Thorn Park Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were safe living at Thorn Park Care Home. There were enough staff to support people. Staff had the training and knowledge they needed to support people. Staff knew people well and knew how to provide them with the support they needed. Care plans were clear, however, risks associated with people’s skin were not always being fully mitigated. We observed that the service was clean and free from odours. Medicines were being administered as and when they should. Medicines were being stored appropriately. However, the processes in place for checking stock balances had not ensured that all stock balances were accurate. Electronic systems, processes and audit checks were in place, however these systems had not identified concerns found at this assessment and we found care / elements of care did not meet the expected standards.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

During the site visit we observed people were comfortable in staffs’ presence and we did not observe any care and treatment to suggest a person was at risk of being abused.

Care Managers and the registered manager have attended the safeguarding training for managers and other staff complete online safeguarding training courses. Staff also attend safeguarding training provided through Plymouth City Council. The service has a 'procedure for reporting adult safeguarding alert' for staff to follow. This requires staff to complete and incident form on the care monitoring system for a manager, or senior, to access and process. Any photos of injuries etc. need to be taken and included in the report. Internal investigation is carried out by the manager, gathering all information and then liaising with the relevant authorities such as the Care Quality Commission, Police and Safeguarding.There was an easy read copy of the safeguarding procedure in a file in people's rooms for them to access with information about what they can do if don’t feel safe or they suspect abuse. All safeguarding concerns were recorded on an electronic system for audit purposes.

People, who were able, told us they felt safe. One person said, “I’m safe, they check on me regularly.” Another said, “They keep us safe, my family are happy with my care.” People’s relatives also expressed how happy they were with the service people received and that people were safe. One said, “I’m comfortable she’s here and safe and I can go on holiday knowing that she is safe.”

The registered manager told us they have a step-by-step safeguarding procedure in place for staff to follow and this is kept in a folder in the main office for staff to access. They also have an open-door policy for staff, people and relatives and encourage staff, people and relative to come to them to discuss any concerns they have which would be dealt with in line with their safeguarding policy. Staff were able to describe what constituted abuse and what they would do if they thought someone had been or were potentially being abused. This would include recording this on their systems, reporting the potential abuse to a senior colleague such as a senior care worker or manager.

Staff knew people well and were able to describe how they cared for people and what they did to mitigate risk. Staff had access to people’s care plans and risk assessments and told us they would check people’s care plans if they did not know how to support them. Staff described what they did to mitigate the risk of people having pressure sores and were able to tell us how often they helped people move in bed and how and where they applied skin creams to protect the skin. We spoke with the chef who told us how they fortify the meals of people that are at risk of malnutrition and who needed to have their food and drinks modified to avoid the risk of choking.

We observed people at risk of skin damage had appropriate pressure relieving equipment in place such as airwave mattresses and pressure relieving cushions to sit on. People at risk from falling had sensor alarm mats and pendants to alert staff when they moved around. Where people were at risk from not receiving enough to eat and drink, we saw staff recorded their food and fluid intake and encouraged people to eat more. We observed staff supporting people to eat and drink when they were not able to eat independently. We observed safe manual handling procedures.

Care plans and risk assessments were in place, up to date and contained sufficient guidance about how to manage or mitigate risk. However, risks associated with people’s skin were not always being fully mitigated. Whilst staff told us people at risk were being supported to change their position in a bed/chair, records did not demonstrate that people were being repositioned according to their assessed need. People were receiving regular skin checks and skin creams had been prescribed. However, records did not demonstrate that staff were applying skin cream according to their prescription. Where people were at risk of falling care plans and risk assessments were in place and described how to mitigate the risk. However, whilst equipment was in place welfare checks on people were not being completed according to their assessed need. This indicated people were at risk of skin damage or falling and is a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. Care plans and risk assessments contain sufficient detail in relation to supporting people to eat and drink safely. Food and fluid charts were mostly being completed well. People who were at risk from losing weight were being monitored and weighed regularly and advice had been sought from people’s GP and dietitian about how to help the person gain or maintain their weight. People were receiving nutritional supplements and fortified diets. People at risk from choking were being managed well. People had been assessed by the Speech And Language Team team when needed and were receiving appropriate modified diets. We observed people being supported to eat their meals safely and in line with their assessed needs.

People, wherever possible, and their relatives were involved in their care planning and managing risks associated with their care needs. One relative told us their relatives care was discussed with them, they said, “I was asked if I wanted to update her care plan.” Most people told us that staff responded appropriately when they were unwell and described when staff had responded to risk. One person said, “They know what they are doing.” Another said, “I tell the staff that I’m not well. They did get a doctor for me when I was feeling so weak and eating very little. I had a couple of nasty falls in the night. I pressed my bell, and they came quickly. They called the ambulance staff who checked me over. I hurt my back and ribs. They put me back in bed and checked on me regularly afterwards.” However, one person told us that staff had not listened to them when they told them they were unwell and needed a doctor. This was raised with staff and a visiting community nurse visited later that day.

We discussed a concern, which had been reported to CQC, affecting some people who walked around the service freely who may have ingested a poisonous substance. Once the risk was discovered the staff sought advice and an ambulance and police were called. To mitigate the risk in future, maintenance staff had taken action to ensure that poisonous substances were not accessible by people. Staff were able to describe what they would do in the event of a fire and if they had any concerns about safety of the service. Staff described how they ensured the service is kept clean and maintained.

The service had a maintenance person who was responsible for the maintenance and safety checks at the service. Audits were in place and were being completed as required. These included fire checks, environment safety checks, waste audits, legionella checks, equipment checks. All safety checks and service contracts were stored on their computer system. The service had a rolling service improvement plan that was updated monthly. The service was undergoing redecoration in some areas and some flooring was being replaced with vinyl to aid cleaning.

People and their relatives told us that the service on the whole was well maintained and safe. They told us that any issues were quickly rectified by the maintenance team. Comments included, “Mum’s room is immaculate. For such a large place it’s difficult”, “The maintenance man is usually on top of things. Mum’s toilet wasn’t flushing properly so I spoke to the maintenance man and it was fixed in no time” and “It seems well maintained but I spend most of the time in my room.” One person raised a concern about their heating which was discussed with the registered manager who told us that the heating was working but they would check on the person to make sure.

Observation of the environment did not identify any risks. The service was well maintained and comfortable. Window restrictors were in place, fire extinguishers were seen around the service and were in date. Radiators were covered, although some did have minor damage. There was dementia friendly signage identifying bathrooms and toilets. Cleaning signs were dotted around where staff were cleaning. The service was not overly cluttered and fire exits appropriately signed.

Most people and relatives told us that there were not enough staff. They described staff as very busy, always rushing, did not have time to sit and chat with people and they had to wait for their care needs to be met. Comments included, “They could do with more staff. There are fewer staff at weekends”, “I think they are very busy; they are always rushing. There’s a big turnover of staff”, “Staff come in, do what they have to do and go” and “Staff do their best but it’s not enough. There are times when you can feel lonely.”

We observed there were sufficient numbers of staff who were quick to recognise people's immediate needs and respond appropriately. Where people required one to one support to keep them and others safe, we saw this was happening. We observed people received support with their meals and with moving around the home and from wheelchair to chairs.

Staff told us that staffing levels on the whole were good, but there were times when they could do with more staff such as in the morning when they helped people with washing and dressing. Staff told us they had an induction when they started at the service which included shadowing experienced staff. The registered manager told us that they were currently fully staffed according to their dependency tool. They told us they had a really good team of bank staff who worked across the providers services, and they covered for sickness and annual leave either with their own staff or bank staff.

We reviewed 3 staff files in relation to recruitment. A process was in place to ensure potential staff were recruited safely. Checks were in place such as Disclosure and Barring Service (DBS), proof of identity, proof to work in this country and obtaining references. However, whilst some recent employment history had been recorded for some potential staff, full employment history had not been taken. We discussed this with the manager who said they would review their recruitment processes and ensure this was included. New staff received an induction which included training in many different areas. The registered manager made sure staff had regular supervisions and annual appraisal. Records confirmed this. The service had a dependency tool based on people’s needs, to assess how many staff needed to be on shift each day. We saw from rotas that staffing was according to their dependency tool.

The head housekeeper told us they enjoyed their job and had a good team working together. They described the cleaning routine and cleaning schedule staff followed and were very proud of the job they were doing. They told us the service was investing in environmental improvements such as replacing carpets with vinyl to improve infection control and aid cleaning. The registered manager told us they performed observations and audits related to infection prevention and control (IPC), have discussions with the housekeeping and together they do spot checks of rooms and staffs’ practice.

We observed that the service was clean and free from odours. During the site visit we saw cleaning taking place throughout the service. PPE was available for staff and we observed staff using PPE safely and appropriately.

The registered manager told us they carry out IPC audits which included spot checks of staffs’ practice and hand hygiene audits. The service sought support from the local authority IPC team when needed. The registered manager told us they had oversight of PPE stocks and ensured these never ran out. Managers from the providers other services also completed IPC audits and checks.The housekeeper described their process for cleaning and who was undertaking each role such as general cleaning and cleaning carpets. Staff cleaned each person's bedroom and the bathrooms every other day unless some people’s rooms need more frequent cleaning. Communal rooms, corridor and toilets were cleaned every day. Cleaning checklists were kept in each room for staff to sign once they have completed cleaning. The head housekeeper had a diary which held records of what needed to be cleaned and when.

People told us the service was clean and staff always wore personal protective equipment (PPE) when supporting them. Comments included, “It’s fantastically clean, the bathroom is cleaned every other day. They are always cleaning”, “My room is clean, there’s nothing broken in it” and “They are on top of the cleaning. There is an occasional smell of urine, but it’s dealt with quickly.”

There were processes in place for ordering and managing stock. However, the processes in place for checking stock balances had not ensured that all stock balances were accurate. We looked at 6 randomly selected medicine records and found 2 medicines stock balance were incorrect. We saw some liquid medicines throughout the service had not been dated when they had been opened which meant that staff may be applying prescribed medicines that were out of date. We raised this with the registered manager who assured us they would take action and will review this concern at out next assessment The service used an electronic Medicine Administration Record (MAR) that prompted staff what and when medicines were due to be administered. We found that medicines were being administered as and when they should. Medicines were being stored appropriately, this included those needing cold storage and those needing extra security. Medicine room and fridge temperatures were being checked daily. Where medicines were being given as and when (PRN), protocols were in place on their electronic care planning system for staff to refer to.

People told us that staff knew what they were doing with their medicines, gave them their medicines on time and stayed with them to make sure they took them. One person said, “It’s the same time every day for pills. They watch me take them and wait until the last one has gone.” A family member told us, “The meds are on time, always before 10.00am. They always stand and watch them take them.”

Medicines were being managed by senior care staff and overseen by the deputy managers. We spoke with two senior care staff about the medicines process and their roles and responsibilities. This included administering the medicines, ordering stock, and the stock checking process/audits. Senior staff confirmed they had received training and had their competencies checked.