Thorndene Residential Care Home

Thorndene is a residential care home providing accommodation and personal care to up to 22 older people, some of whom live with dementia. Accommodation is provided across 2 floors with a communal lounge and dining area on the ground floor. At the time of our inspection 11 people used the service.

From this location a domiciliary care service was also provided. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of this inspection 27 people received assistance with their personal care needs.

People’s experience of using this service and what we found

The service had improved since the last inspection; however, further improvements were still required. People and relatives were happy with the service and told us they felt safe.

Management of medicines had improved since the last inspection, but improvements needed to be embedded and reviewed. We recommended medicine audits include a review of how the effectiveness PRN (as required) medicine is recorded and checks on risk assessments for creams kept in people’s rooms. The provider took action to address these recommendations immediately following feedback at the time of inspection.

Risks to people were assessed, monitored and managed appropriately and systems were in place to protect people from harm and abuse. The provider had acted to manage infection risks and there were enough staff on duty to meet people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider had made improvements to the way in which the service was led and managed. These improvements needed to be embedded and sustained. We made a recommendation about the continued use of an action plan approach to implement changes and developments to embed and sustain the improvements the service had made.

There was a calm and happy atmosphere in the home. Staff were kind and caring and it was clear improvements had been made since our last inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 6 July 2023) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

This service has been in Special Measures since 10 February 2023. During this inspection the provider demonstrated improvements had been made.

The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this inspection to check whether the Warning Notices we served previously, in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, had been met. This focused inspection checked the provider had followed their action plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the Key Questions Safe and Well-Led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to continue to make improvements. Please see the safe and well led sections of this full report.

Recommendations

We have made recommendations about reviewing how the effectiveness of PRN (as required) medicine is recorded and risk assessments for creams kept in people’s rooms. We also made a recommendation that the service should continue to use an action plan approach to sustain and embed the improvements made since the last inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Thorndene is a residential care home providing accommodation and personal care to up to 22 older people, some of whom were living with dementia. Accommodation is provided across 2 floors, with 1 communal lounge and dining area on the ground floor. At the time of our inspection there were 14 people using the service.

From this location a domiciliary care service was also provided. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of this inspection 25 people received assistance with their personal care needs.

People’s experience of using this service and what we found

Systems in place to protect people from the risk of abuse were not effective. The provider had not always reported concerns to external agencies, such as CQC and the local authority where required. Following our inspection, retrospective referrals were made by the registered manager. Staff were trained about how to spot signs of abuse and understood their responsibilities to report concerns.

Since our last inspection, care records evidenced some improvement, however some still lacked details about how to keep people safe and some risk assessments were not effective in identifying all the risks posed to people. Whilst some environmental risks had been mitigated following our last inspection, risks in relation to scalds, fire safety and legionnaires disease were not safely managed.

Records showed people using the domiciliary care agency had not received support for their full allocated times, in line with their assessed needs. Some staff training was not in place to enable staff to safely support people with nutritional needs or catheter care.

Whilst improvements had been made since our last inspection, further improvements were needed to ensure medicines were safely managed. Audits were undertaken and had identified some concerns, but not others. Senior staff were not available through the night, meaning people may not have timely access to ‘as required’ medicines.

Not all accidents and incidents were reviewed by the management team, to enable the service to learn lessons from them.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Whilst some staff supervisions were in place, improvement was required to bring these up to date.

There was a lack of leadership in the service. Audit systems were not always effective in identifying concerns. For example, daily walk around checks did not identify concerns found on inspection. The service did not always work in partnership with external agencies, such as the local fire department, to reduce risks posed to people. Since our last inspection quality audits had been undertaken, however, it was not evidenced that actions had been implemented to improve service quality.

Improvements had been made to promote infection, prevention, and control measures. There was no malodour in the service and several areas had new flooring and furniture in place. Some further improvements were required. The service continued to work closely with the infection, prevention and control team and an ongoing action plan was in place. Some feedback was sought from relatives and staff. Feedback required collating and actions addressed to improve the quality of the service.

A dependency tool had recently been implemented to determine how many staff were required to safely support people, we saw people were supported by enough staff in the care home service. The home had a relaxed atmosphere and people appeared happy in the presence of staff. People told us staff were kind.

Staff told us they felt the service was improving and leadership was supportive. Appropriate referrals were made to healthcare professionals where required. The service continued to work closely with the local infection, prevention and control team, and commissioners.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 10 February 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Whilst some improvements had been made, at this inspection we found the provider remained in breach of regulations.

Why we inspected

We undertook this inspection to check whether the Warning Notices we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has remained inadequate.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Thorndene Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safety, staffing, safeguarding and governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Thorndene is a residential care home providing accommodation and personal care to up to 22 older people, some of whom were living with dementia. Accommodation is provided across 2 floors, with 1 communal lounge and dining area on the ground floor. At the time of our inspection there were 19 people using the service.

From this location a domiciliary care service was also provided. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of this inspection 27 people received assistance with their personal care needs.

People’s experience of using this service and what we found

Systems and processes in place did not always protect people from the risk of unsafe harm. The provider did not always notify CQC or the local authority of safeguarding concerns. Training was not in place for all staff to enable them to identify and provide appropriate pressure care for people.

Risks to people were not always assessed and mitigated to reduce the likelihood of harm. Areas of the home did not provide a safe environment for people. For example, window restrictors and radiator covers were not in place and outside areas were unsafe, placing people at risk of falls. Fire safety procedures were not implemented by staff. For example, fire doors were observed to be propped open.

Staff were not always recruited in line with best practice guidance. Records did not evidence that interviews had taken place or that a robust interview system was completed. One new staff did not receive regular probationary reviews to assess their suitability and performance. Pre employment checks were in place and quality assurance questionnaires completed by the service showed people and relatives were positive about staff kindness.

Medicines were not safely managed. Medicines were not stored at the correct temperature and some medicines belonging to people were found to be stored in different areas of the service. Where medicines errors had occurred, these were not investigated in a timely manner, and lessons were not learned to mitigate future risks to people.

The premises and equipment did not promote safe infection, prevention and control practices. We saw areas of the home to be visibly dirty and food items which were out of date. Records did not evidence that regular cleaning was undertaken, and frequent touch points were not effectively cleaned to prevent the spread of infection.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.For example, consent was not always gained from people in relation to their care and support’.

High quality person centred care was not always provided. People were not always provided with call alarms to enable them to request support when needed. Care plans did not contain enough detail to guide staff on how to provide individualised care. There was a lack of oversight in relation to record keeping and care plans were not effectively audited to ensure records reflected people's current needs. People's records were not stored confidentially.

The provider did not have sufficient oversight to ensure quality and safety in the service. Auditing systems were not effective. For example, concerns in relation to infection, prevention and control, environmental risks and medicines were not identified, with lessons learned to improve.

Quality assurance systems were in place for people, staff and relatives to give their feedback of the service provided. However, records did not evidence that concerns identified had been actioned in a timely manner. For example, where concerns had been raised regarding the outside area, this was not completed in line with the home’s timescale.

Staff told us the registered manager was approachable and they felt able to raise concerns. Records showed relatives were positive about the leadership in the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 December 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to the safety of people living at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Thorndene Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safety, staffing, safeguarding and governance.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Thorndene Residential Home is situated on the outskirts of Doncaster and is in easy reach of local shops and amenities. The home is registered to provide accommodation for up to 22 older people. Accommodation is located on both the ground and first floor. There is a small car park at the front and enclosed gardens at the side and rear of the home. At the time of this inspection there were 20 people living at the home.

From this location a domiciliary care service was also provided. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of this inspection 33 people received assistance with their personal care needs.

People’s experience of using this service and what we found

People were not always safe. Risks to people’s safety had not always been assessed and recorded. For example, one person who smoked created a potential risk to themselves and others. However, there was no risk assessment in place for this. People received their medicines as prescribed. However, some medicine records were incorrect and the medicine audit had not identified this.

People and relatives were generally positive about the staff that cared for them. Staff feedback varied about the service and staffing levels. Most people told us there were not enough staff. People using the DCA service said often staff did not arrive at the agreed time. We saw people living in the care home were left unsupervised whilst eating and for considerable periods throughout the day.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We were somewhat assured the provider was adhering to infection control practices. Infection prevention and control measures were in place and staff understood how to prevent the spread of infection. Staff wore personal protective equipment, although we observed one staff member going outside for their break and not removing and changing their personal protective equipment (PPE) when they returned into the home. There was also no place for staff to put their coats and bags, so these had been left in the dining room.

The registered provider did not have effective governance systems in place to maintain and improve the quality and safety of the service. Analysis of accidents and incidents did not include all accidents that had happened so could not identify any patterns or trends to help mitigate risk and prevent reoccurrence. Quality assurance audits were not always effective. For example, medicine audits had not identified an error with the recording of controlled drugs. Where actions were identified from audits there was not always confirmation of when staff were required to action these by.

Rating at last inspection

The last rating for this service was requires improvement (published 23 September 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

We found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link Thorndene Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified three breaches of regulation. People did not always receive safe care and treatment, there was a lack of sufficient suitably qualified staff and good governance systems were either not in place or were not robust enough to demonstrate people’s safety was effectively managed. This placed people at risk of harm.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and the local authority to monitor their progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Thorndene Residential Home is situated on the outskirts of Doncaster and is in easy reach of local shops and amenities. The home is registered to provide accommodation for up to 22 older people. Accommodation is located on both the ground and first floor. There is a small car park at the front and enclosed gardens at the side and rear of the home. At the time of this inspection there were 15 people living at the home.

From this location a domiciliary care service is also provided. At the time of this inspection 21 people received assistance with their personal care needs.

People’s experience and what we found:

Improvements had been made since our last inspection which took place in September 2019. We found risks associated with people's care were identified and risk assessments were in place to minimise the risk. Staff were knowledgeable about potential risks with people's care and how to keep people safe.

Positive changes to the environment and in the infection prevention and control procedures were seen. There were sufficient staff available to meet people's needs and to socially engage with them whilst adhering to the current restrictions due to the COVID-19 pandemic. The provider, registered manager and staff had managed the current COVID-19 pandemic well and implemented effective procedures.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received support from staff who knew them well, understood their needs, and were kind and caring. People felt that a bond of trust existed between them. Relatives told us staff were courteous, moved and handled people competently, and spoke in a gentle manner. A relative told us, “[Name] chooses what he wants to do. Carers respect that. Carers never force anything but make suggestions. They are obliging and ask if he needs anything. We have hit on the right care support team.”

People's medicines were managed safely. There were protocols in place setting out when medication prescribed to be taken on an "as and when" basis should be administered. Staff had their competency checked and there was a record of this.

People were safeguarded from the risks of abuse, staff received training in this area and knew how to recognise and report abuse. Staff were confident appropriate action would be taken to keep people safe. One person told us, “Our care is excellent. We would speak up if it wasn’t.”

The management team supported staff to deliver person centred care to people. The provider engaged people in the service and listened to their comments. Everyone spoken with was aware of receiving three monthly quality assessment questionnaires and everyone considered the provider to be competent, responsive, and available to communicate with them by telephone or in person. The managers and senior staff were well spoken of and the service was considered well managed.

Governance arrangements were effective, reliable and drove improvements. There were a series of audits which helped the provider and registered manager to identify where improvements were needed to continue to develop the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Rating at last inspection and update:

The last rating for this service was requires improvement (published 23 September 2019) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had been made and the provider was no longer in breach of regulations.

Why we inspected:

We undertook this focused inspection in line with our current methodology in the COVID-19 pandemic, to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 'Thorndene’ on our website at www.cqc.org.uk.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Thorndene Residential Home is situated on the outskirts of Doncaster and is in easy reach of local shops and amenities. The home is registered to provide accommodation for up to 22 older people. Accommodation is located on both the ground and first floor. There is a small car park at the front and enclosed gardens at the side and rear of the home. At the time of this inspection there were 18 people living at the home.

From this location a domiciliary care service was also provided. At the time of this inspection 22 people received assistance with their personal care needs.

People’s experience of using this service and what we found

The concerns detailed in this report all relate to the quality of care provided at the care home. We did not find any issues of concern relating to the domiciliary care service.

People lived in an environment that posed some risks to their health, safety and well-being, particularly if they were living with dementia. There was also a lack of robust infection control processes in place and risk assessments were not always effective because they were not always updated to reflect people’s current needs. Systems to receive, store, administer and dispose of medicines were safe.

People were cared for by enough staff. However, deployment of staff needed to be thought through to ensure that those people who required more monitoring were not left unattended. Safe recruitment procedures were being followed.

People told us they felt safe in the care of the staff. Staff had a good understanding of abuse and their responsibilities in keeping people safe. However, the Care Quality Commission had not been notified about incidents and safeguarding concerns, in line with regulatory requirements.

People and relatives were happy with the service they received and consistently said the care and support they received from staff was good. Staff knew how to respect people's privacy and dignity.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

A minimal number of activities were available to people. Further work was required to ensure these were available more often and were person-centred and meaningful to people. We have made a recommendation about the development of activity provision in the home.

Governance arrangements were not as effective or reliable as they should be. Further improvement was needed in the quality assurance processes to identify shortfalls and to drive improvement. Recorded evidence of the auditing and monitoring of the service needed to be embedded into management systems.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 3 March 2017). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We found evidence that the provider needs to make improvement. Please see the relevant key question sections of the full report. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.