Archived: Thistleton Lodge

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.

At the last inspection on 28 January 2015 we asked the provider to take action to make improvements because we found breaches of legal requirements. This was in relation to person centred care, consent and capacity, safe care and treatment, safeguarding service users from abuse and improper treatment, nutrition, staffing levels and governance of the home. The provider sent us an action plan saying they would meet the legal requirements by 06 July 2015. During our inspection visit on 06 April 2017 we found these actions had been completed.

Thistleton Lodge Care Home is a large detached property in its own extensive grounds. It is easily accessible and there is ample car parking space for visitors. There is a lift and access for wheelchairs throughout. The service can accommodate a maximum of 54 people and specialises in providing care for people who live with dementia. At the time of our inspection visit there were 50 people who lived at the home.

There was a registered manager in place. 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 who lived at the home told us they were happy with their care and liked the staff who looked after them. One person said, “The staff are brilliant and we get the best care possible.”

We observed staff providing support to people throughout our inspection visit. We saw they were kind and patient and showed affection towards the people in their care.

We saw people who lived at the home were clean and well dressed. They looked relaxed and comfortable in the care of staff supporting them.

People who lived at the home and their visitors told us they enjoyed a variety of activities which were organised for their entertainment. One person who lived at the home said, “They are always organising something for us to do. There is never a dull moment.”

Staff knew people they supported and provided a personalised service. Care plans were organised and had identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

We found people had access to healthcare professionals and their healthcare needs were met. We saw the service had responded promptly when people had experienced health problems.

The service used innovative methods to ensure care was provided in a way that was responsive to people's needs. For example, staff on night duty wore pyjama type uniforms to help orient people to place and time.

People who were able told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

The service had sufficient staffing levels in place to provide support people required. We saw staff members could undertake tasks supporting people without feeling rushed. People who lived at the home told us staff were responsive to their needs.

We looked at the recruitment of four recently appointed staff members. We found appropriate checks had been undertaken before they had commenced their employment confirming they were safe to work with vulnerable people.

Staff spoken with and records seen confirmed a structured induction training and development programme was in place. Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs.

Staff spoken with and records seen confirmed training had been provided to enable them to support people who lived with dementia. We found staff were knowledgeable about the support needs of people in their care.

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

The environment was maintained, clean and hygienic when we visited. People who lived at the home were happy with the standard of accommodation provided.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

We found equipment used by staff to support people had been maintained and serviced to ensure it was safe for use.

Medication procedures at the home were safe. Medicines were safely kept with appropriate arrangements for storing in place.

The service had a complaints procedure which was made available to people on their admission to the home. People we spoke with told us they were happy with their care.

The service used a variety of methods to assess and monitor the quality of the service. These included resident meetings and care reviews.

We found the provider had effective systems in place in order to gain consent from people before any care was delivered to them. Where people were unable to make decisions for themselves, the provider acted in accordance with the law and ensured decisions were made in the best interests of people concerned.

People's needs were asessed and used to inform individual plans of care. These helped to ensure that people's needs were met in a way that was safe and which protected them against risks of inappropriate care.

People were not protected against the risks associated with the unsafe use of medicines. The provider did not have effective measures in place to ensure the home's medicines policy was followed at all times.

The home maintained accurate and appropriate records. This helped to ensure that up to date and relevant information about people was maintained so that care and treatment could be planned and delivered appropriately and safely.

We found the provider had not ensured staff who cared for people living with dementia had the knowledge and skills required to provide care and support that fully met their needs. We found little evidence that people were involved in the planning of their care as written records were incomplete.

People we spoke with were generally happy with the care and support they received and spoke highly of the staff team and the home in general. We found, however that people's risk assessments and plans of care were not reviewed and updated in line with changes in their needs. This could result in inappropriate or unsafe care being delivered to people.

We found the home did not have suitable arrangements in place for storing, administering, recording or auditing the use of people's medication.

We found records at the home did not always include accurate and up to date information about people who used the service.

"I'm happy that staff always ask me and explain what they need to do before they help me with [personal care]."

"I love it here...I wouldn't want to be anywhere else...You wouldn't find anywhere better."

"The staff are fantastic, just like family."

We found that the provider had well trained staff who ensured that consent to care and treatment was gained from people who used the service. Staff at the home were well supported to carry out their role and there was a good team ethos amongst the staff and management. The provider took a person centred approach to assessing people's needs and delivering care, which promoted the health and welfare of each individual. We saw that the care that was delivered to people was of a high standard and people were satisfied with the care and support they received. The registered manager had effective systems in place for monitoring and assessing the quality of care that was provided.

The relatives we spoke with told us, ''this is the third home my relative has been in and we are more than happy with it.'' One relative said, “If anything changes, I’m always told straight away and it’s much better than where (user of the service) was before.”

The staff that we spoke with understood the signs of abuse and what to do if they had concerns. One member of staff told us they were more than happy to whistle blow they said ‘’I wouldn’t hesitate’’.

The staff we spoke with all told us that they had completed an induction and one told us, ‘’ When I started I spent two weeks working with an experienced member of staff ‘’

One person using the service that we spoke to said ‘’ I have no complaints and would tell the manager if I had’’