Thornton House Residential Home

Thornton House Residential Home is a residential care home that was providing personal care to 22 older people at the time of the inspection. The service can support up to 22 people in one adapted building. At the time of the inspection there were 14 people with age related conditions, including dementia, living at the service.

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

Governance systems remained ineffective. Quality assurance systems were not robust. and records were not accurate and complete. Poor practice was allowed to carry on and the provider did not properly identify or mitigate risks to the health and welfare of people living at the service. The provider had failed to act on actions and recommendations issued by professional bodies.

Improvements had been made to the environment although there remained substantial concerns and areas for improvement. Some areas of the service had been redecorated and communal bathrooms and some communal toilets had been updated and replaced.

Improvements had been made to ensure people were protected people from the risk of abuse and improper treatment. Incidents and accidents involving people were reported, recorded, investigated and lessons were learned.

Improvements had been made to staffing. There were enough trained staff to meet people’s needs. Staff had received mandatory training and training in relation to dementia care.

Improvements had been made and visitors were welcomed at any time and their access to communal areas of the service were not restricted. People enjoyed the group activities on offer but there was little else on offer for people to be engaged in or stimulated by.

Medicines were managed safely by trained and competent staff.

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’s food and drink needs were met. The chefs had a good understanding of people’s dietary needs.

Relatives, social care professionals and staff felt the new manager had improved the quality of the service people received and was open and transparent.

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 (22 November 2023).

Previous breaches

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

This inspection was carried out to follow up on actions we told the provider to take at the last inspection. The overall rating for the service has remained inadequate based on the findings of this inspection.

Enforcement

We have identified breaches in relation to Regulation 12 Safe Care and Treatment and Regulation 17 Good Governance at this inspection. 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.

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.

Thornton House Residential Home is a residential care home that was providing personal care to 22 older people at the time of the inspection. The service can support up to 22 people in one adapted building. People were living with age related conditions, including dementia.

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

The provider had not fully protected people from the risk of abuse and improper treatment. Incidents and accidents involving people were not consistently reported, recorded and investigated. Lessons were not learned from accidents and incidents to drive improvement or to mitigate future risk.

The provider failed to ensure there were enough trained and competent staff to meet people’s needs of people living at Thornton House and to keep them safe. Staff had received mandatory training but had not received training in relation to dementia care and the management of behaviour that may challenge.

A lack of robust governance and daily management oversight had resulted in issues relating to the quality and safety of the care people received. Governance systems in place had failed to identify the concerns we found and whilst regular checks and audits were in place, these were ineffective.

The quality of people’s care plans and risk assessments were variable in quality and content. Personal behaviour support plans were not in place to guide staff in the management of people that had behaviour that may challenge. We found the language used in some people’s records to be disrespectful and undignified. Staff used language that was not always person centred when engaging with people.

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.

Thornton House needed decoration and refurbishment in communal areas and within some people’s bedrooms. Signage for people living with dementia required improvement.

Relatives gave us mixed feedback that included positive and negative comments in relation to all areas of the service.

Some communal activities took place within the home however, these did not meet the needs of all people living at the service.

People’s food and drink needs were not consistently met. The chef had a good understanding of people’s dietary needs.

Medicines were managed safely by trained and competent staff.

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 good (Published 3 August 2021).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding incidents that had not been reported. A decision was made for us to inspect and examine those risks.

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 changed from good to inadequate based on the findings of this inspection.

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 Thornton House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to person centred care, dignity and respect, safe care, safeguarding, staffing, premises and governance at this inspection.

Please see the action we have told the provider to take at the end of this 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, 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.

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

There had been improvements made to the management and oversight of the service. A new registered manager and area manager had been deployed. Systems introduced to monitor and assess the quality and safety of the service had driven improvement.

Improvements had been made to the infection, protection and control practice at the service. Staff followed national guidance in relation to COVID-19, infection prevention and control and wore PPE appropriately. The service was clean and hygienic. People had benefited from changes to the environment and décor which also made the service easier to keep clean.

The recruitment of staff was safe and there were enough staff on duty to meet people’s needs. People received their medicines when they needed them from trained staff. Risks to people’s health and safety had been assessed and mitigated and equipment had been serviced and maintained.

Accidents and incidents were recorded and reviewed in order to minimise the risk of reoccurrence. Local safeguarding protocols were followed, and stakeholders had been informed when incidents had occurred. People and their relatives felt the service was safe.

Improvements had been made to the support provided to staff. Staff had completed training that the provider considered essential to their role and had the opportunity to discuss their training and development needs with their manager.

People's relatives spoke highly of the staff team who they described as kind and caring. They told us they were kept informed of their loved one’s wellbeing and felt their loved ones were well care for.

People were supported to eat a balanced diet that met their assessed dietary 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.

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 (report published 24 November 2020) and there were multiple 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 we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced focused inspection of this service on 24 September 2020. At which breaches of legal requirement was found. The provider’s action plan showed improvements to the infection prevention and control practices, staff training, maintenance and suitability of the premises and governance of the service.

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, 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Thornton House Residential Home on our 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 COVID-19 and other infection outbreaks effectively.

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.

Thornton House Residential Home is a care home providing personal and nursing care. There were 22 people living at the service at the time of the inspection most of whom were older people living with dementia and other age-related conditions. The service can support up to 22 people.

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

Systems in place to monitor and assess the quality of the service and drive improvement had not always been applied effectively. Action plans formulated to bring about improvements did not always include timescales for remedial action to take place. Therefore, shortfalls in the quality of the service provided had not always been addressed in a timely manner. Accident, incidents and low-level safeguarding concerns had not always been shared with the local authority in line with their contractual agreements.

The service had not always followed national guidance in relation to infection prevention and control. Not all staff wore or disposed of PPE appropriately. The premises and equipment were not all suitable for the intended purpose and well maintained. Some areas of the service identified at the last inspection as being in a poor state of repair had not been addressed by the provider prior to this inspection.

Most staff had not completed training essential to their role which the provider considered to be mandatory. The provider gave assurances that any gaps in training would be addressed by November 2020. Care plans for people who did not eat a regular diet did not include up to date information about their specific dietary requirements.

The recruitment of staff was safe and there were enough staff on duty to meet people’s needs. People received their medicines when they needed them. Risks to people’s health and safety had been assessed and mitigated. Accidents and incidents were recorded and reviewed in order to minimise the risk of reoccurrence and people’s relatives felt their loved ones were safe.

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. Meals were freshly made each day and people’s preferences were catered for. Referrals were made to healthcare professionals when needed and relatives were kept informed of people's changing needs. People's relatives spoke highly of the staff team who they described as kind and caring.

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published January 2020) and there was a continued breach of regulation. The service remains rated requires improvement. This service has not been rated higher than requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 12 November 2019 at which breaches of legal requirements were found in relation to the governance of the service and the premises and equipment. The provider completed an action plan after the last inspection to show what they would do and by when to improve the premises and equipment.

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

This focused inspection was also to check if 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, 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 not changed. 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 Thornton House Residential 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relations to the governance of the service and premises and equipment. We also identified breaches in relation to infection, prevention and control and staff training at this inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

The provider had not ensured they always took steps to monitor and improve the safety and quality of the service people received. The provider had not fully implemented good practice recommendations made by external agencies in relation to the environment, equipment and staff practice, to minimise the risk to people's health and safety.

Some areas of the service had not been well maintained and were in poor state of repair. Staff did not always wear personal protective equipment appropriately. These issues increased the risk of infection and of harm occurring.

We have made a recommendation about the adaptation of the environment to meet the needs of people living with dementia.

The range of activities on offer to people was limited but people enjoyed the visiting entertainers and the activities that were provided.

People's needs had been assessed and their care had been planned with their involvement. The manager was updating people's care plans to make sure they were fully completed. People received their medicines when they needed them and supported to access healthcare professionals when appropriate.

People were treated with dignity and respect by kind and caring staff that knew them well. People's dietary needs and preferences were catered for and most people enjoyed the homemade food on offer.

People and their relatives were happy with the care people received. They had the opportunity to give their views in a number of ways and able to raise any concerns they may have. 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.

There were sufficient numbers of suitably qualified and safely recruited staff on duty to meet people's needs.

The manager had a good understanding of people’s needs. People and staff felt management were open and approachable.

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 22 January 2019) and there were two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection some improvements had been made but other shortfalls were identified so the provider was still in breach of one regulation. We also identified another breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement at five of the last six inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the governance of the service and maintenance of equipment and the environment.

Please see the action we have told the provider to take at the end of this report.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Thornton House Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home is registered to accommodate up to 22 people. At the time of the inspection there were 19 people living at the service one of whom was in hospital.

The home is required to have 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.

At this inspection we found shortfalls in relation to the safety and governance of the service. This was because medication was not always managed and administered safely. Good practice infection control and health and safety guidelines were not always followed and repairs to the emergency lighting identified in as being needed in August 2018 had not been made. The provider had systems in place for assessing the quality of the service but these had not been effective at identifying shortfalls in the quality of the service and driving improvement.

The providers had policies and procedures in place for staff to refer to but these had not been written in accordance with best practice guidelines and held out of date information.

Staff were recruited safely and there were enough staff on duty to respond to people's needs. New staff had completed an induction and were required by the provider to complete a nationally recognised qualification which provided them with underpinning knowledge and an introduction to working in care. However, staff had not always completed the training the provider considered mandatory.

Staff knew what they needed to do if they had any safeguarding concerns about people who lived at the service. They could describe what abuse may look like and knew how to report any concerns.

People's needs had been assessed before they made a decision about moving in. This information had been used to create care plans which detailed the support they needed to meet their health and social care needs.

People had formed positive relationships with staff who they told us were kind and caring. People felt confident they would be listened to if they raised any concerns.

People who needed help to eat were supported appropriately. People enjoyed the food on offer and mealtimes were a social and relaxed occasion.

People found the range of activities on offer stimulating and enjoyable. They also enjoyed trips out to local attractions and the entertainers that visited the service.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and report on what we find. We saw that the registered provider had guidance available for staff in relation to the MCA and had made appropriate applications for the Deprivation of Liberty Safeguards (DoLS). Care records reviewed included mental capacity assessments and best interest meetings.

You can see what action we have asked the provider to take at the back of the full version of the report.

Thornton House Residential home is registered to provide accommodation and personal care for up to 22 older people. The service also offers a day-care facility and bathing service to people within the local Community. The home is single room accommodation over two floors. Not all rooms have en-suite facilities. The service is close to the village of Little Sutton where there are a range of local shops that people can access. At the time of our inspection there were 20 people living at the service.

The service 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.

At the last focused inspection on 7 October 2016 we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements were required as the registered provider had failed to protect people from the risk of receiving unsafe care and treatment. After the inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breaches identified. They informed us they would meet all the relevant legal requirements by 30 November 2016. This inspection found that the required improvements had been made at the service.

Individual risk assessments were completed to ensure people supported, relevant others and staff were protected from the risk of harm.

People and staff described the registered manager as ‘approachable and supportive’. Effective systems were in place to monitor the safety and quality of the service and to gather the views and experiences of people and their family members. The service was flexible and responded to any issues or concerns raised. People told us they were confident that any concerns they had would be listened to, taken seriously and acted upon.

The service was accessible, clean and safe. Staff were able to describe their responsibilities for ensuring people were protected against any environmental hazards. Fire safety and all other relevant Health and Safety checks were appropriately completed at the service.

An assessment of people’s needs was carried out and appropriate care plans were developed. Care plans detailed people’s preferences with regards to how they wished their care and support to be provided. Care plans were regularly reviewed and updated to ensure people received the care required to meet their changing needs.

The overall management of medication and associated records was safe. People received their medication on time by staff who had received the appropriate training and competency checks. PRN medication protocols were in place regarding medicines to be taken ‘when required’.

Staff had undertaken safeguarding training and were confident about recognising and reporting suspected abuse. Procedures for minimising the risk of abuse and responding to an allegation of abuse were in place.

Staff had been employed following appropriate recruitment checks that ensured they were suitable to work in health and social care. We saw that staff recruited had the right values and skills to work with people who used the service. There were sufficient levels of staff in place to ensure all people’s needs were met people were kept safe.

Staff communicated with others in a respectful and professional manner. The service worked with healthcare professionals to ensure people’s health and wellbeing needs were met. People received prompt medical and wellbeing services and staff assisted people to follow recommendations in relation to their health.

People are 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 support this practice. The registered manager and staff understood what their responsibilities were for ensuring decisions were made in people’s best interests. Staff obtained people’s consent prior to providing care and support.

Staff confirmed they felt supported in their roles. They received regular support through daily discussions and meetings, however written records of supervisions were not always kept up to date. The registered manager confirmed that they would update records moving forward. Staff attended regular training sessions in areas such as moving and handling, first aid and safeguarding adults to update their knowledge and skills.

People told us that staff always treated them with kindness and respect. They told us that staff were mindful of their privacy and dignity and encouraged them to maintain their independence.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Thornton House Residential Home on our website at www.cqc.org.uk

Thornton House Residential home is registered to provide accommodation and personal care for up to 22 older people. The service also offers a day-care facility and bathing service to people within the local community. The home is single room accommodation over two floors. Not all rooms have en-suite facilities. At the time of this inspection 21 people were living at the service.

There was 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 that action had been taken to improve the overall safety and oversight of the service. However, we identified a further breach of Regulation.

We could not improve the rating for Safe or Well Led from “Requires Improvement" because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

You can see what action we told the provider to take at the back of the full version of the report.

The registered provider and the registered manager had implemented a series of audits in order to monitor and review the effectiveness of the service. This looked at key aspects such as care documentation, medicines, health and safety, cleanliness and infection control. Whilst, these audits were now in place, they were not fully effective in highlighting some of the concerns noted on inspection.

Staff did not follow the guidance made available to them on the use or monitoring of pressure relieving matrasses. This meant that people could be at risk of developing a pressure ulcer.

Not all safety checks on water and equipment had been carried out in a timely manner at the time of this inspection. The registered provider confirmed following the inspection that these were now completed.

People told us that they felt safe and that they had no concerns about the care they received. They said that staff were kind, patient and knew them well. The registered manager had identified and informed the relevant agencies about any matters of concern within the service.

People said that the service was homely. They had no complaints about the standard of cleanliness or the building itself. Comment was made that some of the improvements such as the bathroom and lift were taking a long time to come to fruition. People said that they were kept comfortable and staff had the right equipment to be able to care for them safely.

People and their families knew who the registered manager was and felt that they could go to her with any concerns or complaints. They felt that she went over and above to ensure that people were kept comfortable as did all the staff. People and staff had the opportunity to share their views on the service.

People who used the service told us they were happy at the home and had no concerns with the care and treatment provided. The relatives' we spoke with also told us they had no concerns. Comments included; "Mum is always clean and well cared for and well fed. That is enough for me", "I couldn't get any better. They have made a new woman out of me since I came here" and "I'm always bathed and showered. The food isn't bad either."

People who used the service told us they felt safe at the home. The relatives' we spoke with also told us that they considered Thornton House was a safe place to live.

The relatives and people who used the service told us they thought the service had enough staff. They told us that call bells were answered in a timely manner.

We saw the service carried out monthly audits of various aspects of the service's operations such as medication management, care planning and the homes environment. When concerns were identified, an action plan was drawn up to enable progress to be made.

We found that records were kept securely and could be located promptly when needed.

'The staff are fantastic. I couldn't fault any of them.'

'The staff are very good I get on smashing with them. It's a very good service.'

We spoke to a relative and a friend of people who used the service. They said that a good service was provided and that the staff were caring and helpful.

We spoke to a health care professional. They said that the staff made appropriate referrals to them and followed any advice given.

Records showed that people had been assessed before they began to use the service and they had a care plan in place detailing the support they needed.

There were systems in place to obtain the views of the people who used the service and their relatives about how the service operated. Records showed that action was taken to address any shortfalls identified.

A tour of the home indicated that the service was clean and well presented.

There were practices in place to ensure that the recruitment of staff appropriately supported the people who used the service.

We found that improvements were needed to the records around the promotion of health and safety of the home environment.