About the service: Hawthorne Nursing Home is a residential care home that provides personal and nursing care for up to 36 people. At the time of our inspection 30 people lived in the service.

People’s experience of using this service:

The home had made improvements since our last inspection, the people that we spoke to said that Hawthorne Nursing home was a good place to live and that staff treated them with respect and kindness.

People’s health and social care needs were managed well by management and the staff team. There were positive relationships with professionals which supported people’s overall wellbeing.

Medicine was administered safely and there were clear protocols in place for medicine which taken when required. Records were kept up to date and Medication administration records (MAR) were all correct and checked by nursing staff and the registered manager.

The registered manager showed evidence of ongoing quality monitoring across all aspects of the service. Any concerns raised by residents’ relatives or staff were investigated and addressed. This was also used to inform improved practises throughout the home.

People had enough to eat and drink. People were offered choices and had an input into the menu planning. The lunchtime experience was relaxed, and staff were assisting with serving meals and assisting people to eat where necessary.

There were a variety of activities both to keep people occupied and entertain them and physical activities to assist with people’s mobility. People were consulted on what they wanted to do giving people choice and control.

Rating at last inspection: At the last inspection Hawthorne Nursing Home was rated as Requires Improvement. The last inspection took place on 10 January 2018.

Why we inspected: This was a planned inspection based on the rating at the last inspection. We saw improvements had been made since our last inspection. The registered manager now has systems and processes in place to respond to complaints and to monitor the quality of the service.

Follow up: We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

This inspection took place on 18 December 2017 and 10 January 2018 and both days were unannounced.

Hawthorne Nursing Home is a ‘care home with nursing’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Hawthorne Nursing Home accommodates up to 36 people in one adapted building. At the time of our inspection 25 people lived at Hawthorne Nursing Home.

The service is required to have 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. At the time of our inspection there was a registered manager in post and she was available during the inspection.

During our previous inspection on 1 November 2016 we rated this service as ‘Requires Improvement’ and there were no breaches of regulations. At this inspection, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. You can see the action we have told the provider to take at the back of this report.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. Risks were managed so that people were protected from avoidable harm and were not unnecessarily restricted. Sufficient staff were on duty to meet people’s needs and staff were recruited through safe recruitment practices.

Medicines were safely managed and people were protected against the risk of infection. Themes and trends in relation to accidents and incidents were reviewed and investigations of specific incidents were carried out.

People’s needs and choices were assessed and care was delivered in a way that helped to prevent discrimination and was in line with evidence based guidance. Staff received appropriate training, support and supervision. People received sufficient to eat and drink.

People’s healthcare needs were monitored and responded to appropriately. External professionals were involved where appropriate; however, we saw one example of where the service did not provide a fully effective transfer for a person moving to another service.

Adaptions and signage to the premises ensured it was suitable for people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were cared for by staff who were pleasant and kind; staff were mindful of how people felt and offered reassurance. People were involved in decisions about their care and support and information had been made available in accessible formats. Advocacy information was made available to people.

Staff respected people’s privacy and dignity and promoted their independence. Most people’s visitors and friends were able to visit without being restricted; however, we saw one example where the provider had stopped a family member from visiting their relative in the care home. We were told of the reasons for this but we concluded that not all reasonable steps had been taken by the provider prior to the restriction.

One relative’s complaints were not responded to appropriately.

Staff were aware of people’s interests, hobbies and preferences; staff took steps to ensure people enjoyed meaningful activities and stayed connected to their local community.

People were involved in planning their care and support. People were treated equally, without discrimination. The registered manager had limited knowledge of the Accessible Information Standard, however efforts had been made to ensure people with communication need

This inspection took place on 1 and 2 November 2016 and was unannounced.

Accommodation for up to 36 people is provided in the service over two floors. The service is designed to meet the needs of older people living with or without dementia. There were 29 people using the service at the time of our inspection.

A registered manager was in post and she was available during the inspection. 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.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. However, safeguarding training figures required improvement and appropriate safeguarding records were not kept.

Risks were not always managed so that people were protected from avoidable harm. Medicines management and infection control practices required improvement.

Sufficient staff were on duty to meet people’s needs. Staff were recruited through safe recruitment practices.

People’s rights were not fully protected under the Mental Capacity Act 2005. The environment could be further improved to better support people living with dementia.

Staff received appropriate induction, training and supervision. People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate.

There was limited evidence that people and their relatives were involved in decisions about their care. People did not always receive care that respected their privacy and dignity.

Staff were kind and knew people well. Advocacy information was made available to people.

Not all care records contained sufficient information to support staff to meet people’s individual needs.

People generally received personalised care that was responsive to their needs. A complaints process was in place and staff knew how to respond to complaints.

The provider and registered manager were not fully meeting their regulatory responsibilities and systems in place to monitor and improve the quality of the service provided were not fully effective.

People and their relatives were involved or had opportunities to be involved in the development of the service.

Staff told us they would be confident raising any concerns with the registered manager and that appropriate action would be taken.

This inspection took place on 5 November 2015 and was unannounced.

Accommodation for up to 36 people is provided in the home over two floors. The service is designed to meet the needs of older people. There were 15 people using the service at the time of our inspection.

There is a registered manager and she was available during the inspection. 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.

Safeguarding training attendance and medicines management required improvement. Safe infection control practices were not always followed. However, systems were in place for staff to identify and manage risks and respond to accidents and incidents. Sufficient staff were on duty to meet people’s needs and they were recruited through safe recruitment practices.

Staff did not receive sufficient supervision, training and appraisal. However, consent to care and treatment was sought in line with legislation and guidance. People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate. People’s needs were met by the adaptation, design and decoration of the service.

Staff were caring and treated people with dignity and respect. Staff involved people in decisions about their care.

People received personalised care that was responsive to their needs. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were not fully involved in the development of the service. Systems to monitor and improve the quality of the service provided required further improvement to address the issues identified in this report. However, staff told us they would be confident raising any concerns with the management and that the registered manager would take action.

This inspection took place on 19 November 2014 and was unannounced.

Accommodation for up to 36 people is provided in the home over two floors. The service is designed to meet the needs of older people.

There is a registered manager and she was available throughout the inspection. 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.

People and their relatives told us they felt safe in the home. Systems were in place for staff to identify and manage risks and the premises and equipment were safely maintained. People had mixed views on whether sufficient staff were on duty, however, we saw that people received prompt care when requesting assistance. Staff were recruited through safe recruitment practices and people told us they received medicines when they needed them.

A person told us that staff knew what they were doing and we saw that staff received appropriate induction, supervision and training. We saw that people’s rights were protected under the Mental Capacity Act (MCA) 2005, however not all staff understood the requirements of the MCA. People were happy with the food provided at the home, however, we saw that improvements could be made so that mealtimes were a more pleasurable experience. A person told us they could see the GP when they needed to and we found that the home involved outside professionals in people’s care as appropriate.

People had mixed views on whether all staff treated them with kindness, however, we observed interactions between staff and people living in the home and staff were kind and respectful to people when they supported them. However, we did not see evidence of people being involved in their care planning and staff members did not always use terms which respected the people they were supporting.

Information was available to support staff to meet people’s personalised needs, however, this was not consistent for all people and we did not see many people being supported to follow hobbies or interests they enjoyed. People who used the service told us they knew who to complain to if they needed to and we saw that complaints had been handled appropriately by the home.

People and their relatives could raise issues at meetings, by completing questionnaires or raising them directly with staff and we saw that the registered manager responded appropriately to them. There were systems in place to monitor and improve the quality of the service provided.

We carried out this inspection to follow up on a warning notice we issued to the provider and manager in respect of the care and welfare of people who use services. We told the provider and manager the service must be compliant with the notice by 3 July 2013.

We also carried out the inspection to check that the provider had met the compliance action that we set at our previous inspection on 20 May 2013 regarding the management of medicines.

We did not speak with people using the service at this inspection. We inspected care records and other documentation.

We found action had been taken to ensure people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We also found that action had been taken to ensure that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We found that the warning notice had been complied with and the compliance action had been met.

We visited the location to carry out a scheduled inspection. However, we also carried out the inspection to check that the provider had met the compliance actions that we set at our previous inspection on 1 December 2012.

We spoke with two people using the service. One person told us that staff delivered care according to their needs and their needs were met. They also said, “It’s run very well actually and the food is good.” Another person told us staff “definitely” delivered care according to their needs and their needs were met. They told me they could see their GP when they needed this and enough activities took place.

We found that where people did not have the capacity to consent, the provider acted in accordance with legal requirements. However, we found that risk assessments and care plans were not always up to date and as a consequence did not provide staff with up to date guidance on how to meet people’s needs. We also found that pressure care records were still not fully completed. This is the third inspection where this outcome has not been met.

We found that people were cared for in a clean, hygienic environment. However, we observed inappropriate administration of medication and medication training needed to be updated.

We found that people were protected against the risks of unsafe or unsuitable premises. We also found that staff attended mandatory training.

While this was a scheduled inspection we had also received some concerning information regarding a number of issues. The main issues were people being left in their chairs without stimulation, people being ‘toileted’ only once a day, staff ‘drag lifting’ people who use services instead of using correct equipment, poor care, people being put in wheelchairs for the convenience of staff and management not responding to reports of concern. We also checked whether the provider had met the compliance actions that we set at our previous inspection on 29 September 2011.

We spoke with four people who use services. They were all happy with the care provided by the service.

We found that people were listened to but did not always experience care, treatment and support that met their needs. We found that people’s hydration and nutritional needs were met and there were effective recruitment procedures in place.

We found that there was sufficient staff to meet people needs and the provider assessed the quality of the service provided. However, training levels needed to be improved.

We decided to use a Short Observational Framework for Inspection (SOFI). This tool was designed for inspectors to record their observations during the inspection of care homes where people have dementia or severe learning disabilities. The tool allows an inspector to sit and observe. It provided a snapshot observation of care, as experienced by people using the service. It was used alongside other information collected during the inspection process.

Short intervals of half and hour were used when observing in one of the two lounge areas.

We saw a mixed picture of the care provided.

We asked two people about their meal and they told us they enjoyed it.

We asked one person who lived at the home about ‘pop music’ played in the dining room when they ate their meals and they told us, “They did not mind it as they were used to it now.”

One person told us, “It was nice to see when non-mobile people had their hands and feet massaged by the coordinator.”

Two people explained that they enjoyed the bingo and quizzes at the home provided by the staff.