The inspection took place on 12 March 2018. The inspection was unannounced.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Hawthorn Lodge is a ‘care home’. 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. Hawthorn Lodge provides personal care for up to 20 older people and people living with dementia type illnesses. At the time of our inspection there were 19 people living at the home.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC 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.

The atmosphere of the service was homely, warm and welcoming. People who used the service were relaxed in their own home environment.

People were supported to have choice and control from being supported by person centred approaches. Person centred care is when the person is central to their support and their preferences are respected.

People were always respected by staff and treated with kindness. We saw staff being discrete and considerate.

People’s support plans were person centred. They included details of peoples care needs and a ‘one page profile’ that described their individual support needs. These were regularly reviewed.

Support plans contained risk assessments that were individualised. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. This supported people do the things they wanted to live their lives fully.

The support plans we viewed also showed us that people’s health was monitored and referrals were made to other health support professionals where necessary, for example; the falls team or community nurse.

Staff understood safeguarding issues and procedures were in place to minimise the risk of abuse occurring. Where concerns had been raised we saw they had been referred to the relevant safeguarding department for investigation. Robust recruitment processes were in place.

Staff understood the importance of equality, diversity and protecting peoples’ rights.

Information was provided in accessible formats and access to advocacy services was available.

People were supported to have maximum choice and control of their lives and we saw staff supporting them in the least restrictive way possible; the policies and systems in place supported this practice.

Where people lacked the mental capacity to make decisions about aspects of their care, staff were guided by the principles of the Mental Capacity Act 2005 (MCA) to make decisions in the person’s best interest. For those people that did not always have capacity, mental capacity assessments and best interest decisions had been completed for them. Records of best interest decisions showed involvement from people’s family and staff.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs.

People were supported to maintain their independence on a daily basis.

Support staff told us they felt supported to carry out their role and to develop further and that the registered manager led by example. They were supportive and always approachable.

When we looked at the staff training records, they showed us staff were supported and able to maintain and develop their skills through trainin

We inspected Hawthorns Lodge on 19 January 2016. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Hawthorns Lodge provides accommodation and care for up to 20 older people who may be living with dementia. The home is a purpose built bungalow style accommodation. It is situated on the same site as Hawthorns Residential Home.

The home is recorded as not having had a registered manager in post since June 2014. 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. The lack of registered manager was found to be an administrative error. The registered manager for Hawthorns Residential Home covers both locations and had expected that they would be registered for both locations. The manager had noted this discrepancy and submitted the relevant forms to ensure this location is added to their registration.

People told us that staff worked with them and supported them to continue to lead fulfilling lifestyles. Staff outlined how they supported people to continue to lead independent lives. We found that a range of stimulating and engaging activities were provided at the home. We found that people were encouraged and supported to take responsible risks and positive risk-taking practices were followed. Those people who were able to were encouraged and supported to go out independently, and others routinely went out with staff.

People we spoke with told us they felt safe in the home and that staff made sure they were kept safe. We saw there were systems and processes in place to protect people from the risk of harm.

People who used the service and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. The registered provider and manager had closely considered people’s needs and by using rolling cover ensured that for the 20 people using the service from 6am until 10 pm there was a senior carer and three to four care staff were on duty during the day and a senior carer and a care staff member on duty overnight.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff received a wide range of training, which covered mandatory courses such as fire safety as well as condition specific training such as dementia care.

Where people had difficulty making decisions we saw that staff gently worked with them to work out what they felt was best. Staff understood the requirements of the Mental Capacity Act 2005 and had appropriately requested Deprivation of Liberty Safeguard (DoLS) authorisations. Staff had been working hard to ensure capacity assessments were completed in line with the Mental Capacity Act 2005 code of practice. They and the manager recognised that they were still developing the skills needed to always complete these accurately and they needed more space on the sections relating to people’s ability to take on board information to write their analysis.

We observed that staff had developed very positive relationships with the people who used the service. The interactions between people and staff were jovial and supportive. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity. Staff also sensitively supported people to deal with their personal care needs.

People told us they were offered plenty to eat and we observed staff to assist individuals to have suffic

During this inspection we spoke with three people who used the service, a visitor, the acting manager, the provider and three members of staff.

People told us that they were happy and there was plenty to do in the home. One person said, "I like all the staff, they are always kind to me."

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect.

We saw that people had their needs assessed and that care plans were in place.

The care records examined showed that people and their families were involved in making decisions about their care and treatment.

People were safe and their health and welfare needs were met by sufficient numbers of appropriate staff.

During the visit, we spoke with four people who used the service and a relative. As this was a routine visit we asked people about the choices on offer; what the care was like; and what people thought about the staff. People told us that they always found the staff delivered a good standard of care; were really kind and went out of their way to make sure their needs were met. Relatives thought the staff were excellent at their jobs and people were being appropriately supported.

People said, “I’m happy with the care and the staff really know how to look after us”, “The staff are brilliant and everything is as it should be”, and “The girls really work hard to make sure we are alright.” From our observations and discussions with the people who used the service we found that care staff worked in ways that supported the people and treated individuals with humanity as well as empathy. We observed that staff continuously involved people in discussions and always sought their views.

We observed that staff needed to leave the communal areas unattended for large

portions of time in order to attend to personal care needs of the people who used the

service. We found that staff were obliged to eat their lunch on a chair in the corridor so

they could be at hand to assist the other staff member if needed. At times, in order to

compensate for the lack of staff, the more able people who used the service supported

the less able get to the toilet or deal with their distress. These people told us they liked

helping out but we saw that some of the tasks they completed should not be their

responsibility to undertake.