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Thorp House Requires improvement

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 13 April 2019

We inspected Thorp house on 9 and 10 January 2019. We returned on 11 January 2019 to give the registered manager feedback and to clarify some of the findings. The first day of the inspection was unannounced. We arrived at 6am on the second day of the inspection so we could talk to night staff and see how people were supported in the early hours of the morning as they were getting up.

Thorp House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home can accommodate up to 41 people. The home supports people with nursing and residential care needs and supports people living with dementia. At the time of the inspection there were 39 people in the home as two were in hospital at that time. The home was full and requests were being received for beds when they became available.

The home was a large extended building set over two floors. There were a number of communal areas on each floor and one corridor from the ground floor led to five self-contained apartments. The main kitchen and laundry facilities were on the ground floor.

The home had a registered manager in place who at the time of the inspection had been registered with the Care Quality Commissions for just over two years. 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.

The last inspection in January 2018 found the provider in breach of four regulations. The home was found to require improvement overall and in all key questions of safe, effective, caring, responsive and well led. Breaches were found in how the provider managed safeguarding concerns and whistleblowing, how the provider upheld the dignity and respect of people living in the home, how risks were managed and how the provider audited and managed systems to identify concerns and continuously drive improvement.

At this inspection we found action been taken to meet the requirements of the regulations and two of the previously breached regulations were now fully met. We found the provider and all staff at the home were very conscious of upholding people’s dignity and ensured people were respected at all times. We also found all staff had received training in safeguarding and when we spoke with them they displayed a good understanding and knowledge of when and where to report concerns. We found action had been taken to improve how risks were managed but some further action was required. People’s needs were not assessed at point of change and action from the changes was not always evident or easy to find. This regulation remained in breach.

We found the same with the systems and processes in place for auditing and monitoring provision of the service that still required improvement. We found some issues were found in the systems used by the provider and there was still a settling in period for new technology. This included a lack of shared understanding by everyone as to how to use the systems and gather the right information from them. This information was crucial to effectively monitor and audit how they were improving the service received by people living in the home. This regulation remained in breach.

Additional concerns were also found that led to a further three breaches of the regulations. There was a lack of formal consent being gathered from people in the home and the lack of decision specific capacity assessments and best interest decisions. This was specifically the case for restrictive practice such as bed rails and when medicines were given covertly. This means when they were given to people in their food or mixed

Inspection areas

Safe

Requires improvement

Updated 13 April 2019

The service was not consistently safe.

There were not enough staff to support people effectively through the night and the allocation and role of staff through the day needed more thought.

We found assessments of people�s needs were not updated to identify any areas of risk that required additional support when people�s circumstances changed.

Medicines were mostly managed well but we had some concerns for which we have given a recommendation.

We found the home had taken the findings of the last inspection and worked hard on addressing concerns. Issues were discussed in staff meetings and staff were motivated to learn from previous issues.

We found the home was clean and steps were taken to address any shortfalls identified.

Effective

Requires improvement

Updated 13 April 2019

The service was not consistently effective.

Valid consent was not gathered from the people living in the home for the service they received and for specific reasons such as bedrails

The design of the premises required more thought to ensure it best met the needs of the people living there.

Holistic assessment was completed at the point of admission to the home

Staff had received good training since the last inspection and a supervision rota was in place.

People were supported to receive enough nutrition and hydration.

The provider had systems in place to support people upon admission to hospital and liaised well with other healthcare professionals to meet people�s needs

Caring

Good

Updated 13 April 2019

The service was caring

We saw people were given choices about what they had to eat and their daily routine but the staffing concerns had an impact on how these were delivered.

People were shown respect from the staff in the home and their dignity and autonomy was upheld

People told us staff were caring and asked them their consent prior to care delivery.

Responsive

Requires improvement

Updated 13 April 2019

The service was not consistently responsive.

Care plans were written in a person-centred way but more was needed to ensure people were involved in developing and reviewing their care to ensure the care they received was person centred and met their needs.

The home�s activity coordinator delivered activities which were welcomed by the people in the home but the layout of the home made it difficult for one activity coordinator to meet the needs of everyone in the home.

A complaints procedure was accessible to people in the home and we saw how they were managed. Systems were not yet developed for the registered manager to make best use of the information received and captured in the care planning system

There was basic end of life care planning in place but this was to be expanded upon

Well-led

Requires improvement

Updated 13 April 2019

The service was not consistently well led

Audits and procedures for quality assurance were still in the process of development due to ongoing issues with the systems used.

The structure in the home did not always support staff to undertake their role in an empowering and accountable way.

Since the last inspection the registered manager had developed a shared understanding and vision for improvements.

The registered manager had developed relationships with local professionals to enable the service to be delivered.