This inspection took place on 25 and 31 January 2018. Both visits were unannounced.

We previously inspected Hawthorns on 02 November 2015 and rated the provider to be Good overall with a Requires Improvement rating in the effective question. At this inspection, we have rated the key questions Caring, Responsive and Well led as Requires Improvement. As a result, the overall rating has changed to Requires Improvement.

Hawthorns is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hawthorns accommodates four people in one adapted building. Adaptions in place were to assist people with their physical disabilities such as a stair lift. The home has areas where people can spend time together as well as people having their own personalised bedroom. People have access to a garden. There were four people living at the home when we carried out our inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the last inspection on 02 November 2015, we asked the provider to take action to make improvements. This was in relation to a consistent approach being undertaken when people did not have the mental capacity to make their own specific decisions. We saw action had been completed following the previous inspection.

During this inspection, we found that the registered provider had failed to display their current inspection rating. It is a legal requirement for people to have access to the rating to inform their judgement about the service. You can see what action we told the provider to take at the back of the full version of the report

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Applications were made to the local authority when people had restrictions on their freedom as individuals. When applications had been approved, the Care Quality Commission were not notified as required by law. You can see what action we told the provider to take at the back of the full version of the report

People who lived at the home had done so for a number of years. As a result, people’s needs had changed. The registered manager was aware of the need to increase staffing levels to meet people’s needs and was working to achieve this. We heard conflicting accounts from staff as to how care needs were meet while providing personal care. The registered manager was not aware of the inconsistency in people’s personal care until brought to their attention as part of this inspection.

Systems to access and monitor the quality of the service provided needed to be improved. This was so any shortfalls in standards were identified and actioned. You can see what action we told the provider to take at the back of the full version of the report

People and their relatives felt they were safe living at the home. Staff had received training on recognising and reporting abuse. People were positive about their care and about the staff who cared for them. People were supported to be independent were possible.

Medicines were administered to people by staff who were trained to do this to ensure people received them correctly. People’s healthcare needs were identified and professionals were involved in their care as needed to promote wellbeing. People were supported as needed while eating and drinking and had a choice of meal. Staff knew how to reduce the risk of cross infection within the home.

People were supported to have maximum choice and control of their life and staff supported them in the least restrictive way possible.

Relatives spoke positively about the registered manager and felt any concerns they had would be listened t

This inspection took place on 2 November 2015 and was unannounced. The provider of Hawthorns is registered to provide accommodation for up to 4 people with learning disabilities. At the time of this inspection 4 people lived at the home.

There was a registered manager in post. They were not at work at the time of our inspection but we spoke with them and the registered provider over the telephone. 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 and associated Regulations about how the service is run.

People’s consent was sought by staff before they helped them with anything. Staff made sure people understood what was being said to them by using gestures, short phrases, words or special systems of pictures. However, a consistent approach was not taken when people did not have the mental capacity to make their own specific decisions about some aspects of their care so that the principles of the Mental Capacity Act 2005 had been followed and recorded. This is because we saw specific equipment was in use but no documentation to reflect, where appropriate, individual people’s mental capacity had been assessed.

We saw there were systems and processes in place to protect people from the risk of harm which included people having access to information about abuse using pictures. People were supported by staff who knew how to recognise and report any concerns so that people were kept safe from harm. Relatives of people told us they felt staff kept people safe. People were also helped to take their medicines by staff who knew how to manage these in line with safe principles of practice.

Staff were recruited in a safe way and had received appropriate training and were knowledgeable about the needs of people using the service. The health and welfare needs of people were met because there were sufficient numbers of staff on duty who had appropriate skills and experience. This included staff having the knowledge in order to meet people’s care and support their needs in the least restrictive way.

People were appropriately supported and had sufficient food and drink to maintain a healthy diet. We saw people living at the home had been assessed for the risks associated with eating and drinking and care plans had been created for those people who were identified as being at risk. Where staff had concerns about a person’s nutrition they involved appropriate professionals to make sure people received the correct diet and supported people to attend resources offered in the community to help them achieve their healthy weight. Staff were aware of people’s nutritional needs.

We saw people being treated with dignity and respect. Relatives told us staff were kind, considerate and caring. There were examples of staff showing they cared for people and the warmth of touch was used, such as, hugs. We saw staff were attentive, polite and sought consent before providing care and support using people’s own preferred communication styles so that people were included in their chosen lifestyles as much as possible.

People were supported to access healthcare services to maintain and promote their health and well-being. People showed us they were encouraged to make their rooms at their home their own personal space and felt they belonged there. People who lived at the home and their relatives had been involved in the development of the care plans which were regularly reviewed. People were supported in a range of interests and hobbies, usually on an individual basis, which were suited to their needs. This included going on holidays to different countries so that people were supported to experience new things for fun.

There were management systems in place to monitor the quality of the service. Relatives of people living at the home told us they had found the registered manager and provider approachable and told us they would raise any complaints or concerns should they need to. There was evidence learning from incidents and investigations took place and changes were put in place to improve the services people received. This supported people to benefit from a management and staff team who were continually looking at how they could provide better care for people.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Prior to our visit we reviewed all the information we had received from the provider. During the inspection we spoke with the four people living at the home. We spoke by telephone with two relatives and asked them for their views. We also spoke with the staff present at the time of the inspection. These were one senior care worker and three care workers. We also spoke with the provider by telephone. We looked at some of the records held in the service including the care files for the four people. We observed the care and support people who used the service received from staff and carried out a tour of the building.

The summary below describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

We found that people's needs had been assessed and individual care plans drawn up to meet people's needs. These assessments and plans included consideration of risks to the person and how these could be managed to keep the person safe.

There were arrangements in place to deal with foreseeable emergencies. We were told by staff members we spoke with that they were able to contact a manager when they needed to. We were told the owner rings each day to ensure people are well.

The provider carried out checks on staff prior to them starting work to ensure they were suitable to work with people. The provider ensured there was enough staff to meet people’s needs.

Two people supported had received training on safeguarding. Staff had been trained in safeguarding and knew what to do in the event of abuse being suspected, witnessed or alleged. People were protected from the risk of abuse because the provider had ensured that safeguarding policies and procedures were in place and available to staff.

We found the home was clean and hygienic providing a safe environment for people.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The provider had not submitted any applications, however relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. Relatives told us they were happy with the care and support people received. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. Staff had received training to meet the needs of the people living at the home.

We saw in care plans that risk assessments had been completed that promoted people’s independence. We found staff worked in accordance with these assessments with moving and handling.

Is the service caring?

We found that people were supported by kind and attentive staff. We saw staff talking with people in a respectful manner and using non-verbal communication consistent with people’s individual care plans. We saw staff took care to ensure people had enough to eat and drink. We saw that activities were planned and that people's involvement was monitored.

Family representatives we spoke with told us they were now happy with the service and found the manager approachable.

Is the service responsive?

We found that each person's needs were regularly reviewed with care plans updated if needed. Records showed that people were supported in line with these plans.

People had access to activities and had been supported to maintain relationships with their relatives. Activities and holidays people had requested had been provided. We found that relatives were encouraged to visit whenever they wished.

We found that people’s own rooms had been personalised and reflected their own interests and things they liked.

Is the service well-led?

The provider had quality assurance processes in place. People's views had been obtained by the provider along with the views of family representatives and staff. The provider had taken action as a result.

People supported and their relatives told us they would feel able to raise any concerns they had with the provider and were confident their concerns would be dealt with.

We found that quality checks were carried out by the provider and that the health and safety of people was monitored.

People supported, relatives and staff all commented that the manager of the home was approachable and supportive.

We inspected Hawthorns and spoke with three of the people who lived at the home and briefly with a member of staff on duty. We were unable to hold conversations with the people who lived at the home due to their communication difficulties. We spent time and observed the care and support people received.

On the day of the inspection the service was a member of staff short which was covered by the registered manager. We spoke with the registered manager. We looked at care records for two people and other supporting documents for the service.

We saw that people were respected by staff. Staff asked people if they were happy with them giving care before they gave it.

People’s needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. We saw that staff were aware of each person’s needs and how to give care and support to meet those needs. People told us they: “Liked” the staff who worked at the home. We saw that staff were kind and caring in their approach to people who lived in the home.

We saw that medicines in the home were managed safely and given to people as they had been prescribed.

Recruitment procedures were in place and followed to make sure that suitable people were employed to work at the home.

There was a complaints procedure in place at the home. We found people knew how to make a complaint and felt supported in that process.

We inspected Hawthorns and found that people were supported to make everyday decisions by staff at the home. People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

Records showed that people’s needs had been assessed and care and treatment was planned and delivered in line with their individual care plan.

We found that people who used the service were protected from the risk of abuse. People told us they liked living at Hawthorns and that they felt the staff gave them the help they needed. We saw that staff had a kind and caring approach towards people they supported.

Staff received regular training and support so that they were able to give people the care they needed. Staff told us they were given many opportunities to do training and were well supported by the registered manager.

The registered manager told us that a full review of the quality of service they provided was being carried out and a report of this review would be produced in February 2013.