Thistley Lodge

Updated 10 August 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

On 26 June 2019, one inspector carried out this inspection and they were supported by a specialist nurse who had experience of supporting people with a mental health condition. One inspector returned on 27 June 2019.

Service and service type

Thistley Lodge is a care home with nursing. Nursing cover was provided five days a week with an on-call support for staff in the evening and weekends should staff need nursing advice.

People in care homes receive accommodation and personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This first day of our inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

Due to people’s anxieties and mental health conditions, we were unable to hold a full conversation with people to get their feedback of what it was like living at Thistley Lodge. Some people gave us a word or short sentence to tell us they were happy. No one told us they were unhappy. We spoke with five members of staff, including the registered manager, an associate director for quality and service transformation, a nurse and care workers.

We reviewed a range of records. This included three people’s care records and multiple medication records. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found because some records were not available to us on the day. We gave the provider 48 hours after our inspection visit to provide us with evidence of their quality assurance records. These were sent to us and we used this information to reach our judgements.

Updated 10 August 2019

About the service

Thistley Lodge is registered to provide nursing and personal care for up to eight people who have a diagnosed mental health condition. At the time of our inspection visit there were five people living at the home. Care is provided across two floors and communal lounge and dining areas were located on the ground floor. People’s bedrooms were not ensuite so people used communal bathrooms located on each floor.

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

Since the last inspection visit, the registered manager had changed. The new manager had been in post since February 2019 and became CQC registered manager on 29 April 2019. The provider had begun to improve their internal audit systems. The provider’s internal quality assurance teams had completed audit visits against the providers action plan to improve the quality of care people received. However, some records of completed audits and the actions taken required closer scrutiny and monitoring. Fire risk assessments needed to be updated and time is needed for the quality assurance system to become embedded in normal practice to show its effectiveness and sustainability.

Staff said the registered manager and nurse were visible, approachable and supportive. Staff said changes over the last few months were for the better. Staff felt they worked better as a team which helped ensure people received the physical and emotional support they needed. The registered manager was working with other organisations and healthcare professionals to improve outcomes for people.

The provider used agency staff to support their own staff whilst recruitment continued. Staff said agency use was limited and the provider used the same agency staff for consistency which helped people feel more relaxed with those staff providing their care.

There were sufficient numbers of care staff on duty to keep people safe from risks of harm. The nurse used staff dependency tools to ensure staffing levels continued to meet people’s needs. The registered manager and deputy manager could support staff on the floor if emergencies happened.

Staff training had improved since our last visit. Some staff had completed training and further training sessions were planned to ensure staff’s skills and knowledge continued to be refreshed. Staff understood their roles and responsibilities, such as safeguarding people from poor practice. Staff told us they were confident to record poor care and if no action was taken, staff were more confident to refer onwards to safeguarding teams and to us.

People’s dietary needs, preferences and nutritional needs were assessed and known by staff and when needed, people were referred to other professionals to support their healthcare needs. Some people had their food and fluid intake monitored and further improvements were needed to ensure those records were of value to determine next steps.

People received their medicines safely from trained and competent staff. Nurse staff completed regular checks on stocks, administration and storage to ensure medicines were given safely and as prescribed.

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.

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

This service has been in Special Measures since 11 December 2018. People who use adult social care services have the right to expect high-quality, safe, effective and compassionate care. Where care falls below this standard and is judged to be inadequate it is essential that the service improves quickly for the benefit of people who use it. Special measures will give people who use the service the reassurance that the care they get should improve.

Following our last Inspection in December 2018 where the provider had numerous breaches of the Health and Social Care Act, the provider completed an action plan after the last inspection to show what they would do and by when to improve. We took enforcement action which included imposing conditions on their registration to restrict admissions to the service while the provider took measures to improve the quality of service.

During this inspection the provider demonstrated that improvements have 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 and the provider was no longer in breach of regulations.

The last rating for this service was Inadequate (published 5 April 2019).

Why we inspected

This inspection was based on the rating at the last inspection. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to the Key Questions Safe, Effective, Caring, Responsive and Well Led.

Follow up

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

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