Town Thorns Care Centre

Town Thorns Care Centre is a care home that provides personal and nursing care to up to 66 people. The home provides care and support to younger and older adults, some of whom are living with a physical disability, a sensory impairment and/or dementia. At the time of our inspection there were 49 people using the service.

Town Thorns Care Centre accommodates people in a large, refurbished building which is divided into 4 separate units. Each unit has a variety of communal spaces such as lounge areas and dining areas. At the heart of the home there is a multi-functional space for everyone to use which includes a café, hairdressers, and a shop. There had been recent improvements to the outside space where people could now benefit from landscaped gardens and a walkway around the home.

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

The home had been through a programme of change prior to our inspection visit. The registered manager and the head of care had spent a significant amount of time transferring care records onto an electronic system, managing an extensive refurbishment programme, and changing their model of care internally by re-structuring how they delivered nursing care more holistically. Because of this, some of the providers systems and processes had not been operated effectively to ensure records always supported the good practices within the home. Audits had not always identified gaps in risk monitoring charts.

Despite this, people and relatives told us the home had a good management structure and staff felt valued. There was an open culture of learning within the home. The registered manager had a service improvement plan which continually monitored the service. Where actions had been identified at this inspection, they were added to the improvement plan for completion in a timely way.

People told us they felt protected from the risk of abuse. Staff were trained in safeguarding adults and understood their responsibilities to identify and report any concerns. People told us they were supported by staff who treated them with kindness and compassion. There was a strong visible person-centred culture where staff were motivated to provide high quality care. Staff understood the importance of seeing people as individuals with their own preferences and personalities.

Staff received an induction when they started working at the home. The induction included working alongside experienced members of staff in order to learn people's individual care preferences. Staff had completed the provider's training programme and people told us staff were well trained.

Overall, there were enough staff to provide safe care and treatment. We saw, and people told us, staff responded to their needs in a timely way. The home was using a high number of temporary staff supplied through an agency whilst undergoing a recruitment campaign.

People were offered opportunities to engage in a wide range of activities. Activities were often held in the multifunctional communal lounge, in the centre of the home which gave people the opportunity to socialise with people who might reside in other areas of the home. People were offered regular trips outside the home, so they maintained a sense of belonging within the wider community of the local area.

People's needs were assessed before they moved into the home so their care could be planned based on their needs, wishes and choices. Staff understood people’s communication needs and gave people information in a way they would understand. Care plans were focussed on the person’s whole life and detailed important information about their needs, preferences and backgrounds, and were regularly reviewed.

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’s health needs were met. Staff supported people to maintain their health through regular appointments or timely referrals with healthcare professionals. The GP visited the home twice a week, but staff told us they would not hesitate to refer any healthcare concerns to the GP outside their scheduled visits if this was necessary.

People and relatives were generally positive about the food provided. People were provided with a choice of meal options and drinks were always available. The chef catered for people’s preferences and dietary needs.

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 16 December 2017).

Why we inspected

The inspection was prompted in part due to concerns received about medicines management. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

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.

The overall rating for the service remains good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Town Thorns accommodates people in one building, divided into three separate units. Each unit had communal spaces such as lounge areas and dining areas. The home also had communal spaces in the centre of the building for everyone to share. There were garden spaces and visiting pods available for people and their families to use.

We found the following examples of good practice;

Visitors were welcomed to the home. Staff were observed to be approachable and caring. The home was clean and welcoming.

People received regular visits from their relatives and friends, in accordance with government guidance. There were designated entrances for visitors and families to enter the home safely. The provider had developed garden areas to encourage visitors to see their relatives in a safe environment where they could exercise social distancing. However, the provider also encouraged people to visit their relatives in their bedrooms and communal areas of the home whenever this was possible.

The provider was developing their service through an extensive re-furbishment programme. During the COVID-19 pandemic the provider kept families and people informed of developments at their service through regular letters, newsletters and telephone calls.

Town Thorns is divided into four separate units over three floors and provides personal and nursing care for up to 66 people of all ages, including people living with dementia and physical disabilities. There were 57 people living at the home when we inspected the service.

A requirement of the service’s registration is that they have a registered manager. 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 and the associated Regulations about how the service is run. There was a registered manager in post at the time of our inspection visit. We refer to the registered manager as the manager in the body of this report.

We last inspected this service on 15 February 2017, when we found Safe was rated ‘Requires Improvement’. We found there was a breach in Regulation 13, as safeguarding concerns had not been consistently reported to us across the different units at the home. Senior staff had not always identified incidents as safeguarding concerns, and reported them to the correct authority for investigation. We also found there was a breach in Regulation 12, because individual risks to people’s health and well-being were not always managed and mitigated. At this inspection we found improvements had been made and have rated the service as ‘Good’ in Safe.

Since our inspection on 15 February 2017 we have reviewed and refined our assessment framework, which was published in October 2017. Under the new framework certain key areas have moved, such as support for people when behaviour challenges, which has moved from Effective to Safe. Therefore, for this inspection, we have inspected all key questions under the new framework, and also reviewed the previous key questions to make sure all areas were inspected to validate the ratings.

At our previous inspection we had identified that safeguarding concerns were not always appropriately referred to CQC and other agencies, and were not always fully investigated, to ensure people received safe care. At this inspection we found the home had made significant improvements to how safeguarding concerns, accidents and incidents were categorised, analysed and investigated. We found monitoring systems were in place to identify any patterns and trends arising from such concerns. In addition the manager had arranged refresher training for all staff on how to document such concerns, and how to refer concerns to the management team for investigation. The manager had notified CQC and the local authority of any concerns which required investigation.

At our previous inspection we found Individual risks to people's health were not always being managed appropriately to ensure people were protected. At this inspection we found risk management plans had been updated to ensure the environment and premises were managed safely, and risks to people were minimised. In addition, we found people had individual risk assessments completed and staff were instructed on how to minimise risk to people’s health and wellbeing.

Most people told us there were enough staff to meet their needs, and there were enough staff during our inspection visit to ensure people were cared for safely. However, two people, on the residential unit, told us they sometimes had to wait for assistance to go to bed, in the evening.

All necessary checks had been completed before new staff started work at the home to make sure, as far as was possible, they were safe to work with the people who lived there. People were supported by a staff team that knew them well, as the use of agency staff had been reduced since our previous inspection.

Staff received training and had their practice observed to ensure they had the necessary skills to support people. Staff treated people with respect and dignity, and supported people to maintain their privacy and independence.

People had been consulted about their wishes at the end of their life. Plans showed people’s wishes about who they wanted to be with them, and the medical interventions they had agreed to.

People received their medicines as prescribed to maintain their health and wellbeing. People were supported to access healthcare from a range of professionals inside and outside the home, and received support with their nutritional needs. This assisted them to maintain their health.

The provider, manager and staff understood their responsibilities under the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom. The manager had made applications to the local authority where people’s freedom was restricted, in accordance with DoLS and the MCA requirements. Decisions were made in people’s ‘best interests’ where they could not make decisions for themselves.

People were supported to take part in social activities and pursue their interests and hobbies. People made choices about who visited them at the home, which helped people maintain personal relationships with people that were important to them.

People knew how to make a complaint if they needed to. Complaints received were investigated and analysed so that the provider could learn from them. People who used the service and their relatives were given the opportunity to share their views about how the service was run; action was taken in response.

Quality monitoring procedures identified some areas where the service needed to make improvements. Where issues had been identified in checks and audits the manager took action to address them to continuously improve the quality of care people received.

Town Thorns is divided into four separate units over three floors and provides personal and nursing care for up to 66 people of all ages, including people living with dementia and disabilities. There were 57 people living at the home when we inspected the service.

A requirement of the service’s registration is that they have a registered manager. 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 and the associated Regulations about how the service is run. There was an experienced registered manager in post at the time of our inspection visit. We refer to the registered manager as ‘the manager’ in the body of this report.

Care and nursing staff received training in safeguarding adults and understood the correct procedure to follow if they had concerns. They were confident if they raised concerns with their manager, these would be investigated appropriately. However, we found that safeguarding incidents were not always recorded and referred to the local authority by managers, as some incidents were being addressed as behavioural concerns. The provider had not identified that safeguarding concerns were not consistently reported and investigated as such.

Individual risks to people's health were not always being managed appropriately to ensure people were protected. In addition not all incidents at the home were being investigated and recorded on an accident and incident log, to ensure risks to people were being managed, and any trends and patterns could be identified. The manager reviewed their procedures following our inspection visit to ensure accidents, incidents and safeguarding concerns were recorded and reported consistently in the future.

We received mixed feedback about whether there were enough staff throughout the home. On the residential unit we received feedback that staffing numbers were not always sufficient to ensure people were cared for safely. The manager was introducing quality assurance and monitoring measures to review the number of staff allocated to each unit at the home.

All necessary checks had been completed before new staff started work at the home to make sure, as far as was possible, they were safe to work with the people who lived there. People were supported by a staff team that knew them well. Staff received training and had their practice observed to ensure they had the necessary skills to support people. Staff treated people with respect and dignity, and supported people to maintain their privacy and independence.

People had been consulted about their wishes at the end of their life. Plans showed people’s wishes about who they wanted to be with them at this time and the medical interventions they agreed to.

People received their medicines as prescribed to maintain their health and wellbeing. People were supported to access healthcare from a range of professionals inside and outside the home and received support with their nutritional needs. This assisted them to maintain their health.

The provider, manager and staff understood their responsibilities under the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom. The manager had made applications to the local authority where people’s freedom was restricted, in accordance with DoLS and the MCA requirements. Decisions were made in people’s ‘best interests’ where they could not make decisions for themselves.

People were supported to take part in social activities and pursue their interests and hobbies. People made choices about who visited them at the home, which helped people maintain personal relationships with people that were important to them.

People knew how to make a complaint if they needed to. Complaints received were investigated and analysed so that the provider could learn from them. People who used the service and their relatives were given the opportunity to share their views about how the service was run; action was taken in response.

Quality monitoring procedures identified some areas where the service needed to make improvements. Where issues had been identified in checks and audits the manager took action to address them to continuously improve the service.

We found there were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

We spoke with five visitors who made positive comments about the care and support their relatives received. We were told, 'I visit each day and have no concerns' and 'The staff are caring.'

We looked at the care records for five people and found that their needs were assessed prior to admission so that plans of care and support reflected the way people liked and needed to be cared for. We found that care records were reviewed on a regular basis to make sure they accurately described the care people needed.

People told us they had opportunities to take part in activities which they enjoyed. One person commented, "There is something to do every day. There is never a dull moment."

We observed that staff responded promptly to people when they asked for support and treated people with respect whilst providing care.

We found the home to be clean with systems in place to prevent the risk of the spread of infection.

People living in the home and their visitors told us they had been provided with information about raising concerns and complaints. We were told, "The staff make every effort to resolve any concerns."

We found there was a system in place to recruit new staff so that people were not placed at risk of having unsuitable staff working in the home.