Archived: Thistleton Lodge

Updated 3 September 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was carried out by two inspectors and an inspection manager.

Service and service type

Thistleton Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

The inspection was unannounced on day one and announced on day two.

What we did before inspection

We completed our planning tool and reviewed information we had received about the service since the last inspection. This included notifications we had received from the provider, about incidents that affect the health, safety and welfare of people supported by the service. We looked at previous inspection reports. We also sought feedback from partner agencies and health and social care professionals. This information helps support our inspections. We used all of this information to plan our inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We gained information from four people who lived at Thistleton Lodge and six relatives. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with six members of staff including the registered manager and deputy manager. We also spoke with a visiting professional.

To gather information, we looked at a variety of records. This included medicine records and five people's care records. We looked at information in relation to recruitment, staff training and supervision records. We also looked at other information related to the management of the service including audits, surveys and meeting minutes. We did this to ensure the management team had oversight of the service and they could respond to any concerns highlighted or lead in ongoing improvements. We walked around the building to check the home was clean, hygienic and a safe place for people to live and checked maintenance.

Updated 3 September 2019

About the service

Thistleton Lodge Care Home is a large detached property in its own grounds providing care for up to 54 people in three units. Two units specialised in providing care to people living with dementia There was a passenger lift for ease of access and the home was wheelchair accessible. At the time of inspection 47 people lived at the home.

People’s experience of using this service and what we found

Although people said they felt safe at Thistleton Lodge, this did not reflect our findings on this inspection. People’s medicines were not consistently managed safely or in line with good practice guidelines. This meant errors were more likely to occur. People were not always protected from avoidable harm because senior staff did not fully assess all health concerns or behaviour that challenged. There were hazards in the home which placed people at risk of harm. The registered manager did not consistently follow correct process in response to concerns. All of these findings increased risk and the possibility of harm to people. We have required the provider to address these.

There were poor infection control practices which put people at risk of cross infection.

We have made a recommendation for the provider to consider current infection control guidance.

Staff had been recruited safely, trained and supported. People told us there were enough staff to support them.

People were not consistently supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The registered manager had not consistently assessed people's capacity to make specific decisions in accordance with the Mental Capacity Act 2005 or supported them with decision making. Staff reviewed and updated assessments and care plans. However, these did not cover the full range of people’s diverse needs, always involve them or deliver care in line with good practice guidance. We have required the provider to address these issues.

Parts of the environment needed attention to provide a safe, pleasant place for people to live. We made a recommendation for the provider to make improvements to the environment.

People were usually supported to access health and social care professionals, but referrals were not always made promptly when equipment failed. Staff supported people to eat healthy nutritious food and drink sufficient fluids and knew their likes and needs. There was dementia friendly signage and equipment to assist people moving around the home and meaningful activity. People and relatives felt staff had the skills, knowledge and experience needed to provide good care.

Staff were caring in their approach. However, they did not always look at different ways to care for people when distressed or uncooperative with care. Care plans did not always help staff to deliver the right support or show people’s involvement in care plans. We have required the provider to address these.

Locks had been removed from some bathrooms, reducing privacy for people. We made a recommendation about managing privacy to maintain people’s dignity.

People told us staff were kind, friendly and supportive and most said they and their relatives were happy at Thistleton Lodge. Staff knew people well and were familiar with their likes and dislikes. We saw caring and sensitive interactions and people were encouraged to make choices throughout the inspection.

Care records did not always have information to provide people with personalised care based on their current needs. We have required the provider to address this.

People knew how to complain and most felt the registered manager would take action to resolve any concerns. There were frequent and varied social and leisure activities. People could stay in the home when heading towards end of life. Staff knew the importance of supporting people to have a comfortable, pain free and peaceful end of life.

The service was not suitably monitored and managed. There was a lack of oversight and risks were not fully understood or addressed. We have required the provider to address this.

The provider was not always clear about their responsibilities to notify CQC of incidents about significant events that occurred in the service. Most people supported, and relatives told us they had confidence in the registered manager who was open and transparent. They talked with and sought people's views. The registered manager was receptive to our inspection feedback and proactive in starting to address the issues we found. Staff told us they felt well supported and enjoyed working at Thistleton Lodge.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At the last inspection the service was rated good (published 26 April 2017).

Why we inspected

The inspection was prompted in part due to concerns received about medicines, infection control, staffing, staff recruitment and training, staff attitudes, care, equipment and record keeping. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see safe, effective, caring, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe and person-centred care, management of medicines and governance and monitoring of the service and accurate record keeping this inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.