Thorn Park Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The provider supported the registered manager to develop their skills and knowledge. The managers at the service knew people well and understood their needs. The registered manager told us that the culture and ethos of the service was to make sure that people had a good standard of care. The manager was open to the concerns identified at this assessment regarding skin care and stock balances of medicines held at the service. Quality assurance and governance systems were in place to monitor the quality of care given to people living at the service. However, the oversight and application of these systems had failed to identify the concerns we found at this assessment and we found the governance arrangements did not meet the expected standards.

This service scored 71 (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 Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The registered manager told us they kept themselves up to date by attending care forums, reading CQC reports and attending peer group discussions. The provider supported the registered manager to develop their skills and knowledge and had funded the registered manager’s level 7 management course. The provider had also given the registered manager the role of director after recognising their competency with their systems. We discussed our concerns in relation to skin care and monitoring records, with the managers, who understood the concerns and were open and honest in admitting they had not had sufficient oversight and told us that they would address the concerns we raised. The registered manager told us their door was always open and they were seen out ‘on the floor’ working alongside staff to ensure staff demonstrated their vision, culture and values. Staff confirmed that this was the case. The managers at the service knew people well and understood their needs. The registered manager told us that the culture and ethos of the service was to make sure that people had a good standard of care and lived in an environment that had elements of a good hotel rather than a care home. Deputy managers described their role which included working alongside staff caring for people.

There were robust processes in place to ensure the service was managed by appropriately skilled managers. The manager told us interviews for managers were usually undertaken by two registered managers. The new care manager at the service was interviewed by the registered manager at Thorn Park and the registered manager from Seymour Court. This allowed for transparency and for two experienced managers to use their skill set and knowledge to ensure the candidate had the right skills, and personality to undertake a role in management. Monthly managers meetings were held throughout the providers services to ensure all managers had the opportunity to share best practice ideas and learn from mistakes. The managers have regular video calls with the provider.

The managers attended handovers in the morning alongside staff to discuss any issues or concerns staff came across on their shift. Staff were also supported with regular staff meetings, group supervisions and one to one supervision meetings to raise any concerns. Staff were invited to comment on the service through questionnaires and were given the option for these to be anonymous. The registered manager had an open-door policy to ensure that staff could come in and raise concerns in private. The service used an external HR agency to manage staff disputes. Information about who staff and people could contact to raise concerns, such as CQC and PCC, were displayed around the service. The registered manager worked in an open and transparent way when incidents occurred at the service, in line with their responsibilities under the duty of candour, and records confirmed this. The registered manager was supported by the provider and attended monthly meetings to discuss the service.

Staff felt the manager was available and approachable and they could raise any issues or worries they may have. Staff told us they were supported by the management team and felt confident to raise any concerns. One staff member told us, “Yeah, I do feel supported. There do listen and when I've talked with them, they do listen." Another staff member described the manager as ‘lovely’ and ‘approachable’.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We discussed our findings with the registered and deputy manager. They told us they expected staff to complete the repositioning as set out in the care plan and document this on the electronic records system. The managers confirmed staff would not document elsewhere. The registered manager told us they expected the seniors would check these records. The registered manager and deputy were unable to explain why there were so many discrepancies in the recording of repositioning. They agreed that from our findings they could not be assured that the care had been given, but felt that staff were repositioning people but just not recording this. The managers admitted that the senior team had not been checking as thoroughly as they should, and the records had not been checked regularly by themselves. We discussed our findings in relation to skin care with staff. 6 care staff confirmed that repositioning was recorded on the electronic records system and nowhere else. Staff told us that senior care staff were responsible for checking that care tasks had been completed on a daily basis and this was overseen by the deputy managers. Staff understood their roles and responsibilities and who they needed to go to if they had concerns or needed to report about any change in people’s care needs. Staff at all levels were able to describe who they were accountable to and who supported them. For example, care staff told us that they would report any issues to the senior carers who in turn told us they were supported by the deputy managers. We saw evidence that staff worked with other agencies and professionals and shared information appropriately. Where there had been incidents, actions had been taken to minimise the risk of reoccurrence.

The service had electronic care planning system, and electronic auditing systems. Whilst governance systems were in place to monitor the quality of care given to people, the oversight and application of these systems had failed to identify the concerns we found in relation to skin care and stock balances of medicines. This put people at risk of harm. The registered manager told us the system allowed them to look at all aspects of people's care needs. They confirmed senior staff and care managers were responsible for checking staff were completing care tasks i.e repositioning and prescribed cream application. Senior care staff had ‘senior team daily check lists’ to complete and sign off each day. We reviewed ‘senior checklists’ for January and February. Not all days had a completed checklist. We also found whilst staff were signing they were checking people were being repositioned and their skin care had been applied, these checks did not reflect what we found and what had been recorded on their computer system. Managers daily oversight/visual checks of the electronic record systems and their daily walk around observations, had not identified the omissions we identified. The care managers and registered manager also undertook monthly audits of care plans and risk assessments. These checks had also failed to identify the omissions in care delivery. Whilst staff were able to tell us about the processes in place for the oversight of care, in practice their systems had failed to identify the concerns we found. The provider completed monthly site visits and had full access to all the systems. We reviewed site visit records from 12 February and 11 March 2024, however, these site visits did not follow any formal audit process and did not identify that care was not being monitored. Failing to have sufficient oversight of auditing processes was a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People told us staff would contact the doctor if they were unwell and called for an ambulance if they needed this. There were no other comments from people or their relatives about their experience of staff working with partnerships and communities on their behalf.

We requested feedback from 9 health professionals involved with the service. We received 3 responses. One response did not have any reliable feedback to give. One visiting healthcare professional was very positive stating that the service was the best of the service’s they support, were the most organised, knew people well, were knowledgeable and the people all appeared clean and well cared for. A social care professional reported that they always found Thorn Park Care Home staff to be very responsive to people's changing needs. They also reported that the team worked really closely with them around ensuring that they had all the information they required to make an informed choice about whether they could meet a person's needs. If there were any areas of concern that caused them questions or concerns, they would request a Trusted Assessor assessment to support their decision making.

The service had weekly ward rounds with a GP and nurse practitioner and had access to them by phone and email in between ward rounds. The service also took part in multi disciplinary team (MDT) meetings through the care home liaison team. They had a good working relationship with the local authority. Staff liaised with the bed bureau at the hospital and had developed a trusting working relationship that ensured people were accurately assessed before being accepted back from hospital. The service had sought training from local health professionals, for example, community nurses have delivered skin care records (SKINN bundles) training and they had also received training on end of life care from health professionals. Reviews of people’s care records demonstrated that staff were working with health professionals and they were acted on advice given.

Conversations with the registered manager demonstrated that staff worked well with a range of health professionals. Staff told us they contacted people’s GP’s, community nurses and pharmacy when needed and followed advice given.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.