St Thomas' Priory

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. This meant people were not treated with compassion and there were breaches of dignity; staff caring attitudes had significant shortfalls.

The service was in breach of legal regulation in relation to dignity and respect.

This service scored 35 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not consistently treat people with kindness, empathy, or respect for their privacy and dignity. We observed instances where people’s rights were not upheld. On the second day of the inspection, 1 person with capacity told us staff removed their call bell at night, compromising their autonomy and ability to seek assistance. Following our feedback, the provider raised a safeguarding concern and began an investigation. However, the person also said no member of the management team had previously asked whether they were experiencing any difficulties, which failed to promote dignity or respect their right to be heard.

Staff did not always demonstrate discretion when discussing personal care. On 2 occasions, staff were observed speaking loudly about toilet use in communal areas, addressing both people and colleagues. These interactions lacked sensitivity and failed to maintain privacy, directly compromising the dignity of those involved. However, other staff told us how they promoted people’s dignity. One staff member said, “We make sure we treat people with dignity and respect. Where we support people with personal care, we shut the door for privacy.”

We also observed positive interactions between staff and people. People told us staff were kind and supported them safely, and some staff were observed engaging warmly and respectfully with those in their care. One person told us, “The staff help me with personal care, they [staff] treat me with respect.” Another person told us, “The staff look after me, they administer my personal care. The staff close curtains and the door, it is done privately.”

The provider did not consistently treat people as individuals or ensure care, support, and treatment reflected personal needs and preferences. People’s strengths, abilities, aspirations, cultural backgrounds, and protected characteristics were not always considered in care delivery.

Staff did not consistently communicate in a respectful or appropriate manner. On day one of the inspection, we observed staff using infantilising language, including phrases such as “troublemaker,” “good boys,” and instructions like “sit down and eat your meals or your relative will be cross.” This approach failed to uphold dignity and demonstrated a lack of respectful engagement. In response, the provider revisited their ‘toxic language guidelines’ with staff and reviewed concerns with dignity champions.

We observed 1 person being supported into the lounge with glasses in place but without hearing aids, despite both being required. This omission undermined the person’s dignity and did not reflect person-centred care.

While staff generally demonstrated a good understanding of people’s risks and needs, 1 agency staff member stated they would assist a person with personal care alongside a colleague. However, the staff member’s gender was not in line with the specific requirements outlined in the person’s care plan. This presented a risk that the person may receive care in a manner that does not align with their documented preferences and needs.

Positive examples were also noted. One person experiencing bereavement was encouraged to write daily memories of the person who had passed and store them in a safe place for reflection. This demonstrated thoughtful, individualised support.

The provider did not consistently promote people’s independence or ensure they had choice and control over their care, treatment, and wellbeing. People were not always supported to understand their rights or express their preferences.

During the second day of the inspection, 1 person remained in bed and asked staff to assist them out, saying “please get me up.” Daily records showed no indication of the person being out of bed for over 2 days, and no documented rationale explained this prolonged period. Although the provider said the person had been unwell, there was no ongoing record of discussions to check whether they felt better or wished to join others in communal areas. This lack of engagement compromised dignity and failed to respect the person’s expressed wishes.

The environment did not consistently support accessibility or autonomy. On 1 floor of the home, several people living with dementia mobilised independently. However, many bedroom doors lacked handles and were painted white, making them difficult to identify. One person was observed attempting to enter their room but was unable to do so due to a lock positioned at the top of the door. Although action was taken following our visit, the failure to routinely assess environmental barriers placed people at risk of losing independence and compromised their dignity.

Relatives told us the staff respected people’s choices, 1 relative told us how the staff respect their [family members] choice to have a shower or a bed bath, another told us how their [family members] choice of activities was respected.

Staff told us how they promoted choice. One staff member said, “We give people options, we will ask them what food they want. We always ask for consent before we support with personal care.”

The provider did not consistently listen to or understand people’s needs, views, and wishes. Staff did not always respond in the moment or act to minimise discomfort, concern, or distress.

On the first day of the inspection, 1 person requested their handbag 13 times, speaking to 5 different staff members. No one responded until inspectors intervened. The same person asked about lunch 3 times and received no reply. These repeated, unanswered requests failed to uphold personal autonomy and did not meet the person’s emotional needs.

On 1 floor, we observed people shouting insults towards other people and 1 person threatening others with violence. While staff intervened, there were periods when staffing levels were insufficient to manage the situation effectively. One person became visibly upset in a communal room, and although the supervising staff member offered comfort, another person began threatening someone nearby. This continued until another staff member entered and diffused the situation by playing music and encouraging people to dance.

Staff gave mixed feedback. One said they had enough time to respond to people’s needs, while others reported feeling stretched and unable to provide timely support. On other floors, people and relatives told us staff responded promptly, and support was readily available. One relative commented, “The staff are fabulous, and they are respectful to [my family member].”

The provider did not consistently promote staff wellbeing or enable the workforce to deliver person-centred care. Staff shared mixed views about the support they received. Some told us they felt listened to and valued, while others said their concerns, such as feeling understaffed or unsupported, were not acknowledged.

One staff member described receiving personal support from the provider, when they needed this during a difficult time at home. Monthly staff recognition days were held to celebrate good practice, and the provider invested in staff development by appointing champions in areas such as dignity and oral health.

Despite these initiatives, inconsistent feedback suggested further action was needed to ensure all staff felt supported and empowered to deliver high-quality, person-centred care.