Thornhill Nursing Home

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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 provider was in breach of legal regulation in relation to promoting 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 treat people with kindness, empathy and compassion, or respect their privacy and dignity. Across the 3 days of inspection, we observed some caring and kind interactions between staff and individuals using the service. However, we also observed multiple instances where people's dignity and privacy were not upheld, and respectful care was not consistently delivered.

One person was observed wearing a skirt that was significantly too large. As they walked, the garment slipped down, exposing their buttocks. Staff did not notice or take any action to preserve the person’s dignity. On the nursing unit, individuals cared for in bed were not dressed in day clothing and were left in nightwear with bedroom doors open, exposing them to unnecessary observation. There was no evidence within their care plans to suggest this was in accordance with their personal preference. In another case, a person with a catheter had their leg bag hanging by the ankles, consistently full and fully visible on all 3 days of inspection. This not only compromised their dignity but also posed a potential clinical risk if left unmonitored. We also observed people living with dementia not receiving appropriate support during mealtimes. Individuals were left to manage cutlery unnecessarily or without assistance, which could lead to distress and unmet nutritional needs. These practices demonstrated a lack of consistent respect for people’s dignity, choice, and individual needs, impacting both their emotional wellbeing and quality of care.

The provider did not treat people with kindness, empathy and compassion, or respect their privacy and dignity. Across the 3 days of inspection, we observed some caring and kind interactions between staff and individuals using the service. However, we also observed multiple instances where people's dignity and privacy were not upheld, and respectful care was not consistently delivered.

One person was observed wearing a skirt that was significantly too large. As they walked, the garment slipped down, exposing their buttocks. Staff did not notice or take any action to preserve the person’s dignity. On the nursing unit, individuals cared for in bed were not dressed in day clothing and were left in nightwear with bedroom doors open, exposing them to unnecessary observation. There was no evidence within their care plans to suggest this was in accordance with their personal preference. In another case, a person with a catheter had their leg bag hanging by the ankles, consistently full and fully visible on all 3 days of inspection. This not only compromised their dignity but also posed a potential clinical risk if left unmonitored. We also observed people living with dementia not receiving appropriate support during mealtimes. Individuals were left to manage cutlery unnecessarily or without assistance, which could lead to distress and unmet nutritional needs. These practices demonstrated a lack of consistent respect for people’s dignity, choice, and individual needs, impacting both their emotional wellbeing and quality of care.

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing. People were not consistently supported to exercise choice and control in their daily lives. Mealtime observations highlighted restrictive practices that limited people's autonomy. Choices offered were minimal, and where options were provided, these were not clearly explained. There were no visual aids such as pictures or show plates to help individuals, particularly those with communication or cognitive needs, make an informed decision. Snacks were not routinely offered between meals, and several people were observed being served meals while seated in armchairs in communal lounges, without being asked if they wished to dine at a table.

We spoke with individuals who told us they felt they had limited options in their day-to-day routines. One person said, “You are allotted 1 bath a week, you can’t have a shower,” indicating a lack of flexibility or personal preference in care planning. People who were more independent with dressing confirmed they were able to choose their clothes daily. However, those who were cared for in their rooms, or who chose to remain in their rooms, received limited interaction or engagement from staff, leading to increased isolation and a reduction in emotional wellbeing.

Engagement with the community was minimal. People told us they did not often leave the home unless supported by family. This restricted opportunities for social stimulation and connection outside the service. We received consistently positive feedback about the activity co-ordinator, who was recognised for making genuine efforts to deliver group activities despite limited resources. However, this individual effort was not supported by a whole-service approach, and meaningful engagement remained inconsistent and dependent on 1 staff member.

The provider did not listen to or understand people’s needs, views and wishes. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress. Call bells were available in people’s bedrooms, and where individuals were able to use them, staff responded in a timely manner. Similarly, where sensor mats were in place, staff responded promptly when alerts were triggered. However, we found that not all people had access to call bells, and some were unable to use them independently due to physical or cognitive impairments. This meant that they were reliant on staff noticing them or waiting for routine checks.

We observed that in such cases, people experienced delays in receiving assistance. For example, 1 person was heard repeatedly calling out for help over a prolonged period. Staff did not respond to their calls in a timely or compassionate manner, and on multiple occasions, particularly during the first 2 days of the inspection, the person’s calls were ignored. This lack of responsiveness caused visible distress and demonstrated a failure to meet people’s needs with dignity and respect. Another person was observed requesting assistance to use the toilet from the start of the lunch period and was not supported until approximately 2 and a half hours later, by which time they had experienced incontinence. This delay in response compromised the person’s dignity and comfort and highlighted a failure to deliver care in line with individual needs.

The absence of accessible means for people to request assistance, combined with delayed or dismissive responses, placed individuals at risk of unmet care needs and avoidable emotional harm. It also indicated a failure to ensure equitable care for those most dependent on staff intervention. This significantly impacted people’s feelings of safety, dignity, and wellbeing.

The provider did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Staff morale was observed to be low, and staff did not consistently demonstrate confidence or positivity in relation to their roles or working at the service. Several staff members told us they felt apprehensive about speaking with inspectors due to previous negative experiences during past inspections. Some staff expressed fear that their comments would be misrepresented, stating they had received negative feedback internally following the last inspection and were concerned this might happen again.

We did not see any formal staff appreciation or recognition initiatives in place during the inspection, and staff were unable to share examples of how their contributions were acknowledged or valued. This absence of a supportive culture contributed to a lack of motivation and impacted overall team cohesion.

Rotas and staff deployment were not effective on the first 2 days of inspection. This resulted in staffing pressures across the units, with staff struggling to take breaks without leaving areas understaffed. This compromised both staff wellbeing and the quality and continuity of care delivered to people. The lack of consistent staffing arrangements and supportive leadership contributed to a working environment that did not promote staff confidence, retention, or performance, ultimately impacting the delivery of safe and effective care.

The provider had taken steps to address shortfalls in this area, and some improvements were noted on day 3 of the inspection.