Hawthorne Court Nursing Home is a purpose built nursing home and reablement unit, accommodating up to 80 older persons, including people who are living with dementia.

The inspection was unannounced and was carried out on 7 and 9 June 2017.

At the last inspection on 24 and 26 August 2015 the service was rated Good. At this inspection we found the service remained Good.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission 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 home is run.

The service was overall responsive to people’s needs and any concerns they had. We have made a recommendation that the provider researches and implements current good practice in relation to mental health and dementia care planning.

People told us they felt safe living in the home and that care was delivered in a safe manner. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. The assessments were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

People were supported by sufficient staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

Staff developed caring and positive relationships with people and were sensitive to their individual choices and treated them with dignity and respect. People and their families were encouraged to express their views and be involved in making decisions about their care and support.

People were supported to have enough to eat and drink. Mealtimes were relaxed and staff supported people in a patient and friendly manner.

There was a programme of activities for mental and social stimulation and there were plans to provide these at different times to meet people’s preferences.

People were encouraged to provide feedback on the service provided, both informally and through a quality questionnaire.

The registered manager demonstrated an open and inclusive style of leadership. Staff understood their roles and responsibilities and there were clear lines of accountability within the service.

There were systems in place to monitor quality and safety of the home provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

During this inspection we met some of the people who used the service and spoke with the registered manager, a deputy manager, two nurses, six care staff, the activities coordinator and the chef. We looked at care and support records for nine people who used the service. People’s needs were assessed and care and support was planned and delivered in line with their individual care plan. Their health needs were monitored and referred to health professionals appropriately. A person who used the service said “I am happy here. People are kind to me”. People were protected from the risks of inadequate nutrition and dehydration. There were enough qualified, skilled and experienced staff to meet people’s needs and we observed that staff provided support in a patient, caring and friendly manner. People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

During this visit we spoke with six people who were using the service, three relatives, seven members of staff and the new registered manager. Some of the people we spoke with told us they could not remember staff discussing their care with them. Others told us that this had been discussed with them prior to or just after their admission.

People we spoke with were mostly positive in their comments about the service. For example, one person said: “All the staff are very good. They have lots of patience and treat us well”. Another person told us: “It is a very nice home. They talk to me when they have time. I feel safe here”. Some of the people we spoke with told us they would like more entertainment and day trips.

During our visit we observed positive interactions between staff and people using the service. The expert-by-experience observed that the home, though very large, had a warm, calm atmosphere. The service had a policy and procedures in relation to the management of medicines. A person using the service said:”They manage it well in here”.

Some of the people we spoke with told us they would like staff to have more time to talk with them. Feedback from staff about staffing levels was also mixed. We saw that the service had taken steps to improve continuity of staffing.

There were systems in place to monitor the quality of service that people received and to identify, assess and manage risks.

Not all of the people using the service were able to verbally communicate with us. We therefore spent time during our visit observing the care and support being given and how staff interacted with people.

Overall, the people who spoke with the expert by experience were very pleased with the care being provided. Some people said that the staff were very busy and that the home needed more staff. The expert by experience found that the home had a nice atmosphere and the staff she spoke with were very caring. We observed that staff were polite and considerate and their interactions with people were positive. People received support from staff at mealtimes if they required it. Some said they could choose to eat in the dining areas or in their rooms and could have alternatives to the main menu if they asked. Every person we spoke to knew how to make a complaint if they needed to and most of them said they did not need to. People said that the home was kept clean and tidy.

People we spoke with were happy with the care and support they received. People said they felt safe in the home and enjoyed the meals.

Relatives spoken with said they thought the quality of the care provided by staff was good.

Most of the people living in the home and their relatives spoke of their concerns about the staffing levels in the home and the impact of the changes to staffing levels being introduced by Hampshire County Council are having on the home. They felt that currently there was not enough staff on duty to fully meet peoples’ needs.

This inspection visit took place on 24 and 26 August 2015 and was unannounced.

Hawthorne Court is a purpose built nursing home accommodating up to 80 older persons, including people who are living with dementia.

At the time of this inspection the service did not have a registered manager. 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 2008 and associated Regulations about how the service is run.

People’s care plans were not reviewed consistently and did not always reflect people’s needs. Staff were kind and caring but the service was not always responsive to people’s individual needs.

There were systems and processes in place to protect people from harm. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns.

Medicines were managed safely as the staff responsible for administering people’s medicines were suitably trained and competent.

There were sufficient numbers of staff to meet people’s needs. Safe recruitment practices were followed and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home.

Staff were supported to carry out their roles and received an induction and on-going training and supervision. Staff worked in a manner that respected people’s privacy and protected their dignity.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. Where people’s liberty or freedoms were at risk of being restricted, the proper authorisations were in place or had been applied for.

People received on-going health checks and support to access healthcare services. They were supported to eat and drink enough to meet their needs.

People were confident they could raise concerns or complaints and that these would be dealt with.

There was a positive and open culture within the service, which encouraged people’s involvement and their feedback was used to drive improvements. There were a range of systems in place to assess and monitor the quality and safety of the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.