Hawthorne House

Processes to manage risks were not always effective. People’s care records did not always include information to ensure staff supported people consistently and safely. Some staff were not aware of changes to people’s risks. Medicine management required improvement. We could not be confident that people received medicines as prescribed. Managers understood local processes and procedures for ensuring continuity of care as people moved between services. Overall, records of people’s referrals and healthcare appointments were made at times people needed. Rotas demonstrated staffing levels were maintained to ensure people received their allocated support hours and there were staff with the necessary skills to support people.

This assessment did not assess all quality statements within this key question. We assessed 5 quality statement; capable, compassionate and inclusive leaders, freedom to speak up, governance and assurance, partnerships and communities and learning, improvement and innovation. Systems and processes did not always drive forward improvements. Although a range of audits and checks were carried out, these were not always effective in identifying and mitigating areas of risk. Where we found concerns, such as risk management, these had not always been identified. This showed quality assurance systems were not always effective. A learning culture was in place but not fully embedded. At the time of our assessment, there was no registered manager in post. A manager was in post and had applied to be registered with us. They had been a registered manager at one of the provider’s other homes. Although overall we received positive feedback about the manager, some people and relatives expressed concern over effective communication and did not always feel if issues were raised, these were responded to in a timely way. The provider's oversight and governance systems were not always operated effectively in assessing, monitoring and improving the quality and safety of the service provided. This was a continued breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The manager was responsive to our feedback and began to address the shortfalls identified during our assessment with an action plan. Staff spoke positively of the manager and said they were visible and approachable. Staff described a supportive environment where they felt able to raise concerns with confidence they would be listened to.