6 July 2023
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 Health and Social Care Act 2008.
As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
This inspection was completed by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Thistle Hill Care Centre is a ‘care home.’ People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Thistle Hill Care Centre is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 8 residents, 1 visitor, 4 family members, and 7 staff members including the clinical lead, a nurse in charge, the registered manager and regional director. We observed a medication round and associated medicines practice. We reviewed records associated with the management and oversight of the service, 3 care plans, and 4 staff files, associated training and support records, and a range of policies and procedures used by staff as a point of reference to support them in their roles.
6 July 2023
About the service
Thistle Hill Care Centre is a nursing home providing personal and nursing care for up to 85 people. At the time of the inspection 81 people received a service. Thistle Hill Care Centre accommodates people across three separate wings with their own adapted facilities. The Deighton wing supports people living with Dementia, the Ripley wing supports people with physical nursing needs and the Farnham wing supports younger adults with physical health needs. The premises are fully accessible with a lift to access the Deighton wing. Ripley and Farnham are on the ground floor.
People's experience of using this service and what we found
Checks to maintain a safe and clean environment were completed and recorded. The provider had an up to date infection prevention and control policy in place for staff to follow. The policy would benefit from a review to ensure it remained effective and considered all latest guidance to keep internal areas of the home free from odours that were offensive or unpleasant.
Staff had good access to personal protective equipment to manage the risks associated with the spread of infection including COVID-19 and adhered to government guidance to protect people.
People received initial assessments of their needs and information, including risks to formulate care plans for staff to use as a point of reference when supporting people. For example, care plans included personal emergency evacuation plans (PEEPs), to ensure required levels of support were quickly provided to support any safe emergency evacuation of the home.
The provider had good governance procedures in place which were used to manage and check service quality. Any areas identified for improvement were logged and actions implemented. Oversight was used to evaluate repeating trends. For example, where people were at risk from falls, outcomes were used to reduce further incidents by ensuring people maintained their mobility in a safe way, with access to any required equipment and support.
People told us they felt safe with the staff who supported them. Staff were clear on types of abuse to look out for and how to raise their concerns when required. The registered manager understood their requirement to notify relevant organisations to ensure any safeguarding allegations were routinely investigated with any outcomes and actions implemented.
Where people required support to take their medicines this was completed safely as prescribed. The provider worked closely with other health professionals and supported people with any required referrals to maintain their health and wellbeing.
Staff were safely recruited into their roles and were supported with a range of training and support to perform their duties. This included observations of their practice and regular supervisions.
People told us they were happy with the service they received. They told us they were confident in approaching staff and the registered manager with any concerns and that any feedback or suggestions would be responded to.
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. People told us they felt a part of the community where they lived and enjoyed good access to a range of relevant activities.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 26 July 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
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.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Thistle Hill Care Centre on our website at www.cqc.org.uk.
We have made a recommendation for the provider to review their policy and procedures for the management of unpleasant odours in the home. We found no evidence during this inspection that people were at risk of harm from these concerns.
We will continue to monitor information we receive about the service, which will help inform when we next inspect.