About the service: The Hawthorns (Evesham) is a care home that provides accommodation and support for up to 47 people who require either nursing or personal care. Personal and nursing care is provided to people living with dementia or an acquired brain injury. At the time of the inspection 46 people were using the service. Six people with an acquired brain injury were living on the top floor and 40 people living with dementia were on the first and ground floor. The first and ground floor had been separated into four areas so only ten people living with dementia were together with their own lounges and kitchens.

People’s experience of using this service: People using the service benefitted from an extremely well led and caring service. People and their relatives were placed at the heart of the service and involved at every level. Assessments to support staff to mitigate risks were in place and people were activity encouraged to take positive risks. Staffing levels were high. Medicines were administered safely, and the service was piloting an electronic Medicine Administration System (eMAR) that had been developed by Shaw Healthcare Ltd. The registered manager had worked hard to reduce or discontinue when required (PRN) anti-psychotic medicines, using techniques to identify any triggers and put distraction technique's into place rather than administer medicines.

Staff had received a high level of training. Staff were fully supported to gain extra qualifications. If English was not the staff members first language another staff member would support them. The support staff received, generated a highly motivated staff team. People were very happy with the food provided and the cook had thought of innovative ways to support people to eat who preferred food on the move.

Staff demonstrated an exceptionally high level of kind and supportive care. Staff continuously smiled as they went about their work. Staff collaborated with people and their relatives to make sure they knew about the person’s interests and needs so they could have a positive impact on the person’s life. Where people had equality and diversity needs these were managed sensitively.

There was a truly holistic approach to planning, and delivering care and support. Each person’s care plan was linked to how they wanted to be cared for, their preferences and their needs. People were at the heart of a service that was organised to suit their individual needs. Every person had their own activity timetable that covered all their needs such as intellectual, social, sensory, spiritual and emotional needs. Although they had an activity coordinator, who was extremely dedicated and cheerful, all staff provided continuous short snappy activities throughout the day.

The atmosphere within the service was exceedingly friendly, comfortable, inviting and open. Positive and innovative ways to support people had been and were continuously being developed. The registered manager had recently won the Hennell Aware for Innovation and Excellence in Dementia Care. This award is to celebrate the achievements of someone who have shown their ability to implement positive change for people with dementia.

Rating at last inspection: The rating at the last inspection was good, (published in March 2016.)

Why we inspected: The inspection was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

This inspection took place on 18 and 20 January 2016 and was unannounced.

The provider of The Hawthorns is registered to provide accommodation with personal and nursing care for up to 47 people. Personal and nursing care support is provided to people with dementia and acquired brain injury. Bedrooms, bathrooms and toilets are situated over three floors with stairs with passenger lift access to each of them. People have use of communal areas including lounges and dining rooms. At the time of this inspection 46 people lived at the home.

There was a registered manager in post. They were not at work at the time of our inspection but one of the deputy managers and the area manager were at the home. 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.

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. People were supported by staff who knew how to recognise and report any concerns so 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 around their practice.

People 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. There was some additional learning for the cook around the preparation of food to meet the needs of people who required modified diets. This had already been identified and additional training had been planned. Staff were aware of people’s nutritional needs and were responsive to the need to ensure people always received safe food options. Where staff had concerns about a person’s nutrition they involved appropriate professionals to make sure people received the correct diet.

Staff were recruited in a safe way and had received appropriate training and were knowledgeable about the needs of people who lived at the home. The health and welfare needs of people were met because there were sufficient numbers of staff on duty who had appropriate skills and experience. Staff used their knowledge and skills to meet people’s individual needs and made sure the support offered was done in the least restrictive way.

People were asked for their permission before staff provided care and support so people were able to consent to their care. Staff made sure people understood what was being said to them by using gestures, short phrases and words. Where people were unable to consent to their care because they did not have the mental capacity to do this decisions were made in their best interests.

Staff were seen to be kind and thoughtful towards people and treated them with respect when meeting their needs. People’s privacy was respected and they were supported to maintain their independence with signage. Interesting things for people to interact with were located throughout the home, which provided opportunities for people with dementia. People were also supported to learn and regain their own levels of independence with healthcare professionals support which included physiotherapists

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. People who lived at the home and their relatives had been involved in the development of the care plans which were regularly reviewed to reflect changes in people’s needs.

The provider had responsive systems in place to monitor and review people’s experiences and complaints to ensure improvements were made where neces

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

Systems had been in place to make sure that the registered manager and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

People were protected against the risks associated with medicines because the provider had made improvements following out last inspection in November 2013. There were now appropriate arrangements in place to manage medicines.

Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. There was a current application in place for one person and further work was planned to review all people in the home. This meant that people would be safeguarded as required.

Is the service effective?

People’s health and care needs were assessed with them, but they were not always involved in writing their care plans due to their conditions. The provider had also considered information and involvement from relatives, other health professionals and staff. Relatives told us: “They listen to what we have to say so they understand why he might do certain things” and: “They keep us up to date with any changes”.

We saw that people’s preferred routines, likes and dislikes had been recorded and staff knew about them. Visitors confirmed that they were able to see people in private and that visiting times were flexible and the home were accommodating and welcoming.

The staff told us told us their training had been kept current and that they had received formal supervisions. This meant the provider demonstrated that staff employed to work at the home had the skills and experience needed to support the people living there.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. A relative told us: “I am here every day, it’s like my home. The staff know us well and are very caring”.

Staff we spoke with had a good knowledge of people's individual needs, and knew how to support people so that their needs were met. Staff spoke about people as individuals and we observed that staff listened to people’s views and opinions.

Is the service responsive?

People completed a range of activities in and outside the service regularly and the provider had staff dedicated to arranging and supporting people to attend these activities.

We saw the home had been responsive to people’s changing needs and had responded to professional advice that had been provided. For example, we saw the home had requested one person to be reassessed due to their changing needs. Appropriate support had then been arranged to meet the person’s needs.

Is the service well-led?

The provider had a quality assurance system in place. We saw records that identified shortfalls and the actions that had been taken to address them. The provider listened and responded to people, staff and visitors who had left comments and suggestions.

Staff told us they were clear about their roles and responsibilities. Staff told us that they felt the home reflected people’s care and welfare needs. They told us that the system in place meant they felt supported in their role and where to find information when needed. For example, there was information for each person for the staff to follow and record the care provided.

When we carried out our inspection care and support was provided to 45 people.

We spoke with the registered manager, the deputy manager and five support workers. We spoke with six people who visited people who used the service. Due to the health needs of people who used the service we spent time observing the care and support provided to people.

The majority of people we spoke with were complimentary about the care provided. One visitor described the staff as: “Very special people” and added “I come in as a visitor and go out as a friend.” Another visitor described the care provided as: “Genuine” and: “Brilliant”. During our inspection we did however find that people did not always receive appropriate stimulation to meet their diverse needs.

We found that improvements were needed to ensure that people always received their medication as prescribed and on time.

Equipment provided within the home was regularly checked to ensure it was safe for its intended purpose.

The provider had systems in place to enable them to monitor the quality of the service provided. These systems were in place to ensure that people received appropriate care and support.