Thornhill Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care and support.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s care needs were not always accurately assessed, and some people’s care records were not kept fully up to date with information.

Pre-admission assessments were completed to inform the development of individuals’ care plans. However, we found that some care plans lacked critical information relating to people’s specific health conditions and care needs. For example, 1 person’s care plan relating to their mobility was contradictory. The care plan review in areas detailed how this person had been assessed for use of a wheeled walking frame; but later in the care plan referred to the use of a walking stick. However, we observed staff advising this person they could not walk and required the use of a wheelchair. There was no assessment for this. Another person had a catheter in situ, yet there was no corresponding catheter care plan in place to guide staff on safe and appropriate management. While reviews of care plans were carried out, these omissions had not been identified or addressed through the review process.

The provider did not plan and deliver people’s care and treatment with them. One individual was recorded as being vegetarian; however, their dietary preferences were not reflected in their care plan, and there was no documented evidence of discussions with the person regarding how their nutritional needs would be met. Although clinical assessment tools, such as the Malnutrition Universal Screening Tool (MUST), were in place, they were not consistently or effectively utilised to inform ongoing nutritional review and care planning. For example, some individuals identified as being at high nutritional risk experienced weight loss; however, food and fluid intake records maintained by staff were not reviewed by managers or senior leaders. As a result, there was no evidence of further investigation or appropriate action taken in response to the unexplained weight loss.

When someone has trouble swallowing, certain foods and drinks can be dangerous, they might go down the wrong way and cause choking. International Dysphagia Diet Standardisation Initiative (IDDSI) requirements provide standardised levels for food and drink textures to ensure they are safe and appropriate for people with swallowing problems. We found these were documented within individuals' care plans and communicated to kitchen staff. However, on day 1 of the inspection, we observed limited food portions being served, with no options offered, no opportunities for second helpings, and no fortified snacks provided between meals. Additionally, staff were unable to identify the food that had been prepared for individuals requiring a puréed diet. Mealtime observations on days 1 and 2 highlighted a disorganised dining experience, with some individuals waiting extended periods to be served. Improvements were noted by day 3, following the sharing of initial inspection feedback.

People provided mixed feedback on the food provision, with some informing us, “I don’t get a choice, it’s eat or go hungry,” as well as “it’s not enough food for me.” However, other people told us they received enough food for their appetite.

The provider did not always work well across teams and services to support people.

Communication regarding the involvement and guidance of other healthcare professionals was not always clear or effectively conveyed to all staff members. For example, 1 individual had a new pacemaker monitoring device ordered. This device was handed to a senior agency staff member with instructions to set it up, yet the staff member lacked understanding of the device’s purpose or the rationale for its use.

Additionally, a person’s care plan indicated the need for fluid intake monitoring and limiting due to a heart condition. However, a call to the cardiologist on 6 April 2025 confirmed that such monitoring was not required. Despite multiple care plan reviews, this discrepancy had not been followed up or rectified, even though the individual had experienced recent hospital admissions.

However, we did see evidence of other professionals’ involvement in people’s care, such as partnership working with the GP and district nurses.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. There was evidence of involvement from external healthcare professionals such as chiropodists, dentists, district nurses, and GPs in people’s care and treatment, and this was documented appropriately.

However, people were not consistently supported to make healthier lifestyle choices, particularly in relation to food and drink. Menu choices were not always visible or accessible, and we observed occasions where individuals were not offered alternatives. As a result, staff were not effectively promoting healthy eating or individual choice, which may negatively affect nutrition and wellbeing. Furthermore, people were not always encouraged or supported to access outdoor spaces, despite the known benefits to physical and mental wellbeing. In 1 instance, an individual’s care plan included use of the garden as a therapeutic strategy, yet this was not consistently implemented. Staff reported that limited time and workload pressures prevented them from spending meaningful time with individuals or supporting them to access the garden areas.

By the third day of the assessment, improvements were observed. People were seen accessing outdoor spaces more frequently, with support from leadership staff and the activity coordinator. Additionally, greater emphasis was placed on offering individuals choice around food and drink, supporting a more person-centred approach.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

While staff were recording key care information such as food and fluid intake, weights, bruises, and repositioning for most individuals, this data was not being reviewed or monitored by managers to ensure timely clinical oversight or inform changes in people’s care. This lack of monitoring meant that emerging health concerns or deterioration in individuals' conditions were not identified or responded to in a timely manner, placing people at risk of harm.

Managers confirmed during the inspection that there was no clinical oversight of people’s care, nor were there systems in place to support clinical governance or oversight for nurses on shift, many of whom were agency staff. This absence of structured clinical leadership significantly impacted the provider’s ability to ensure safe and responsive care.

People using the service expressed concerns about the quality of support they received. One person told us, “Staff are too busy to help,” while another reported, “Staff don’t take me to the toilet when I ask, they tell me to use the continence pad.”. This lack of timely care can impact people having positive outcomes, as people would not be supported to have their needs met effectively.

In addition, people and their relatives informed us they were not supported to access social or recreational opportunities outside of the home. The lack of access to community engagement limited individuals’ ability to maintain social connections and fulfilment, adversely affecting their overall quality of life.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment. Initial consent was obtained at the commencement of individuals’ care packages, and this was recorded within the provider’s electronic care planning system (PCS). However, subsequent care plan reviews did not demonstrate ongoing involvement from people using the service or their representatives. There was no evidence to show that consent had been revisited or reaffirmed over time to reflect any changes in care needs or preferences.

During the first 2 days of inspection, we observed instances where staff did not seek consent or offer people choice prior to delivering personal care. This lack of person-centred practice meant that some individuals received care without meaningful involvement or agreement, which may undermine their autonomy, dignity, and trust in the care provided. The absence of continuous consent and involvement in decision-making limits individuals’ rights to participate in their own care and may result in care being delivered that does not align with their preferences or changing needs.