This inspection took place on 17 and 18 October 2018 and was unannounced. This meant the staff and the provider did not know we would be visiting. The Hawthorns was last inspected by CQC on 9 and 10 May 2016 and was rated 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 risk 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.

The Hawthorns 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.

The Hawthorns accommodates up to 98 older people with neurological and nursing needs, with some people living with dementia. On the first day of our inspection there were 89 people using the service.

The home had a registered manager in place. A registered manager is a person who has registered with 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 provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. There were sufficient numbers of staff on duty to meet the needs of people who used the service. Staff were suitably trained and supported to provide care to people who used the service through regular supervision and appraisal.

The provider had effective procedures in place for managing the maintenance of the premises and appropriate health and safety checks were carried out. The home was clean, spacious and suitable for the people who used the service.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities about safeguarding and staff had been trained in safeguarding vulnerable adults. Appropriate arrangements were in place for the safe management and administration of medicines.

People who used the service and their relatives were complimentary about the standard of care at The Hawthorns. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Care records showed people’s needs were assessed before they started using the service and care plans were written in a person-centred way and were reviewed regularly. Person-centred is about ensuring the person is at the centre of any care or support and their individual wishes, needs and choices are taken into account.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. People had access to healthcare services and received ongoing healthcare support. Care plans were in place that recorded people’s plans and wishes for their end of life care.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs, in the home and within the local community.

The provider had an effective complaints procedure in place and people who used the service and their relatives were aware of how to make a complaint.

The provider had an effective quality assurance process in place. People who used the service, relatives and staff were regularly consulted about the quality of the service through meetings and surveys.

Further information is in the detailed findings below.

This inspection took place on 9 and 10 May 2016 and was unannounced. This meant the staff and the provider did not know we would be visiting. The home had a registered manager in place. A registered manager is a person who has registered with 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 Hawthorns was last inspected by CQC on 3 February 2014 and was compliant with the regulations in force at the time.

The Hawthorns is located in a residential setting in Peterlee in County Durham. It provides accommodation with personal care for up to 98 people within three different categories of care, neurological rehabilitation (34 beds), dementia care (Seaham House, 27 beds) and general nursing (37 beds). On the day of our inspection there were 94 people using the service.

We saw that entry to the premises was controlled by key-pad entry but was generally open during the day. All visitors were required to sign in. This meant the provider had appropriate security measures in place to ensure the safety of the people who used the service.

The home comprised of 98 bedrooms, the majority of which had en-suite bathrooms. Facilities included several lounges and dining rooms, communal bathrooms, shower rooms and toilets, a hairdressing room, sensory room, treatment room, a gym and several communal gardens. The general reception was large and spacious with a comfortable seated area which provided people who used the service and visitors with tea/coffee facilities and a computer with internet access.

People who used the service and their relatives were complimentary about the standard of care at The Hawthorns. We saw staff supporting and helping to maintain people’s independence. People were encouraged to care for themselves where possible. Staff treated people with dignity and respect.

The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. There were sufficient numbers of staff on duty in order to meet the needs of people using the service.

Training records were up to date and staff received supervisions and appraisals, which meant that staff were properly supported to provide care to people who used the service.

The layout of the building provided adequate space for people with walking aids or wheelchairs to mobilise safely around the home and was suitably designed for people with dementia type conditions.

The service was working within the principles of the Mental Capacity Act 2005 and any conditions on authorisations to deprive a person of their liberty were being met.

All the care records we looked at contained evidence of consent.

People were protected against the risks associated with the unsafe use and management of medicines.

People had access to food and drink throughout the day and we saw staff supporting people at meal times when required.

People who used the service had access to a range of activities in the home.

All the care records we looked at showed people’s needs were assessed. Care plans and risk assessments were in place when required and daily records were up to date. Care plans were written in a person centred way and regularly reviewed.

We saw staff used a range of assessment tools and kept clear records about how care was to be delivered and people who used the service had access to healthcare services and received ongoing healthcare support.

The registered provider had a complaints policy and procedure in place and complaints were fully investigated.

The provider had a robust quality assurance system in place and gathered information about the quality of their service from a variety of sources.

The majority of people we spoke with were satisfied with the care and treatment. For example people told us, “They look after me well”; “Everything is OK”; “They look after me brilliantly, I am off my medication and I am going home soon to my family”; and, “My care is spot on, there are no problems at all, the food is spot on and hot.”

As some people who used the service had complex communication needs, they were not able to share with us their experiences. Therefore, during the inspection we observed the quality of interaction between staff and people on the unit where people with dementia were accommodated.

During our observation, we saw staff offered people eye contact and took time to communicate clearly. We saw staff were attentive and responsive to people’s different needs. We saw they took time to help people eat, drink and with their care needs and asked people before intervening with care tasks. We observed staff used eye contact, touch and appropriate humour to provide care with compassion. Where necessary, staff offered re-assurance and diversion when people became unsettled or agitated.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The needs of people who used the service were assessed, where necessary care plans developed, and interventions and progress was monitored and reviewed.

We looked around the home and its environment. We saw that it was decorated to a good standard and was well maintained across all three units. There was no evidence of malodour and the environment, furniture and fittings appeared clean. The decorative finish was suitable for the needs of people using the service. People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

The provider had carried out appropriate pre-employment checks to ensure the suitability of staff. People were cared for, or supported by, suitably qualified, skilled and experienced staff.

People were made aware of the complaints system. We found people had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. Also people’s complaints were fully investigated and resolved, where possible, to their satisfaction.

People expressed their views and were involved in making decisions about their care and treatment. We spoke with several people who used the service and their relatives. One person said “I have been invited to a planned review meeting to discuss my husbands care”

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We spent time talking with several people, and watched how staff gave them support and care. People were very happy with the care provided. Comments included “Staff are marvellous” “The staff talk to me”

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service.

We visited this location on a weekday and were able to talk to five people who used the service. Comments made were that individuals ‘like living here’, that ‘staff often chat’, knew how to complain and that there is ‘loads of food’.