Hawthorn Lodge Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We have identified breaches in relation to dignity and respect, person-centred care and safe care and treatment. Safety risks to people were not always managed well. Risks were not always effectively identified and actions in place to mitigate risk. People, and those important to them, were not always involved in making decisions about how they wished to be supported to stay safe. Staff practice did not consistently demonstrate they understood their duty to protect people from abuse. When concerns had been raised, managers reported these promptly to the relevant agencies and worked proactively with them, to make sure timely action was taken to safeguard people from further risk. Staff received relevant training to meet the range of people’s needs at the service. However, observations of staff engagement indicated staff needed some person specific training and guidance to support safe working practice. Staff received support through supervision and appraisal to support their continuous learning and improve their working practice. Managers made sure recruitment checks were undertaken on all staff to ensure only those individuals that were deemed suitable and fit, would be employed to support people at the service. Infection prevention and control processes and staff practice did not effectively maintain an environment that was hygienically clean and reduce the risk of infection.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt able to speak up if they had a concern. However, they were not always confident that changes would be made. One person said they did have the opportunity to speak to managers but “We get no real feedback.”

Staff told us that they had regular supervision sessions but were not clear if learning opportunities when safety incidents occurred were discussed. One staff member said, “I don’t think we discuss it.”

There were processes in place to review incidents and then make improvements. Staff supervision documents included a section on learning when things had gone wrong. There was a clear policy on the duty of candour. This policy guided staff to tell the person (or, where appropriate their advocate) when something had gone wrong. We reviewed complaints that had been made and saw this policy had been followed.

People told us that communication between the care home staff and other health providers was good, and they were supported to access healthcare professionals. One person said, “My GP comes every Tuesday to make the rounds. Specsavers come in and the chiropodist is about every 2 months.”

Staff had good knowledge of which health and social care professionals supported which people. Staff were able to explain when these professionals visited, and what type of support they offered.

Partners told us they had no concerns. One partner who supported a person living at Hawthorn Lodge said, “I found the staff to be helpful and informative of the patient and their needs.”

Documentation regarding people’s needs was not always accurate. This meant if the person required a hospital admission, hospital staff would not have clear guidance on how the person liked to be supported. Where people required external health and social care support, we saw that suitable referrals had been always been made. For example, one person required a referral due to weight loss which had not been made.

People told us they did not always feel they were kept safe from abuse. One person said, “I don’t feel safe as my flat has been ransacked 4 times now”. Another person said, “I feel safe as there’s usually someone around for company and I’m smart enough to ask for help.” People told us that there were no unlawful restrictions imposed on them. They were free to complete their own routines and live their lives as they wished. One person told us, “ I like that we can go anywhere we want downstairs and can go out in the garden too.” Some people would be at risk if they did not have continuous supervision and control, where this was the case, we saw staff had applied the suitable Deprivation of Liberty Safeguards. These safeguards ensure people who cannot consent to their care arrangements in a care home or hospital are protected if those arrangements deprive them of their liberty. However, we did see that people who required increased supervision to maintain their safety were not consistently supported this way.

Staff understood how to respond to allegations of abuse. Staff told us that they had no concerns, but if they did, they were confident the management team would act appropriately. One staff member said, “We look after them [residents] keep them safe and report stuff when needed.” The registered manager understood how to respond to allegations of abuse. They had a clear process of how to investigate and keep people safe.

We saw people and staff did not always have positive relationships. We saw evidence that people were at risk and not always safeguarded from harm. During the assessment, the inspection team intervened as a staff member was heard being verbally abusive to a resident in their bedroom. The registered manager responded appropriately when they were told and took action to safeguard people.

If an allegation of abuse was made, there were appropriate policies in place to guide the staff team. Records showed that incidents were quickly investigated and referred to the local authority safeguarding team if needed. Processes were not implemented to keep people safe. For example, increased monitoring or equipment, was not consistently implemented. Recently a person who required support had been able to leave the home without staff support. The provider contacted the police and local safeguarding team and investigated the incident putting measures in place to improve safety for this individual.

People told us they were not involved in conversations about planning their care and managing risk. One person said, “I’d remember if I’d had any paperwork to sign or see but hear nothing about it.” The provider acted on the feedback people gave and implemented a system to ensure people and relatives were included in care planning and reviews going forward.

The registered manager and nominated individual (NI) talked about thinking holistically about people’s care needs to meet them in a way that is safe and supportive. They described the needs of one person and supportive conversations with them and relatives about moving to a smaller home that would be better suited to the person’s needs. The NI told us, “[Name] has understanding, we have talked and gave assurance and prepared them, working with [person] social workers and family about how we manage the process best, what will be in their best interest.”

We saw people were not always supported safely. One person could become distressed and required regular monitoring. We observed this person alone in the garden area for extended periods of time with no staff interaction.

People’s needs and risks were not clearly documented in their care plans, so staff did not have effective guidance on a person’s mental, physical, and social needs. including how to support people experiencing distress behaviours. Staff had not consistently kept clear records on how they had supported people and at what time. This meant changes in a person’s needs and wellbeing could not be easily identified and improvements made to their planned care. There were clear processes in place for how to respond to an emergency. Staff had clear evacuation processes to follow, and these processes considered the unique needs of people. Whilst we found some positive points in this section, we noted there was a significant amount of improvement required in documentation and recording to provide clear guidance for staff and records which provide an overview of changes in people’s health and wellbeing.

People spoke to the inspection team about their personal space and explained that they felt they did not always feel this was a safe space. One person told us, “It’s been a problem at changeover in the evening as no one is watching the residents.” This meant they felt unsafe in their home environment. No one we spoke with had concerns about the call bells in their bedrooms or staff responding to them although people did say response times to call bells were longer at night. This meant they could request staff support if needed.

Staff told us they took measures to maintain a safe environment in the home and knew how to report any maintenance concerns. The management team described actions taken to improve the safety of the environment. For example, clearing the garden of trip hazards and replacing some of the window frames as part of a gradual improvement process. The NI said, “We are not a large company, and a lot of money is reinvested [in the home].”

We observed not all freestanding wardrobes and chest of drawers were secured to the wall; which presented a risk of harm to people should they be pulled over. We saw furniture in some people’s rooms that was damaged and broken. Doors to rooms used for storage that should have been secure to prevent people accessing them were found to be unlocked. Sensor matts were not always in place in rooms where people needed them. External storage of waste, including clinical waste, was not secure and could be accessed by residents and the public. Stairs were accessible with no measures in place to prevent access which presented a risk of trips and falls to people. People were able to access hot water at a temperature that presented a risk of scalding. Windows were unable to be opened wide. This safety feature prevents people from falling or climbing out and is in line with guidance from the health and social care executive. We saw that call bells were responded to promptly meaning people could access staff support.

There were environmental checks and maintenance carried out. We saw there had been regular checks to ensure the home was safe in the event of a fire (for example, by checking the alarm systems). Systems were in place to ensure the water quality was maintained to reduce the risk of water-borne bacteria (like legionella). However, not all checks were robust enough to identify risks found by the inspection team, and management oversight processes had also failed to identify this. People had access to call bells to call for support if needed. Documentation showed these call bells were regularly checked, to ensure they were working and effective. Staff told us that is someone’s call bell was faulty they used existing call bells from rooms not in use should until it was fixed.

Most people spoken with had concerns about staffing levels and told us there were not always enough staff. This meant people's needs were not always responded to quickly. One person said, “At night it’s terrible - there’s not enough [staff] on to look after us all.” Some people also reported they felt there were less staff at the weekends. People did not highlight any concerns about staff training or competency.

Staff spoke highly of the training provided to them. They explained how some training was face to face, some completed on-line, and they received competency checks completed by the management team. A staff member said, “The training’s really good.” The management team told us they had a “focus on learning.” Staff spoken with told us they had regular opportunities to meet their manager on a one-to-one basis for supervision. These meetings gave them the opportunity to feed back about their experiences and request further guidance/training if needed.

We saw there were enough staff to provide support to people safely. Staff were deployed effectively around the building to provide timely support to people but did not always provide the support required. For example, people who required additional monitoring did not always get timely support.   We saw staff were suitably trained to complete their roles. However, not all staff used their training to respond effectively to people’s needs.

There were clear processes to ensure there were enough staff. The provider had used a calculation tool to assess how many staff were needed to meet people’s needs. The rota’s suggested these staffing levels had then been arranged according to this calculation. Staff had received suitable training to do their role and the management team maintained oversight of training compliance. Once staff were trained, there were ongoing processes to assess their competency including spot checks. However, the documentation used lacked details on any issues or actions such as further support and training to improve staff skills. If staff were not providing the expected level of care, there were clear processes to monitor and improve their performance. Safe recruitment processes were followed. For example, previous employers were contacted to give references on the staff member and a Disclosure and Barring Service (DBS) check was completed. These check the police database for convictions or warnings that may impact the staff members safety to work with people. However, some areas as part of recruitment required improvement, for example: exploring gaps in employment and ensuring applicants completed paperwork in full. The management team and administrator responded immediately to make improvements to the recruitment process and evidence checks completed.

People had concerns about the cleanliness of the home but had no concerns with support they received with their personal hygiene. One person said, “I know the floor needs a wash. If I make a spill and wipe it up, you can see the muck on the tissue.” One person said about support with personal care, “I have to have help but can have a shower as often as I like.”

Staff told us infection prevention and control processes were in place at the home and improvements had been made. One staff member said, “"Things have got better, look, the home is a lot cleaner and tidier now". Another staff member told us, “IPC is definitely better.” Kitchen staff told us they had received food hygiene training, they were able to explain what actions they took to reduce the risk of food borne infections.

The home was not clean and hygienic. We saw any dirt or spillages in the home were not always quickly cleaned up. For example, a spillage kit used in the toilet had not been cleaned away. Spillage kits are used to safely clean up liquids which includes hazardous substances. We observed people’s beds with soiled and stained bedding. Equipment used by people was not free from dust and dirt. Clinical items, including catheter supplies, were not stored appropriately to keep them hygienically clean. We noted areas of the home, including in people’s bedrooms, which had a build-up of dust and dirt. Surfaces and furnishings had not been well maintained meaning they could not be kept hygienically clean. People were not consistently supported in a way that protected them from the risk of infection. For example, 1 person was observed to be supported to use a toilet with a toilet seat soiled with faeces. We saw that staff had access to personal protective equipment (like gloves) throughout the home. This allowed them to support people in a hygienic way. We saw the kitchen was managed in a hygienic way to ensure people did not get food borne infections. The management team responded to our feedback and implemented new IPC quality monitoring measures following our assessment.

There were processes and policies to support with maintaining a clean and hygienic environment, but these processes had failed to ensure the environment was kept hygienically clean and protected people from the spread of infection. Staff had received training in infection control, but did not effectively implement their training.

People told us that staff gave them their medicines and provided the appropriate level of support. One person said, “The lady always supervises me with tablets she gives me.” People did not raise any concerns about when they received medicines or regarding any ‘as needed’ medicines like paracetamol for occasional pain relief.

Staff were able to explain how they supported people to take their medicines safely. They described encouraging people to take their medicines and trying again later if the person did not want to take their medicines at that time. Staff knew who to report medicine concerns or errors to. One staff member said, “I would tell a deputy, they deal with stuff like that.” During conversation about medicines staff did not evidence their understanding of their personal responsibilities in relation to the safe management of medicines. For example, during discussion about missing paperwork they stated, “That’s [care staff] responsibility, not mine.” The management team responded to this concern and retrained staff and checked competencies to ensure people under their role and responsibilities.

Medicines were stored in a locked trolley. It is best practice for medicines trollies to be chained to the wall to prevent people accessing them unsafely. Trollies were not secured in line with guidance. Where medicines needed to be stored at a certain temperature, this had not been done. For example, one person required their cream to be kept in a fridge, but the cream was found in a cupboard in their room. Creams were kept in people’s rooms, they were not stored securely to ensure people were safe from the risk of ingesting toxic substances. Creams had not been labelled when opened to ensure they were not used when expired, and some creams were found to have expired but were still in use. Some people were prescribed patches which are applied to the skin. We saw that a record of placement was not accurately maintained. This meant patches could repeatedly be placed in the same area presenting a risk of skin irritation. Some people at the service were prescribed controlled drugs. These are subject to enhanced restrictions due to the addictive nature of these medicines. We saw staff had followed national legal requirements by storing these medicines in an extra secure place. Staff kept records of when they had given prescribed medicines. However, we found cream in someone’s room used for pain relief that was not recorded on a medicines administration sheet. This meant the person could have been receiving a medicine more often than as directed by the prescriber. Some people required ‘as needed’ medicine. Not all these medicines had a protocol which provides staff with clear written guidance on how this should be administered. Staff lacked guidance on what symptoms the person would show if as needed medicine was required. For example, signs that the person is in pain. This meant people may not receive ‘as needed’ medicines to help them with pain management. Staff had received training on how to administer medicines safely.