Thurn Court

Thurn Court is a purpose built care home providing accommodation and personal care for up to 44 people with mental health, sensory impairment, physical disabilities, older people, and people living with dementia. This includes the assessment unit for up to six people discharged from hospital for short term placement for the purpose of rehabilitation and the assessment of ongoing care and support needs. At the time of our inspection 33 people were using the service.

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

Potential risk related to people’s care, health and welfare were assessed and kept under review. Records showed improvements were needed to ensure actions to mitigate risk when implemented were recorded in a timely manner. This was supported by the provider’s analysis of records, which they had highlighted with staff as an area for improvement.

Systems and processes for the reporting of safeguarding concerns, were in place which were understood by staff. People's medicines were managed safely, supported by clear guidance and protocols. People were supported by sufficient and experienced staff who had undergone a robust recruitment process.

External contractors maintained systems and equipment. There were safe infection and preventions measures in place.

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 and relatives were positive about the quality of the care they received, and of the inclusive and friendly atmosphere of the service. Observations showed staff provided empathetic care and support, and put people at the heart of the service. A health care professional involved in decisions related to people’s health, informed us that staff worked collaboratively with them to achieve good outcomes for people.

Monitoring of the service was carried out through a range of audits, and the seeking of feedback about the quality and the service provided from people and their relatives. Staff worked collaboratively with a range of health and social care professionals to support people’s health and wellbeing. The outcome of internal audits and the analysis of events within the service were shared with staff to drive improvement.

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 17 August 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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

Follow up

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

Thurn Court accommodates up to 44 people in one adapted building and provides accommodation. The service specialises in caring for older people including those with physical disabilities and people living with dementia. This includes the assessment unit for up to six people discharged from hospital for short term placement to assess ongoing care and support needs.

At the previous comprehensive inspection in February 2017 we rated the service as ‘requires improvement. We found there were not enough staff, people did not always receive person centred care, there was a lack of effective leadership and the provider’s quality assurance system was not used effectively. The provider was asked to complete an action plan to tell us what they would do to meet legal requirement for the breaches.

We carried out a focused inspection of Thurn Court on 10 August 2017. This inspection was done to check that improvements to meet legal requirements planned by the provider after our 15 February 2017 inspection had been made. We inspected the service against three of the five questions we ask about services: is the service ‘safe’, ‘responsive’ and ‘well led’? We found improvements had been made but we were unable to change the overall rating.

On 8 November 2017 another focused inspection was carried out in response to concerns about people’s safety and the management of the service. The team inspected the service against two of the five questions we ask about services: is the service ‘safe’ and ‘well led’? The service continued to be rated as 'requires improvement' because there was a lack of oversight to monitor the quality of care provided.

The provider was asked to send us an action plan that outlined how they planned to make the required improvements to meet the legal requirement. No action plan was received. We took this into account when we inspected the service.

You can read the report from our last comprehensive inspection and our focused inspection, by selecting the 'all reports' link for Thurn Court on our website at www.cqc.org.uk

This inspection took place on 27 June 2017 and was unannounced. We returned on 28 June 2018 announced to complete the inspection. At the time of our inspection visit 39 people were in residence.

We found that the provider had made the required improvements to meet the legal requirement. The overall rating of Thurn Court has improved to Good.

Thurn Court had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found the provider had made improvements to how they monitored the service provided. The provider’s quality assurance system had been used effectively. Regular audits and checks were carried out and action taken when shortfalls were identified. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

People were supported to stay safe. Staff recruitment procedures were followed. Staff were trained in safeguarding and other relevant safety procedures to ensure people were safe and protected from avoidable harm and abuse. There were enough staff to support people. Staffing levels were kept under review to ensure people received sufficient staff support.

Risk associated with people’s needs had been assessed; safety measures were put in place. Staff were provided with clear guidance and information to follow to meet people’s needs. Care provided was monitored and reviewed regularly.

People received their medicines as prescribed. Medicines were stored and managed safely. People’s nutritional needs were met. People had access to a range of specialist health care professionals. Staff monitored people’s health and made referrals when people’s health was of concern.

People lived in a clean and tidy home. The design and homely environment ensured people’s safety and privacy was maintained and their independence was promoted. Staff understood their responsibilities to report concerns. Accidents and incidents were recorded and analysed and steps to improve and learn were identified.

Systems were in place that ensured staff were trained, supervised and supported in their role. Staff training incorporated best practice. Staff worked in partnership with other health care professionals to enhance people’s quality of life.

People to be involved in decisions made about all aspects of their care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Decisions were documented and respected by staff. We saw people made day to day decisions about how they wished to spend their time.

People were supported by kind and caring staff. People had developed positive trusting relationships with the staff team. People’s privacy and dignity was respected and their independence promoted. Staff ensured people’s confidential personal information was secure.

People continued to receive care that was responsive and personalised. Staff respected and promoted people’s diverse backgrounds, choice of lifestyle including their sexual orientation. Information was made available in accessible formats to help people understand the care and support agreed. Care plans were personalised, reviewed regularly and provided staff with guidance about how people wanted to be supported. People had the opportunity express their views about their last wishes and develop an advance care plans when needed.

People took part in a range of activities and social events that were of interest to people. People maintained contact with family, friends and had links with the wider community. People’s religious and spiritual needs were met. This type of engagement enhances people’s physical and mental wellbeing, and their sense of belonging to a community.

People and relatives all spoke positively about the staff team, management and the quality of care. People had a range of methods to express their views about the service. The registered manager used feedback and complaints to bring about changes to the service.

The registered manager understood their legal responsibilities. They provided good leadership and supported staff and people who used the service. The registered manager and the staff team were committed to providing quality care and looked at ways to make improvements to enhance people’s quality of life.

Thurn Court is registered to accommodate 44 people including those living with dementia. This includes six interim assessment beds for people being discharged from hospital to determine their ongoing care and support needs. At this time of this inspection visit there were 32 people in residence.

At the last comprehensive inspection on 27 February 2017 the service was rated overall as Requires Improvement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Thurn Court on our website at www.cqc.org.uk

At this inspection we found the service remained Requires Improvement.

We undertook an unannounced focused inspection of Thurn Court on 8 November 2017. The team inspected the service against two of the five questions we ask about services: is the service safe? And is the service well led?

We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework these topic areas are included under the key question of is the service Safe? And is the service Well Led. The ratings from the previous inspection for these key questions were included in calculating the overall rating in this inspection.

Thurn Court had a registered manager. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager provided leadership. However, improvements had not been consistently sustained to meet the legal requirement to display the latest CQC rating and ensure the inspection reports available.

The provider had a quality assurance system in place but it was not reliable. Audits we looked at were not always fully completed, fragmented and where plans were put in place improvements had not been sustained. We found the culture of the service did not always involve or empower people and the staff, to influence the service. There were limited opportunities for people to share their views about the service and to influence how the service was managed.

Staff were supervised and receive appropriate training for their role. Staff felt supported by the registered manager. The lack of formal staff meetings meant that staff were not kept up to date with changes within the service, received feedback from audits and plans to address shortfalls to improve the quality of service provided.

People told us they felt safe at the service and with the staff team. Staff understood risks and signs of potential abuse and were aware of the safeguarding procedure to follow. To maintain people’s safety, the service does not always ensure risks had been managed appropriately. We found no evidence that lessons had been learned or changes implemented to reduce further risk.

People’s safety was promoted as potential risks were assessed, managed and regularly reviewed. Staff were able to demonstrate a good understanding and knowledge of people’s specific needs to ensure their safety. Assistive technology was used to maintain people’s safety without restricting their freedom.

People’s and staff comments found staffing levels were not always sufficient to consistently meet the needs of people who used the service. Care staff had to help in the kitchen to cover unplanned staff absences which further impacted people’s care and their safety.

The management of medicines, recording and stock levels were not always managed in a safe way. Although the service is due to change to a new medicine administration system regular checks should be carried out until the transfer has happened. There was no system in place to trigger a review of medicines at appropriate intervals by the prescribing doctor to ensure they continued to be effective.

People lived in an environment that was maintained. Staff had followed infection control procedures to manage a recent outbreak of an infectious illness.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We undertook this focused inspection on 10 August 2017, which was unannounced. We checked whether they now met the legal requirements. This report only covers our findings in relation to ‘Safe’, ‘Responsive’ and ‘Well-Led’. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Thurn Court on our website at www.cqc.org.uk

Thurn Court is registered to provide residential care, without nursing up to 44 older people, with some of the people living with dementia. At the time of our inspection there were 39 people using the service. The service is located within a residential area and provides accommodation over two floors.

Thurn Court had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found there were sufficient numbers of staff available to meet people’s needs. People told us staff were responsive and that they received personalised care that met their needs.

Care plans focused on all aspects of people’s care needs, including their choice of lifestyle, their preferences and hobbies. Staff had a good understanding of people’s needs and provided care and support that respected their wishes. Care plans were regularly monitored and reviewed.

The registered manager provided leadership. There was one area in need of improvement. The provider’s latest CQC rating was not displayed and inspection reports were not available. This is a legal requirement. The registered manager said they would address it.

We found improvements had been made to the provider’s governance system. People’s views and the opinions of their relatives and staff were sought in a number of ways. A range of audits were carried out to monitor and improve the quality of the service provided. The area manager representing the provider monitored the progress of improvements to help ensure they were sustained.

Thurn Court is a care home that provides residential care without nursing for up to 38 people. At the time of our inspection there were 33 people in residence. The service is located within a residential area, which provides accommodation over two floors.

This was our first inspection of the service since they registered with us on 12 October 2015.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that people’s health and safety was put risk because there were not sufficient numbers of staff available and the deployment of staff was not monitored. Improvements were also needed to ensure the staff followed the infection control procedures, maintained people’s dignity and ensured the environment was safe and secure.

People’s health and welfare was promoted through a range of assessments and the development of care plans which were regularly reviewed. People’s care plans provided information for staff as to the support people required and promoting their independence but staff did not always adhere to the care plans and people’s expressed wishes and preferences. However, in practice people did not always receive care that was personalised and centred on their needs which promoted their independence and wellbeing. People were at risk of receiving inconsistent care or not receiving the care they needed in line with their wishes, preferences and outlined in their care plans.

People told us they were provided with a choice of meals. People’s nutritional needs had been assessed some people were not always supported effectively to eat and drink sufficient amounts to maintain their health.

The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Records showed people and where appropriate their relatives were involved in making informed decisions about all aspects of their care. People were encouraged to make decisions about their day to day lives. However, in practice staff did not always gain people’s consent before supporting them, offering choice or act on decisions made.

Despite the registered manager’s commitment to providing quality care, concerns were expressed that the service was not well managed and lacked leadership. Throughout our inspection visit we brought issues to the registered manager’s attention for action. That showed a lack leadership, oversight and co-ordination which resulted in delays and a reactive approach to the day to day management of the service. We found the provider’s quality assurance system to monitor and assess the quality of the service was not always used effectively. Further monitoring would help assure the provider that that the improvements had been sustained. People’s views and opinions of their relatives and staff were sought in a number of ways.

People’s safety was promoted through the employment of staff. People told us they felt safe at the service. Staff were trained and knew what action to take if they suspected that someone was at risk of harm. People received their medicines at the right times. People with the support of staff accessed a range of health care services to meet their health needs.

Staff were trained to support people and used equipment to enable people to move around safely. Further monitoring of staff’s practices would help ensure people received effective care and support that promoted their rights and independence. Staff’s ongoing support was being provided through individual and group meetings.

People told us staff were kind and caring towards them. People and their relatives were confident to complain and that their concerns would be addressed.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.