The Hawthorns Care Centre

Updated 20 January 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 two inspectors, one medicines inspector and two Experts 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

The Hawthorns Care Centre 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. The Hawthorns Care Centre is a care home with 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.

Inspection activity started on 5 December 2022 and ended on 21 December 2022. We visited the service on 5, 6 and 16 December 2022.

What we did before the 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. 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 used information gathered as part of monitoring activity that took place on 27 October 2022 to help plan the inspection and inform our judgements.

We used all this information to plan our inspection.

During the inspection

We reviewed the home environment, made observations of mealtimes, medicines administration and staff interactions with people.

We spoke with the registered manager, general managers, and 8 members of staff, including the deputy manager, maintenance staff, chef, activities staff and care staff. We spoke with 7 people using the service, and 10 people’s relatives.

We reviewed a range of documents, these included 10 people's care plans and risk assessments, 14 medicines records including associated care plans and 3 topical administration processes. We reviewed policies and procedures, training records, audits, recruitment files and other records in relation to the running of the service.

Updated 20 January 2023

About the service

The Hawthorns Care Centre is a nursing home which provides accommodation for 73 people. The service provides support to older people, some of whom were living with dementia. At the time of our inspection they were providing care for 66 people. The service accommodates people in one adapted building over three floors.

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

We found that medicines were not always managed safely throughout the service. Some aspects of health and safety and environmental risks in the home were not always managed effectively.

The leadership and governance of the home required improvement to ensure audits were effective in promoting improvement and identifying risks. Quality assurance measures in place were not always robust, some issues identified on inspection were not appropriately identified. The registered manager has acted upon feedback from this inspection and was putting plans in place to address the issues identified.

Staff did not always receive training or training updates relevant to their role. This included training in; end of life care, oral health and person-centred care. Some staff did not have training for specific conditions.

Care plans were personalised and contained information about people's history, and personal preferences. People's risk assessments and care plans were reviewed monthly, however some areas of the care plans contained inconsistent or missing information which was not always identified during the audit process.

Activities in the home were limited, particularly for people who were less able to participate in group activities. Further work was required to reduce the risk of people experiencing social isolation through personalised activities.

People and their relatives said that staff were caring and kind. We observed staff were patient and compassionate towards people.

Mental Capacity Act

People were not supported to have maximum choice and control of their lives and staff did not 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for the service under the previous provider was Good, published on 23 October 2017.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

The overall rating for the service has changed from good to requires improvement 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. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Hawthorns Care Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, need for consent and good governance at this inspection. We have made recommendations in training and activities.

Please see the action we have told the provider to take at the end of this report.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk