Thirlestaine Park Care Home

Thirlestaine Park Care Home is a residential care home providing personal and nursing care to 41 people aged 65 and over at the time of the inspection. The service can support up to 63 people. People are accommodated on three floors and on units according to their needs. One unit specialises in the care of people who live with dementia.

Each unit provides people with a single occupancy bedroom with attached toilet and bathing facilities. Each unit has its own lounge, dining room and additional adapted bathing facilities and toilets. There is a designated activities room with cooking facilities. People have access to a large garden and spacious communal balconies leading off the upper floor lounges.

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

People told us they felt safe. Risks which are associated with the care of older and more frail people were assessed and action taken to reduce these. Falls prevention strategies were adopted and people, assessed as being at risk of falling, were provided with the support they needed. Care and nursing staff were well versed in the provider’s falls protocol and knew what action they should take in the event of a person’s having fallen.

Risk management strategies were also in place to manage other risks which can accompany old age and living with dementia, such as loss of appetite, weight, swallowing difficulties and pressure ulcer development. People who lived with dementia were provided with support when they became anxious and confused. This helped reduce potential changes in their behaviour which may affect their wellbeing.

Some people told us they sometimes had to wait longer than they would prefer for staff to respond to their call bell. Some recorded call bell response times were not within the provider’s preferred time frame although many were. Managers and senior staff appreciated the need for call bells to be responded to quickly to help maintain people’s safety. Action was being taken to improve the staffs’ response times to call bells. People told us staff were attentive to their needs when they were with them.

People’s dependency levels were assessed and monitored, and managers staffed the home accordingly. The provider had contingency plans in place to be able to respond to the impact of COVID-19 on staffing.

People and their relatives told us they would feel able to raise concerns and, they felt reassured that these would be addressed. There were systems in place to protect people from potential abuse.

People received their medicines as prescribed. People were supported to manage their own medicines where it was safe for them to do this. Potential risks, associated with certain types of medicines, were identified and managed. Staff were aware of the potential increased risk of internal bleeding when people who were prescribed an anticoagulant and who were also prone to falling.

Action was taken to reduce and mitigate environmental risks. Fire detection systems were maintained, and staff had been trained in how to support people in the event of a fire. Regular servicing and maintenance arrangements were in place to keep the building and the equipment in it safe.

Effective infection, prevention and control arrangements reduced the risk to people from infections which can potentially spread. The service was adhering to current COVID-19 related guidance for care homes.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice. This judgement is limited to the areas focused on during this inspection such as maintaining people’s safety, the management of risk and medicines support.

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 rating for this service was Good (published 12 January 2018).

Why we inspected

This targeted inspection was prompted following receipt of notifications from the provider of serious injury following falls experienced by some people.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific areas of concern. 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. The overall rating for the service has not changed following this targeted inspection and remains Good.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service. If we receive any concerning information, we will decide what regulatory action is appropriate to take.

We found the following examples of good practice.

¿ Visits to the home had currently been suspended for people’s relatives, except for people at the end of their life. When relative visiting restarts the service have a visiting room set up in accordance with recognised safe visiting guidance. Alternative ways, including the use of technology, had supported people’s ability to remain in contact with their relatives.

¿ The home had supported people to self-isolate where possible. People were being supported in their rooms. Personal Protective Equipment (PPE) stations were in place at people’s rooms where required to support staff with appropriate barrier care.

¿ Admission to the home was completed in line with COVID-19 guidance. People were only admitted following a negative COVID-19 test result and supported to self-isolate for up to 14 days following admission to reduce the risk of introducing infection.

¿ People’s health and wellbeing was monitored. People were observed for symptoms of COVID-19 and other potential infections. Healthcare professionals had continued to provide clinical support to people as this was required. People were due to be vaccinated by healthcare professionals imminently.

¿Action had been taken to reduce the risk of infection spreading which had included the correct use of personal protective equipment (PPE), isolation of people affected by COVID-19 and the cohorting of staff to reduce the spread of infection. The service only used agency staff who were familiar with the service and people’s needs, which reduced the risk of COVID-19 entering the service.

¿ People and staff were tested in line with national guidance for care homes. Testing had helped the registered manager identify when full infection control measures needed to be implemented and when staff needed to self-isolate. Staff were being tested prior to every shift.

¿ As part of full infection control measures laundry and waste arrangements had been correctly implemented to reduce the spread of infection.

¿ Cleaning schedules had been enhanced and were followed by housekeeping staff and care staff. The service had adopted a specific cleaning technology which was actively used by all staff, on top of recognised cleaning materials.

¿ The provider’s policy for managing COVID-19 and related infection prevention and control procedures had been reviewed and kept up to date. COVID-19 guidance was also kept up to date for staff reference.

¿ Staff had received training and support in relation to infection control and COVID-19. The provider and staff had taken immediate action to manage an outbreak situation and they recorded the ongoing actions taken to support people and staff through an outbreak of COVID-19.

¿ The manager and deputy manager were implementing wellbeing meetings for staff to support them during the pandemic. Staff felt supported to ensure people’s health needs were maintained.

The care home can accommodate 63 people in one adapted building spread over three floors. Nursing care was provided on the second floor and people living with dementia lived on the first floor. People requiring help with their personal care lived on the ground floor. At the time of our inspection there were 38 people living at the home. People had individual bedrooms with en-suite facilities and also had access to a bathroom with an assisted bath. Spacious communal areas were provided on each of the three floors which included lounges and dining areas. In addition people had access to smaller private lounges, a gym, an activities room and a reception room where they and their visitors could have coffee. Grounds around the home were accessible. Raised flower beds and patio areas were provided. On the first and second floors there were enclosed balconies for people to sit outside.

This inspection took place on 13 and 14 December 2017. At the last comprehensive inspection in October 2015 the service was rated as Good overall.

At this inspection we found the service remained Good.

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’s care and support was individualised reflecting their backgrounds, lifestyles and aspirations. Staff knew people well, treating them with kindness and respect. They understood how to support people who were anxious or upset, helping them to manage their emotions. People had positive relationships with staff, sharing lighter moments and laughing with them. People were encouraged to be independent and staff knew what they could and could not do for themselves. People were offered choices about their day to day lives. 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. Deprivation of liberty safeguards were in place where people were restricted of their liberty.

People’s health and wellbeing was promoted. They had access to a range of health care professionals. When people’s needs changed they received the appropriate health and support to enable them to stay as well and safe as possible. People were supported to have a healthy and nutritious diet which reflected their individual dietary needs. People’s interests were considered when providing a range of activities both inside and outside of the home. People enjoyed art and flower arranging classes, using the gym, gentle exercise, music and individual clubs. A group of people had visited a local airport and had a helicopter ride. People had also been entertained by a choir and local celebrity. Good use was made of technology to make information accessible to people and to ensure they received safe care.

People were supported by staff who had been through a recruitment process which verified their competency and aptitude for the roles they were to perform. Staff had access to training to equip them with the skills to support people. They were supported to develop in their roles with individual meetings, annual appraisals and staff meetings. Staff understood how to keep people safe and were confident about raising concerns about people’s safety and wellbeing.

People’s views were sought as part of the quality assurance process to drive through improvements. A range of quality assurance audits were completed by staff, the registered manager and the provider to monitor and evaluate the quality of service provided. Audits evidenced actions had been identified resulting in improvements to such areas as staff training and supervision, staff levels and the environment.

The registered manager was open and accessible. Complaints were investigated and responded to with action being taken in response to any lessons learnt. The registered manager wished to drive through improvements to provide the best possible service to people and to value the contribution of staff.

This was an announced inspection which took place on the 10 April 2017. Thirlestaine Park Care Home is a care home for up to 63 people.

There was a registered manager in post. 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.

We undertook this focused inspection on 10 April 2017 to check that they had followed their plan and to confirm that they now met legal requirements in relation to a breach of Regulation 19. This report only covers our findings in relation to these issues. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Thirlestaine Park Care Home on our website at www.cqc.org.uk”.

At the unannounced comprehensive inspection of this service on 8 and 9 October 2015 a breach of a legal requirement was found. After this comprehensive inspection, we asked the provider to take action to make improvements to the recruitment and selection processes for new staff. We found that staff recruitment processes had improved to a degree but further improvements were needed.

We have made a recommendation about staff recruitment processes.