Hawkinge House improved Safe and Responsive to Good at this focused inspection, with the provider no longer in breach of regulations 9 and 17. Well-led remained Requires Improvement due to ongoing communication issues with relatives, a lack of registered manager, and the need for new governance changes to embed.
Concerns (6)
moderateCommunication with families: “Most people and their relatives said communication from the service was poor and although some relatives said this has improved slightly, more improvement was needed.”
moderateCommunication with families
: “Some relatives had not been told about visiting restrictions being lifted following an outbreak of COVID-19 in the service. One relative told us they hadn't been informed when their loved one had been taken to hospital.”
moderateComplaints handling: “Relatives told us that some minor concerns they reported were not always addressed quickly... most relatvies reported things going missing... they had not taken any action and there had been no improvement.”
moderateLeadership: “The service did not have a manager registered with the Care Quality Commission (CQC) and the CQC had not received an application at the time of this inspection”
minorGovernance: “These changes were still new when we inspected and needed more time to become embedded in the service.”
minorMedication management: “At the last inspection we saw fridge temperatures were not always recorded. At this inspection this had improved but was still not consistent.”
Strengths
· Risk assessments were comprehensive and up to date with clear instructions for staff to mitigate risks
· Staff were knowledgeable about safeguarding and confident to report concerns
· Medicines were managed and administered safely in accordance with national guidelines
· Robust infection prevention and control measures in place across all assessed areas
· Care plans were personalised, including life histories, likes and dislikes
Quality-Statement breakdown (16)
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Staffing and recruitmentNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesNot rated
responsive: Supporting people to develop and maintain relationships to avoid social isolationNot rated
responsive: Meeting people's communication needsNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: How the provider understands and acts on the duty of candourNot rated
well-led: Working in partnership with othersNot rated
Hawkinge House was rated Requires Improvement overall, with breaches of Regulation 9 (person-centred care) and Regulation 17 (good governance) due to out-of-date care plans, lack of personalisation and insufficient activities leading to social isolation. Caring remained Good and medicines and safeguarding were managed safely, but staffing levels, staff knowledge of individuals and quality assurance mechanisms required improvement.
Concerns (13)
criticalPerson-centred care: “The provider failed to ensure that peoples' care was personalised to meet their individual needs”
criticalGovernance: “Peoples' care plans and risk assessments were not always up to date. The provider did not have robust mechanisms in place to monitor the safety and quality of the service.”
moderateCare planning: “not all risk assessments and care plans were up to date and there were no systems in place to ensure reviews took place”
moderateStaff competency: “Staff didn't always know people very well, and they were not always able to tell us about the people they were supporting”
moderateIncident learning: “There was no mechanism in place for sharing lessons learned across the staff team or the wider organisation.”
moderateRecord keeping: “Daily records of care were lacking in detail and mainly consisted of standard phrases from a tick list”
moderateCommunication with families: “People and their relatives consistently told us that communication was a problem.”
moderateStaff training: “healthcare professionals who worked with the service had identified concerns about staff knowledge in topics such as feeding tubes, wound care, nutrition, fluid intake and dementia”
moderateSafeguarding: “emergency services had been called for a person showing signs of dehydration, which were reported to the local safeguarding authority”
minorMedication management: “where medicines are required to be stored in temperature-controlled conditions, the temperatures were not consistently recorded”
minorComplaints handling: “There was no separate log of complaints which made it difficult for the manager to see the investigation, actions taken”
minorInfection control: “Effective nursing measures were not in place for a person who was showing signs of an infection.”
Strengths
· People reported feeling safe living in the service
· Staff were recruited safely with DBS and reference checks
· Medicines were managed and administered safely in accordance with national guidelines
· Service complied with the Mental Capacity Act and DoLS processes
· Staff treated people with dignity, respect and kindness
Quality-Statement breakdown (24)
safe: Staffing and recruitmentNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law
Targeted IPC inspection of Hawkinge House as a designated care setting for people discharged from hospital with positive COVID-19 status. Inspectors were assured the service met good infection prevention and control guidelines; the service was inspected but not rated.
Strengths
· Designated COVID-19 area had a separate entrance for people and staff to prevent cross contamination
· Separate staff team allocated to the designated setting including nurses, care staff and housekeeping staff
· Self-contained designated setting with its own treatment room, medicines trolley and equipment
· Service was clean with hand sanitising areas throughout
· Sufficient PPE to meet current and future demand and staff using PPE correctly
Quality-Statement breakdown (2)
safe: Staffing - measures in place to mitigate risks associated with COVID-19 related staff pressuresNot rated
safe: How well are people protected by the prevention and control of infection?Not rated