Thomas Knight 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 not always kept safe and protected as they should be through thorough and prompt actions. The provider had not always learned from incidents and did not have effective monitoring and auditing processes in place to ensure that risks did not recur. People were respected and their freedoms protected in line with legislation. When people raised concerns about safety and ideas to improve, they felt they were listened to and the registered manager, and other staff, took action. On a day to day basis, staff protected people from the risks they faced and for the most part demonstrated a good knowledge of those risks.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff and leaders had not always learned proactively and demonstrated that they could be effective at scrutinizing their own processes and driving improvements. The service had made some improvements over time, but not all were sustained and there were times when improvements were overly-dependent on the input from external stakeholders.

Whilst staff worked hard together to meet people’s needs and whilst the provider was responsive to feedback, they had yet to set out a clear vision or strategy for what they wanted the service to achieve. For instance, through an overarching action plan with clear goals. As such, they were making reactive improvements when signposted by other stakeholders, rather than always demonstrating a proactive approach. The provider hoped to employ a clinical lead soon, and had recently implemented a practice development lead to help address these areas.

People felt their needs were well supported by staff and had confidence in the service to escalate any changes or to seek help when required. They received regular optical, dental and other check-ups, and input from behavioural specialists when needed.

Staff and leaders’ feedback demonstrated people were receiving the standard of care described in the quality statement. New admissions care plans were added to an electronic care management app so that staff could review their needs. This included information on peoples care and nutritional needs as well as any risks associated such as falls or fluid requirements.

Some external professionals had positive experience with the service, although some felt the service could be more proactive in their sharing of information and interactions. On occasion visiting professionals received an inconsistent approach from staff. Alongside this however there were some positive comments regarding how well some staff anticipated people’s changing healthcare needs and sought help in some areas.

People told us they felt safe, at home, and trusted staff to keep them safe. At times they felt they had to wait for support but they raised no concerns about their fundamental safety. Some gave examples of when they had to raise a concern, and how it was resolved. We identified instances however when safeguarding referrals needed to be made more promptly about people, by the provider.

The service had not always made safeguarding referrals in as timely a way as possible, and had needed prompting to make safeguarding alerts by visiting stakeholders. This also happened during our inspection visit. Safeguarding as a theme was discussed as part of supervisions/appraisals as well as in team meetings. The home has recently had a 3-day local authority led safeguarding training course, and staff we spoke with knew how to raise concerns. On occasion however, the correct processes had not been followed promptly to endure people were safe.

Processes demonstrated that people are not always receiving the standard of care described in the quality statement. Safeguarding was not consistently reported in a timely way. We did see evidence of this happening for the majority of the time, and there had been some improvements through working with external partners, however we also identified a safeguarding matter that had not been appropriately alerted. Systems and processes in place to ensure safeguarding referrals were made in a timely way had not always worked, and improvements in safeguarding practice had been slow to embed.

Staff understood the risks people faced and helped them reduce them. Feedback from people and their relatives was positive in this regard and risk assessment information we reviewed was up to date. Where we made suggestions for improvements, the registered manager was responsive to this.

Staff and leaders’ feedback demonstrates people are receiving the standard of care described in the quality statement. Management told us they gave consideration to their existing resident mix during admissions and worked closely with the behavioural support clinic when producing behavioural support plans for people who may require them as part of their care.

Whilst people spoke well of the environment generally we witnessed shortfalls that could impact on them. For instance, a glove left covering a smoke detector, a shower room uncleaned throughout day, an overflowing clinical waste bin and a w/c with a broken support arm. There was also a lack of sensory stimulation and some bare environments, which had the potential to have a detrimental impact on people. We acknowledged the provider faced some challenges regarding how some people interacted with the environment, but more could have been done to enrich the environment for people's sensory benefit.

Staff and leaders had not proactively identified areas that needed addressing to make the environment as safe as possible, or as effective in terms of meeting people’s sensory needs. Not all staff we spoke with knew what to do if there was a fire. We fed this back to the provider.

We observed some shortfalls in the environment, both in terms of risks through infection, prevention and control issues (as discussed above), but also the failure to utilise some spaces. For instance, some corridors were bare with few tactile options and we did not observe the activity spaces being used. Most spaces were clean and since the inspection visit the service had made more improvements and received an extremely positive visit from infection and prevention control partners.

The management ‘walkarounds’ and ad hoc visits from the provider's consultant had not always proved effective in identifying and addressing issues in the environment. Policies and procedures were in place to support with a range of potential environmental issues, such as outbreaks.

Whilst most people told us the felt well supported by staff, some did state they had to wait longer that they expected for help from staff. Some said staff were rushed and at times this had an impact on when they received their medicines, or personal care. One said, "Two or three staff are fine, some you have to shout for." Another said, "It's usually okay but there are less on weekends, and I have to wait."

The registered manager and provider felt staffing levels were appropriate. They said they used a dependency tool and overstaffed based on what that recommended. During the assessment visit however, and in conversations with people and some professionals, there were times when staff struggled to get all tasks completed. External stakeholders shared feedback that they sometimes found it difficult to find members of staff when they visited the service.

The provider had auditing and governance systems in place but these had not looked in detail at the dependency tool in use. The provider and leadership team agreed to review the use of the dependency tool.

People told us the home was generally clean and they saw cleaners coming and going. They raised no concerns about the cleanliness of the service. One said, “The cleaners are around regularly." Another said, "It's clean and tidy and has what I need."

The registered manager ensured there were ample supplies of appropriate PPE and related equipment available for staff. There were domestic staff factored in to the dependency tool.Partners raised no concerns regarding infection control.

During our visit we noted areas that required additional cleaning and not all of these were addressed promptly. When we spoke with night staff they told us there were occasions when they struggled to complete cleaning and laundry alongside their care duties. Some areas of the home were well maintained and cleaned during our visit.

Most people felt they received their medicines in line with how they wanted, although some did raise concerns about delays. They felt the administration of medicines was sometimes delayed and that this had an impact on them.

Staff we spoke with were confident in their ability to manage medicines safely. They received regular training and supervision to ensure they were competent. The registered manager and visiting consultant had experience in medicines management, with the latter a registered nurse.

Stock checks and audits had not always identified all areas of improvement required, for instance opening dates on liquids and the timeliness of some medication. The provider had taken on advice from local stakeholders about how to improve medicines management, and had made some improvements.