The inspection took place on 5 December 2016. This was an unannounced visit.

Prior to this inspection this service was inspected on 18 June 2014 where all standards inspected were met.

Hawthorn House is registered to provide accommodation with personal care to six people. The client group consist of people with mental health needs and learning disabilities. At the time of our inspection there were five people using the service. The home is located in a residential area of Tottenham.

There is a registered manager in post. 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.

Staffing levels were allocated based on people’s level of need and planned activities. People’s needs were assessed and care plans created for each person using the service. We observed good interactions between staff and people using the service and people were treated with respect.

Staff understood their role and responsibilities in keeping people safe from harm and knew how to raise any concerns. Assessments were undertaken to assess any risks to the people using the service and the staff supporting them. Risks were assessed and plans put in place to keep people safe.

The service followed safe recruitment practices and carried out appropriate checks before staff started supporting people.

Care staff received supervision and a yearly appraisal. These processes gave staff an opportunity to discuss their performance and identify any further training they required. Care staff placed a high value on their supervision and support.

People received a service that was caring. They were cared for and supported by staff who knew them well. Staff understood the importance of treating people with dignity and respect. Although some people told us that staff did not always knock before entering their rooms. People were supported to maintain relationships with family and friends.

Staff supported people to take their medicines when required and attend healthcare appointments and liaised with their GP and other healthcare professionals. Although staff we spoke with told us that they had received training in assisting people with eating and drinking and knew how to assist people at risk of choking. The service did not seek healthcare professional advice from the speech and language therapist (SALT) in relation to people identified by them as being at risk of choking.

The service had a complaints policy. This included timeframes for dealing with complaints and provided external contact details. People told us that they knew how to make a complaint and felt comfortable approaching the registered manager with any concerns.

We have made a recommendation about engaging people in meaningful activities.

The inspection team who carried out this inspection consisted of an adult social care inspector. During the inspection, we looked to answer five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

As part of this inspection we spoke with two people who use the service, a relative, the registered manager, a director, two care staff. We also reviewed records relating to the management of the home which included, three care plans and risk assessments.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were protected from the risk of unsafe premises because the provider had maintained the building. One person we spoke with told us they felt safe living at the home.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. Staff we spoke with understood people’s needs. A relative told us that they were involved in their relatives care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One person told us that staff were, “very kind.” A relative told us that some staff were caring and others focused on the task.”

Is the service responsive?

We saw that the service had a complaint procedure and staff were aware of this should people wish to make a complaint. One person we spoke with told us that they were able to approach staff if they had any concerns.

Is the service well-led?

Staff we spoke with showed that they understood the needs of individual people they cared for. People were cared for by staff who understood their needs.

There were systems in place for monitoring the quality of the service and people were asked their views of the service and we saw that this was acted on.

When we visited we found that the staff on duty were suitably trained and experienced and a new member of staff had started an induction programme. One member of staff said 'I have learned a lot from my Team Leader.' The home was clean and tidy and people had personalised their bedrooms. One person told us they were 'very pleased' with their newly painted bedroom.

We spoke to all five people who used the service and they all said positive things about the home. All said the staff were kind to them and three singled out three different members of staff for praise. People told us they liked the activities on offer and one person told us they were 'never bored.'

A visiting care co-ordinator said they had no concerns about the home and when asked about the quality of the food they said, 'they [the provider] supply vegetables and salad. There are three square meals [a day] and they give a choice.'

Records were up-to-date and comprehensive and there were handovers between each shift.

On the day of the inspection we spoke with four people who use the service and two staff. People told us that they were treated with respect; one person said "staff treat me good" also that staff support them to participate in activities. They said that they were well supported and felt happy, also that they liked the house and their bedrooms.

Relatives of the people who live at Hawthorn House said that they felt involved by staff when it was appropriate.

We found that premises were clean and the environment was looking homely.

Medication was given by people who were trained and aware of the standard medication administration procedures. People were consulted on whether they needed staff’s support with taking medication and this was recorded.

Staff were supported and able to meet peoples’ needs. Two people told us that they liked staff. Relatives told us that they found staff supportive. One relative told us “they do as much as possible to support independence” another said that they “smile and look happy”.

We did however find that that the home has not had a registered manager for over 18 months which could potentially affect the operation of the home and the care and support received by people living in the service.

You can see our judgements on the front page of this report.

There were four people living in the home at the time of our inspection. One person was not willing to speak to us at all. Another was not able to make any positive comments about the home due to her mental health at the time of the inspection. Two people did talk to us. One person said she was satisfied that staff treated her with respect. She said she was allowed to be as independent as she was able to within the home. She said, "I look after my own room and keep it tidy. I can't cook but I can make a drink and staff will help me when I need help."

This person also said that she had a care plan but did not want a copy of it.

Two people said staff were kind to them and treated them well. One said, "Staff are good here. They treat me right, they help me with everything and I like it." One person said she didn't like the food. Another said, "I love it, I eat everything."