About the service:

Hawthorne House provides accommodation, nursing and personal care for up to 102 people with a variety of mental health problems combined with physical disabilities or challenges associated with behaviours. Care is provided over seven units. One unit is specifically for those people with an acquired brain injury. The other units support people with high level mental health needs, those living with dementia and those who may have developed mental health conditions as a consequence of other illnesses. When we visited in October 2018 there were 79 people living in the home. In January 2019 there were 87 people living in the home, although three were in hospital on the day of our visit.

People’s experience of using this service:

•Hawthorne House opened in the summer of 2017 and there had been three managers by the time of our first inspection visit in October 2018.

•Whilst we observed some very positive care and support to people, we found the provider’s quality assurance system had not ensured everyone achieved such positive outcomes. For example, people within some of the dementia care units did not receive the same level of person centred care as those on the acquired brain injury unit.

•The provider had systems to identify where there were problems in the service, but managers were not always aware of these. This included incidents involving people which had not always been reported to the managers and therefore had not been considered in the management analysis of accidents and incidents so the provider could have an accurate overview to identify any trends or patterns.

•There were sufficient numbers of nursing and care staff on duty to keep people safe and monitor the communal areas of the home. However, due to high levels of staff sickness, staff were often assigned to work in units they were unfamiliar with, and with people who did not know them.

•There was a programme of activities provided by activities staff. However, improvements were required in understanding and responding to people’s individual interests and need for occupation and engagement on the individual units.

•On some units, especially for those people living with dementia, there was little of interest in the décor, such as pictures, photos, or tactile aids people could touch and hold to stimulate their minds.

•Overall, individual risks to people were managed safely.

•People were confident they received the healthcare support they needed to keep their health conditions stable and knew staff would seek further support if necessary.

•Visiting healthcare professionals spoke positively about the service and people received their medicines from staff who had been trained and assessed as competent to do so safely.

•People's needs were met by staff who were skilled, competent and suitably trained. The provider monitored training to ensure staff skills were kept up to date and they received the training they required.

•Staff worked within the principles of the Mental Capacity Act 2005. People were given day to day choices and this was reflected throughout their care plans and through our observations. Staff sought people’s consent before care interventions.

•People were supported to have enough to eat and drink to maintain their well-being. Nutritional risks were known by staff who monitored people’s food and fluid intake when a need had been identified.

•Staff understood the importance of supporting people with empathy and compassion and provided reassurance when people became anxious.

•Staff were non-judgemental and responded appropriately when people became distressed or agitated. They respected people’s diversity and lifestyle choices.

•People’s relationships with family and friends were encouraged.

•People knew the management team and staff felt motivated by the new registered manager.

•The registered manager worked with external organisations to develop the service they provided.

The registered provider was in breach of Regulations