About the service: The Hawthornes Care Home is a care home providing personal and nursing care to 23 people with physical and mental healthcare needs including some people living with dementia. At the time of the inspection 21 people were receiving care and support.

People’s experience of using this service:

People living at The Hawthornes Care Home accessed an extensive activity programme, and were encouraged to go on trips and attend events. The service was working with a local school as part of ‘The Peter pan project’ to encourage intergenerational learning and social inclusion. This was offering people an opportunity to learn about technology, share common interests and was designed to encourage school children to foster meaningful relationships with others. Staff showed kindness and compassion and placed value on their caring role and involvement in people’s lives. People were offered a choice of meals and staff closely monitored people assessed to be at risk of poor food and fluid intake.

The service had completed an end of life care accreditation to ensure people received high standards of care and support, and were involved in the planning of their care at that stage of their life. The service had very good working relationships with the local GP practice and palliative care service.

The service worked in partnership with people and their families, and encouraged feedback on the care provided. We received consistently positive feedback from people, their families and friends about the staff and service received. Staff told us they enjoyed working at The Hawthornes, and spoke highly of the support and encouragement provided by the registered manager.

People had their care and support needs met by sufficient numbers of suitably trained staff. The care environment was clean and comfortable throughout, with risk management plans in place. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems in the service supported this practice.

The service had good governance arrangements in place, and completed internal quality checks and audits. Findings from these were regularly reviewed by the provider.

Rating at last inspection: The Hawthornes Care Home was rated Good in all five key questions at the last inspection. The report was published September 2016.

Why we inspected: This was a scheduled, comprehensive inspection, completed in line with our inspection schedule for services rated as Good.

Follow up: We will continue to monitor this service and will reinspect in line with our schedule for those services rated as good.

The Hawthornes Care Home is registered to provide accommodation and personal and nursing care to up to 23 people. Some people living at the home were living with dementia.

This comprehensive inspection took place on 8 September 2016 and was unannounced.

At the time of this inspection care was provided to 21 people.

The provider is required to have a registered manager as one of their conditions of registration.

A registered manager was in post at the time of the inspection and had been registered with the Care Quality Commission (CQC) since 23 March 2016. A registered manager is a person who has registered with the CQC to manage the home. 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 were kept safe and staff were knowledgeable about reporting any incident of harm. People were looked after by enough staff to support them with their individual needs. Pre-employment checks were completed on staff before they were assessed to be suitable to look after people who used the service. People were helped to take their medicines by staff who were trained and had been assessed to be competent to administer medicines.

People were supported to eat and drink sufficient amounts of food and drink. They were also supported to access health care services and their individual health and nutritional needs were met.

The CQC is required by law to monitor the Mental Capacity Act 2005 [MCA 2005] and the Deprivation of Liberty Safeguards [DoLS] and to report on what we find. The provider was aware of what they were required to do should any person lack mental capacity. People’s mental capacity was assessed and care was provided in their best interests. Staff were trained and knowledgeable about the application of the MCA.

People were looked after by staff who were trained and supported to do their job.

People were treated by kind, respectful staff who enabled them to make choices about how they wanted to live. People and their relatives were given opportunities to be involved on a day-to-day basis about their planned care.

People were supported to be part of the community and they were helped to take part in recreational activities that were important to them. People’s care records were reviewed. Staff knew about people’s individual needs and they had detailed guidance to ensure that peoples received the care that they needed in a consistent way. There was a process in place so that people’s concerns and complaints were listened to. and were acted upon.

The registered manager was supported by a team of management staff and care staff. Staff, people and their relatives were able to make suggestions and actions were taken as a result. Quality monitoring procedures were in place and action was taken where improvements were identified.

A single inspector carried out this inspection. The focus of this inspection was to answer the five key questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

We had received expressions of concern about the quality of the care being provided at this service. As a result, we brought forward our planned inspection date so that we could be sure that people were being cared for appropriately.

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at. If you would like to see the evidence that supports the summary, please read the full report.

Is the service safe?

During our observations throughout the day we could see that there were enough care staff to meet the needs of the people living at The Hawthorns Care Home. However, people and their visitors told us that they often needed to wait for staff to be available to help them. One visitor told us, “They care very well but there’s not enough staff. Some people have to wait ten minutes or more for the toilet.”

People were cared for in an environment that was safe. Regular health and safety audits took place to ensure equipment and systems were working safely.

We spoke with staff and this showed us that they had the skills and experience to care and support people appropriately. One person told us, “It’s very good here. Staff are nice and kind.” A visitor said, “I can’t fault the place. It’s lovely here.”

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to all care services. Proper policies and procedures were in place so that people who could not make decisions for themselves were protected. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People we spoke with and their relatives told us that they or their family member liked living at The Hawthorns Care Home. They told us they received the care and support they needed. One person told us, “It’s very good here. I’ve got a lovely room.” Another person said, “Everyone is very friendly.” A visitor told us, “The care is excellent.” Another visitor commented, “She seems happy, they all seem happy.”

Staff explained how they ensured that people received the food and nourishment that they preferred. We were told about the choice menus available to people and also how meals were fortified for those at risk of malnutrition. One person commented, “The food is very good here.”

Is the service caring?

The people we spoke with told us that staff treated them with care and consideration. We saw that people were supported by kind and attentive staff. All staff were warm, friendly and respectful. They offered choice and encouragement to people.

People told us they could spend their time where they pleased. One person said, “I like it here, we have a good sing song.” We saw that many people liked to spend their day in the main lounge, whilst others were in their rooms or sitting out in the garden.

Is the service responsive?

People knew how to make a complaint. Copies of the complaints procedure were included in the service user guide and in leaflets displayed about the home.

People’s needs were assessed each month. Where they changed we found that the service responded promptly and sought the advice from health professionals. Care records showed that the service worked well with other agencies to make sure that people received their care in a joined up way.

Is the service well led?

The service last sent out satisfaction questionnaires a year ago and these were due to be sent to people shortly. Resident and relative meetings were held every three months, with the dates for upcoming meetings clearly displayed in the home. Actions were taken based on the views expressed by people and their relatives as appropriate.

Staff were clear about their roles and responsibilities. They understood the ethos of the home and had access to training and development that enabled them to provide appropriate care and support. This helped to ensure that people received a good quality service.

The purpose of this inspection, carried out on 02 August 2013, was to follow-up on a previous area of non-compliance.

On 29 May 2013 we visited The Hawthornes and found that there was insufficient space for the safe and appropriate storage of equipment. This was brought to the attention of the provider. The provider supplied us with an action plan which demonstrated that they would be taking action to address the issue highlighted.

During this inspection we found that improvements had been made.

Staff regularly sought the consent of people when they were delivering care. They gave people time to think about their decisions and encouraged participation in developing care plans. One person told us, “I’m actively involved in my care plan.”

Staff gave support to people in ways which encouraged their independence. We saw that care plans were individualised and had been produced in collaboration with people who used the service. We saw people engaging with staff and each other. People told us that they were happy living in The Hawthornes and family members said that they were pleased with the care. This showed us that care was personalised and that people received care that helped them to be active and to enjoy their time.

The environment was bright and homely. Communal areas were decorated with pictures and an activities co-ordinator organised a programme of activities. The provider had taken steps to ensure that people were safe and secure in the home and garden. However, there was insufficient storage space to ensure that equipment could be stored safely and appropriately.

On the day of our inspection the home was staffed with sufficient, appropriately skilled staff.

The provider's complaints policy was current and clearly laid out the steps people needed to take should they wish to make a complaint. Family members and people who used the service told us that they felt confident that they could raise concerns directly with the manager if necessary.

At our inspection on 20 April 2012 we spoke with five people out of the twenty living in the home at the time of this visit. We were told the staff team were very good. People told us staff always asked what they wanted. One person told us, “I have all the independence I want. The carers and nursing staff know me well and I do as I please.” Another person told us, “The staff team know my favourite drink and it is always there for me.”

We saw people looking smart in appearance with clothes well laundered and hair suitably styled. On talking with one person this was how they liked to dress and how they liked their hair. They told us they would pick what they preferred to wear and could have their hair washed and styled whenever they wanted.

We only spoke with one person about medication and was told that they liked to take their own pills when they were ready to.

We were told “This is a good home and things could not be any better as I can be as independent as I want.” “I have my cat and my cigarettes and could not ask for more.”