in place where required.

Most relatives felt engaged by staff and the registered manager. Staff felt the registered manager was approachable and felt able to raise concerns.

People and relatives we spoke with felt the service was safe. Staffing levels were in line with dependency levels. Staff were recruited safely.

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 07 October 2022)

Why we inspected

We received concerns in relation to infection control, safeguarding and medicines management. As a result, we undertook a focused inspection to review the key questions of safe 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 requires improvement to inadequate based on the findings of this inspection.

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 Hawthorn Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to people’s health and safety, and 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 continue to monitor information we receive about the service, which will help inform when we next inspect. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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 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.