Thornton House Residential Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Although the provider had a proactive and positive culture of safety, based on openness and honesty and were assured staff listened to concerns about safety and investigated and reported safety events, as some residual shortfalls had not been fully resolved since the last assessment, we couldn’t always be assured lessons were learnt to continually identify and embed good practice. For example, some aspects of the environment used to support the delivery of care was not of an appropriate standard and presented infection prevention and control risks.

The provider and leaders encouraged transparency and openness about safety. Staff understood their responsibility to raise concerns and report incidents. Opportunities to learn from safety events were communicated to staff to help support improvement and prevent recurrence.

The provider worked with people and healthcare partners toestablishand maintain safe systems of care, in which safety was managed ormonitored. They made sure there was continuity of care, including when people moved between different services.

Processes were in place to help ensure that when people moved between services, key information about the person was included to help ensure continuity of care was met. For example, processes were followed to ensure relevant information was gathered and shared when people were admitted to, or discharged from, the home.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Policies were in place to help ensure people’s safety, such as a whistleblowing and safeguarding policy. Any accidents and incidents were recorded appropriately with suitable actions taken in response to help reduce the risk of recurrence. Staff understood risks regarding abuse/and or person safety and were able to explain how they would report a safeguarding concern. One member of staff told us, “I would whistle-blow if I thought it necessary.”

People and their relatives told us they felt Thornton House was a safe place to live. Comments from people included, “I feel safe here” and “Oh yes, it’s a safe place to be.” A relative confirmed, “With Mum being here, it’s a massive weight off our shoulders.”

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe,supportiveand enabled people to do the things that mattered to them.

Although risks were appropriatelyidentified,information on how to manage risks was not always clear and consistent, meaning people may not have always received the care and support theyrequiredto minimise risks adequately.

For example, somepeople’scare planscontainedinconsistentand/or unclearinformation. For 1 person whohad been assessed as at risk in relation to skin integrity,staff were instructed to carry outpositional changes, however there was no information todirectstaff onhow regular thesechangesshould be.

For another person, theircare planrecordedtheywerenotable touse their call bellandrequiredhourly welfare checks, however, the call bell risk assessment recorded they were in fact able to use a call bell.

For people living with diabetes, more information wasrequiredin their plans of care. For example,for 1 person, theirnutritional care plan did notcontainany information/guidance for staff on asuitablediabetic diet.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The condition of some of the environment and equipment used to support the delivery of care was not ofan appropriate standardand presented infection prevention and control risks.The main kitchen was notably unclean and had a build-up of residue in some areas such as under sinks,worktopsand corners in general.The microwave and fridgewerealso visibly uncleanwith food spatters and residue.Wefed back our concerns to the manager who confirmed they would organise a professional deep clean of the kitchen.

The surfaces onsomepieces of furniture(such as chairs),fittings,wallsand handrailswere damagedwhichrenderedthem difficult to clean. The manager assured ussome damaged items such as chairs werein the process of beingreplaced and/or refurbished.

Signage was used throughout the home to help people living with a cognitive impairment to better navigate the home.People had free access to a large, enclosed garden. Weobservedpeopleutilising andenjoying the outdoorspace at the time of our inspection.

Processes were in place to help ensure the safety of the environment. For example, risk assessments and regular checks of the environment were carried out to ensure the safety and well-being of both people and staff.However, some of these checks had not always been effectiveat highlighting shortfalls.

The provider made sure there were enough qualified,skilledand experienced staff, who received effective support, supervision,trainingand development. They worked together well to provide safe care that met people’s individual needs.

A dependency tool was used to assess the number of staffrequiredto meet people’s care and support needs. Staff had been recruited safely.

Most staff had worked at the home for a long time, during that time, staff had got to know people and had built up meaningful and positive relationships withthem.

Although we were assuredthe provider assessedthe risk of infection, the shortfalls weidentifiedin relation to chipped paintwork, damage to furniture,and the uncleanliness of the kitchen, meant we could not be fully assuredthe risk of infection was always appropriatelyand effectivelymanaged.

Weobservedfabricpullcordsfor lights in the bathroom which were not ideal for cleaning and posed a risk of carrying infection. We discussed this with the manager whoadvisedthey would bereplacedwith plasticcords.We alsoobserveda pedal bin in a communal bathroom which did notoperateproperly, andanother binintended for domestic usewhichcontainedsome clinical waste products.

However, staff were suitably trained in IPC(Infection,preventionand control)practices andthe home had sufficient stocks of PPE.

Although there were areas of good practise with medicines optimisation at the service, there were also areas where improvement was required. The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

The temperature of the medicines room was not being checked and recorded daily. At the time of inspection there was additional stock such as topical preparations stored in the medicines room. This is important as if medicines are not stored at the optimum temperature, this may affect their therapeutic effectiveness.

For 1 person who was prescribed a medicine which was not to be given at the same time as other medicines, this was being administered at the same time as other medicines. This meant there was a risk the medicine may not have been absorbed properly. We highlighted this to the manager who confirmed they would update the person’s medicine records immediately.

However, we also observed some positive practices with regards to medicines. A relative confirmed, “[Name] never used to take their medicines at home, but he does here, staff have achieved that.”