This inspection took place on 30 March and 7 April 2017. The first day of the inspection was unannounced this meant the provider did not know we were coming.

Hawthorn Court provides accommodation for up to 62 persons who require nursing or personal care. At the time of our inspection there were 60 people using the service.

The service had a registered manager. 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.

Risk assessments were completed for each person. For example, falls and mobility. Some people’s risk assessments did not contain specific guidance for staff to follow. We made a recommendation to the provider to address this.

We found accurate Medicines Administration Records (MARs) had been maintained with no gaps or errors. This confirmed people were receiving their medicines correctly. However medicines which were to be returned to the pharmacy were not recorded in the returns book in a timely manner.

Effective recruitment checks were carried out to check whether care workers were suitable for their role. For example, two references being obtained and checks of any gaps in employment.

Health and safety checks were in place with up to date certificates. For example, gas safety certificates and moving and assisting equipment checks.

The provider had processes and systems in place to manager safeguarding, accidents and incidents. Staff were aware of the reporting processes in place to keep people safe.

The provider had a business continuity plan in place in case of an emergency. People had personal emergency evacuation plans in place for staff guidance.

Staff training was up to date. The provider had supervision and appraisal plans in place to support staff. Staff told us they had regular supervision.

The service was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty safeguards (DoLS). MCA assessments and best interest meetings minutes were in place for people who lacked capacity.

People and relatives we spoke with were happy with the care provided. We observed staff providing support in a caring, respectful manner.

People were offered a varied healthy diet with choices and alternatives available. Staff recorded people’s dietary intake where necessary.

People had personalised care plans in place for staff to refer to for support and guidance. Care plans contained people’s preferences, likes and dislikes. Relatives and people told us they were involved in planning care.

People had access to health care when necessary, records demonstrated visits by GP’s and district nurses.

There had been no complaints made about the service. Advocacy information was available for people coming into the service by way of an information pack.

People, relatives and staff told us the registered manager was approachable.

The provider was introducing a quality assurance system to monitor the quality and safety of the service. Some audits had already been completed, with actions recorded to drive improvements.

The compliance team were carrying out a review of the previous provider’s documentation still in use within the service alongside HC One Beamish's documentation to determine where changes would be made to recording systems.

Policies and procedures were in the process of being reviewed and updated.

Comments from relatives included "I am happy with Hawthorn Court. The staff are lovely with my x seems happy here. "The staff are really good at keeping me informed either by telephone or when I pop in". "The manager is about the place if I need a chat".

Care plans were written in a clear and easy to understand way and people's personal preferences were clearly recorded. There were sufficient staff on duty to support people with their care needs.

People had been individually assessed to see if they could make their own decisions.

We looked at how the service recruited staff by checking five staff files. These showed that the appropriate checks and procedures were being followed.

We found people who used the service understood the care and treatment choices available to them. People's needs were assessed, and the planning and delivery of care and treatment met their needs and protected their rights.

We spoke with five people who lived at the home and four relatives also, to find out their thoughts on the care provided at the home. Everyone we spoke with was complimentary about Hawthorn Court.

General comments from people included, “I like it here. I have friends here." also "The staff are very good. They help me when I need it.”

Comments from relatives included, "The staff are helpfull.", "I know my mother is well cared for and we can pop in anytime to see her." and "I am kept upto date on anything that happens and I can see the manager if I have anything to say."

People told us that they had been involved in their assessments of need and in their care plans. They said that they were happy with their care and with their care workers.

Visiting relatives all spoke very highly of the staff and the home. One said, “I’d like to praise the staff, they’ve been excellent. I couldn’t fault anything!” Other comments made included, “The staff are great, they love their job, and they go ‘the extra mile’”, and “Marvellous staff!”. Relatives also told us the food was excellent, and that residents were kept occupied, and didn’t get bored. One said that the staff were very skilful, and were consistently good. Another told us, “I have nothing negative to say about the home”.

This inspection took place on 7 September 2015 and was unannounced. A second day of inspection took place on 9 September 2015 and was announced. We previously inspected Hawthorn Court on 31 October 2013 and found the provider to meeting all legal requirements inspected against.

Hawthorn Court is a purpose built care home providing care for up to 62 people over two floors. All rooms are light and spacious and have en-suite facilities. At the time of the inspection there were 59 people resident at the service. 19 of whom were living in the Grace unit which is specifically designed for people who are living with dementia. The manager explained Grace means Graciousness, Respect, Acceptance, Compassion, and Empowerment.

There were two registered managers at the time of the inspection, one of whom told us they were beginning the process of cancelling their registered manager status. 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.

Some care plans were personalised and contained people’s preferences on how they wanted to be supported and cared for. Other people’s care plans did not detail how they should be supported. This related to the circumstances in which one person needed to use a hoist and how they should be supported to transfer. Another related to how to support and reassure a person when they became distressed and presented with behaviour that staff may find challenging. It had been identified that a person was at high risk of self-harm but there was no care plan in place to support staff with managing and caring for this person.

Care plans were evaluated and reviewed regularly and people and their relatives told us they were included in developing plans if they chose to do so.

Risk assessments were in place for any risks associated with people’s health and well being and also for environmental risks such as fire.

Systems were in place for the recording, investigating and monitoring of safeguarding concerns, complaints and accidents and incidents. Monthly analysis of incidents were completed so any trends or triggers could be identified and appropriate action taken to manage any situations.

Staffing levels were such that staff were able to spend quality time with people engaging and chatting in a warm and compassionate manner. The registered manager explained that they had recently increased staffing due to a complaint that if two staff were needed to support one person with moving and handling it meant there was no one available to support the other people if needed.

Staff told us they were well trained and enjoyed the training that was offered to them at the new training academy. One staff member told us they had a qualification in the safe administration of medicines and had been observed and supervised for four weeks before they had been assessed to administer medicines on their own.

Care plans and risk assessments were in place for the administration of medicines and medicine audits were completed on a regular basis. It had been identified that there were some gaps on medicine administration records and this had been addressed via internal audits.

A robust system was in place for the application and authorisation of Deprivation of Liberty Safeguards (DoLS) in line with the Mental Capacity Act 2005 (MCA). Best interest decisions were recorded in people’s care records and staff were aware of what this meant in relation to people’s care.

People’s nutritional and dietary requirements were met, with referrals being made to dietitians and health care professionals if needed. If people needed to have their meals pureed a product was used which meant the puree could be moulded to resemble the shape of, for example a chicken leg or specific vegetables. This meant food looked more appetising and attractive.

People told us they were treated with dignity, respect and compassion. Staff had a warm and caring approach with people and we observed relationships which were respectfully affectionate and mutual.

People and their relatives said they had no concerns or complaints but knew who to speak to should they have any worries. Complaints records were kept and complaints were responded to in a timely manner and we saw that some changes had been implemented in response to specific complaints and concerns.

There were a variety of ways that people and their relatives could provide feedback to Hawthorn Court. This included independent surveys and reviews but there was also a committee of people and their relatives called Hawthorn voice. This committee focused on events, fundraising and activities for people.

An activities co-ordinator was in post and they were actively engaged with people either with formal, organised activities or spending time with people going out or generally chatting with people and reminiscing.

There was regular communication with staff, which included team meetings which were a two way process of the registered manager sharing information about the service and the company but it was also an opportunity for staff to raise any concerns. Quality was high on the agenda and audits were in place and completed regularly. Where actions for improvement were needed these had been identified but there was not always a record that the work had been completed.

You can see what action we told the provider to take at the back of the full version of the report.