Thornton House Home for Older People

We found the following examples of good practice.

People were supported in a clean environment that supported people’s rights to maintain contact with those who were important to them.

Staff had received training to help ensure their knowledge on infection prevention and control was up to date. Personal protective equipment and infection control hand gel was available throughout the home.

Testing arrangements followed good practice and the outcome of testing was recorded.

Cleaning schedules were in place and followed. There were designated domestic staff and the registered manager carried out regular checks of the environment and cleanliness.

National guidance was available for staff to refer to and policies and procedures were updated as guidance changed.

Thornton House Home for Older People is a residential care home providing personal care to 31 people at the time of the inspection. The service can support up to 45 people across four separate units providing residential and rehabilitation support. They also provided care and support to people living with dementia.

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

Some care plans lacked some information related to people's individual needs and behaviours. The auditing processes in place did not identify the concerns we found around the management of risk and infection prevention. Not all staff followed good practice guidance and company policy, as they travelled to and from work in their uniforms, rather than getting changed when at the care home. People raised concerns related the staff response times when they pressed their call bells. We could not fully investigate this as the call bell system on site did not record staff response times.

The management of medicines was not always safe. We have made a recommendation about the management of some medicines. The registered manager did not have oversight of the training records of all staff working at the home. We have made a recommendation about this.

The management team worked with a variety of agencies to ensure people's health and social needs were met. Onsite face to face visits by families had commenced to promote people's wellbeing. Staff were knowledgeable about how to safeguard people from abuse. Staff had safe recruitment checks before providing care.

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

Rating at last inspection

The last rated inspection for this service was good (published 11 December 2018).

Why we inspected

We received concerns in relation to medicines, infection prevention and the safe use of equipment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

The provider acted during and after out inspection visit to address the concerns raised and lessen the risk that people may be subjected to avoidable harm.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Thornton House Home for Older People on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to safe care and treatment related to the management of risk and the management of some medicines. We identified a breach of good governance and the effectiveness of some audits at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Thornton House Home for Older People is a care home providing accommodation for up to 45 people across four separate units. Each unit has separate adapted facilities. One of the units (Byron) specialised in providing care to people living with dementia. Two units (Keats) provided rehabilitation services and the Wordsworth unit provided mainstream residential care. At the time of our inspection visit there were 28 people who lived at the home.

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

We received information raising concerns about the use of specialist equipment, infection control, and medication and whether people were safe. We wrote to the provider and asked for information around their systems and processes and policy and procedures for supporting people safety.

We inspected the home to see how care was being provided against the information the provider had shared with us. We checked specialist equipment was being fitted and used correctly. We looked around the home to check it was clean and hygienic. We observed staff use of personal protective equipment (PPE) and their infection control practices and checked medicines management. People supported and their relatives told us they felt safe and cared for, staff kept the home clean and used gloves, masks and other equipment safely.

We found specialist equipment was fitted, used and maintained correctly. Medication was managed safely. Personal protective equipment and cleaning materials were readily available to staff and staff were following the latest guidance. This helped protect people from the risk of acquiring infections and the service was clean.

Rating at last inspection

The last rating for this service was Good (published11 December 2018).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about the correct use of specialist equipment, infection control and prevention and management of medicines. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns.

Please see the safe section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Thornton House Home for Older People on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Thornton House accommodates 45 people across four separate units, each of which have separate adapted facilities. One of the units (Byron) specialised in providing care to people living with dementia. Two units (Keats) provided rehabilitation services and the Wordsworth unit provided mainstream residential care. At the time of our inspection visit on 20 November 2018 there were 32 people who lived at the home.

Thornton House is a 'care home.' People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

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. When we undertook this inspection visit the registered manager was on extended leave and wasn’t in post undertaking their day to day managerial duties.

At the last inspection on 20, 21, 29 November and 05 December 2017 we asked the provider to take action to make improvements because we found breaches of legal requirements. This was in relation to safe care and treatment, staffing, notifications of other incidents and good governance. We received a provider action plan and the provider said they would meet the relevant legal requirements by 30 April 2018. During our inspection visit on 20 November 2018 we found these actions had been completed.

During the last inspection of the service we found the home in breach of the regulation associated with ensuring the risks to people's health, care and welfare were appropriately assessed. During this inspection we found 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.

When we last inspected the service we found the deployment of staff during the night was not always sufficient to meet people's support plan requirements. Checks completed during the night on the services four units were inconsistent. This left frail and vulnerable people unsupervised and at risk of harm. During this inspection we found regular checks were completed and people received the support they required.

At the last inspection we found staff had not received training for maintaining and checking bedrails. Good practice guidance says staff must receive training in relation to the safe use of bedrails. During this inspection we found staff had received the required training.

During the last inspection we identified four serious injuries that had occurred over a seven month period which had not been reported to CQC. During this inspection we did not identify any accidents which the service hadn’t reported to CQC.

When we last inspected the service we found the quality and accuracy of documentation maintained by the service was inconsistent. We found gaps in records and a lack of information about people at risk of losing weight with their dietary intake. During this inspection we found records maintained were accurate and reflected people's needs.

At the last inspection the service used a variety of methods to assess and monitor the quality of the service. However, these had not been effective and had failed to identify the concerns we found during the inspection process. During this inspection we found the service had effective auditing and quality assurance systems in place.

During this inspection people who lived at the home and their visitors told us they were very happy with the care provided at the home and staff were caring and compassionate. They told us staff were kind and attentive and spent quality time with them. Comments received included, “The girls here are all carers. They are so competent they know what people need.” And, “The staff are wonderful, they will do anything for you.”

People told us they felt safe in the care of staff and were happy living at the home.

Procedures were 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.

Staff had been recruited safely, appropriately trained and supported.

We observed the daily routines and practices within the home and found people were treated equally and their human rights were respected.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. People received their medicines as prescribed and when needed and appropriate records had been completed.

Support plans were organised and had identified care and support people required. We found they were informative about care people had received. We saw people had consented to their care and treatment and where appropriate family members who had the legal authority to do so.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required. The design of the building and facilities provided were appropriate for the care and support provided.

We saw there was an emphasis on promoting dignity, respect and independence for people supported by the service. They told us they were treated as individuals and received person centred care.

We observed the daily routines and practices within the home and found people were treated equally and their human rights were constantly being respected.

The service had safe infection control procedures in place and staff had received infection control training.

Meal times were relaxed and organised around people’s individual daily routines. People who required help to eat their meals were supported by caring, attentive and patient staff.

People were supported to have access to healthcare professionals and their healthcare needs had been met.

The service had information about support from an external advocate should this be required by people they supported.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Further information is in the detailed findings below.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection on 05 April 2016 the service was rated Good.

At this inspection carried out 20, 21, 29 November and 05 December 2017 the service was rated Requires Improvement. This is the first time the service has been rated Requires Improvement.

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with CQC about the incident indicated potential concerns about the management of risk of falls from beds. This inspection examined those risks.

We looked at how the service managed risk to keep people safe. We found risk was not appropriately addressed and managed. This placed people at risk of harm. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities, 2014 (Safe care and treatment).

We found the deployment of staff during the night was not always sufficient to meet people’s support plan requirements. Checks completed during the night on the services four units were inconsistent. This left frail and vulnerable people unsupervised and at risk of harm. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Staffing) as the registered provider had failed to ensure staff were effectively deployed at all times.

Staff had been recruited safely, trained and supported. Staff told us they received regular supervision and their work was appraised annually. However staff had not received training for maintaining and checking bedrails. Good practice guidance says staff must receive training in relation to the safe use of bedrails. (MHRA Safe Use of Bed Rails. December 2013). This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014 as the registered provider had failed to ensure staff had the required skills to provide safe care and treatment.

During the inspection we identified over a seven month period one serious injury had not been reported to CQC, one accident where the nature of the injury had not been recorded and two injuries which potentially were reportable. This meant that we did not receive all the information about the home that we should have done. This was a breach of Regulation 18 of the Care Quality Commission Registration Regulations 2009 (Notification of other incidents).

We found quality and accuracy of documentation maintained by the service was inconsistent. We found gaps in records and a lack of information about people at risk of losing weight with their dietary intake. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good governance) as the registered provider had failed to ensure records maintained were accurate and reflected people’s needs.

The registered manager used a variety of methods to assess and monitor the quality of the service. However these had not been effective and had failed to identify the concerns we found during the inspection process. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good governance).

The service had not discussed with people and documented their preferred end of life wishes.

We have made a recommendation about this.

We spoke with 16 people who lived at the home and two people visiting their relatives. People who lived at the home told us they were happy, safe and well cared for. One person said, “The staff are really nice and are looking after me well. I have found them very helpful.”

People visiting the home told us they were made welcome by friendly and caring staff and had unrestricted access to their relatives. They told us they were happy with the care provided and had no concerns about their relatives safety.

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.

Medication procedures observed protected people from unsafe management of their medicines. People received their medicines as prescribed and when needed and appropriate records had been completed.

We saw there was an emphasis on promoting dignity, respect and independence for people who lived at the home. People told us staff treated them as individuals and delivered person centred care. Support plans seen confirmed the service promoted people’s independence and involved them in decision making about their care.

We looked around the building and found it had been maintained, was clean and hygienic.

The design of the building and facilities provided were appropriate for the care and support provided.

The service had safe infection control procedures in place and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

People had been supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff knew people they supported and provided a personalised service in a caring and professional manner.

People 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. Catering staff had information about people’s dietary needs and these were being met.

People who lived at the home told us they enjoyed a variety of activities which were organised for their entertainment. These included exercise classes, bingo, quizzes, pamper sessions and arts and crafts.

People told us staff were very caring towards them. Staff we spoke with understood the importance of high standards of care to give people meaningful lives.

The service had information with regards to support from an external advocate should this be required by them.

The service had a complaints procedure which was made available to people on their admission to the home and their relatives. People we spoke with told us they were happy and had no complaints.

During the inspection the management team were receptive to feedback and worked with us in a positive manner. They provided information we requested and took prompt action to address any concerns.

You can see what action we have asked the registered provider to take at the back of the full version of the report.

Thornton House Home for Older People is registered to provide personal care and accommodation for up to 44 older people. Care is provided on a 24 hour basis, including waking watch support throughout the night. The home is divided into four areas. Two providing rehabilitation care. One dementia care and one residential care. At the time of the inspection there were 42 people living at the home.

Accommodation is provided over two floors, with a lift providing access to the first floor. There are a range of communal rooms, comprising of a lounges, dining rooms and kitchen areas. There are garden areas with seating for people to use. Car parking is available at the home.

The home is managed by a registered manager. A registered manager has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they were happy living at Thornton House Home for Older People and the care met their individual needs. People described staff as ‘wonderful’ and ‘thoughtful’ and told us they were involved in their care planning.

There were systems in place to protect people at risk of harm and abuse. Staff were able to define abuse and the actions to take if they suspected people were being abused.

We found individual risk assessments were carried out and care plans were developed to document the measures required to reduce risk. Staff were knowledgeable of the measures in place and we observed these were followed these to ensure peoples’ safety was maintained.

We found medicines were managed safely. We saw people were supported to take their medicines in a dignified manner and there were systems in place to ensure medicines were stored securely.

We found appropriate recruitment checks were carried out. This helped ensure suitable people were employed to work at the home. We found there were sufficient staff to meet people’s needs. People were supported in a prompt manner and people told us they had no concerns with the availability of staff.

Staff received regular support from the management team to ensure training needs were identified. We found staff received appropriate training to enable them to meet people’s needs.

Processes were in place to ensure people’s freedom was not inappropriately restricted and staff told us they would report any concerns to the registered manager.

We found people were offered a variety of foods and people told us they liked the meals at Thornton House Home for Older People.

People were referred to other health professionals for further advice and support when assessed needs indicated this was appropriate. We spoke with four visiting health professionals who voiced no concerns with the care provided at the home.

Our observations during the inspection showed staff treated people with respect and kindness. People told us they considered staff were caring and we saw a positive rapport between staff and people who lived at the home.

Staff knew the likes and dislikes of people who lived at the home and delivered care and support in accordance with people’s expressed wishes. During the inspection we noted people were supported to carry out activities which were meaningful to them.

There was a complaints policy in place, which was understood by staff. Information on the complaints procedure was available in the reception of the home.

People who lived at Thornton House, and their relatives, were encouraged to express their views and opinions of the service. Their views were used to improve and develop the service.

We found new staff were recruited safely and all staff received regular training to give them the skills and knowledge to look after people properly. We spoke with three staff. They told us they would feel confident to speak out against poor practice if needed. People living in the home said, 'I am treated very well' and 'Everyone is very kind and patient'.

People were happy with the staff team. Comments included, 'Staff are lovely; absolutely brilliant' and 'Staff help with a smile and kind manner'. Staff told us they were happy working in the home.