The inspection visits took place on 20, 21, 29 November and 05 December 2017. The inspection visit on 20 November 2017 was unannounced. Thornton House accommodates 44 people across four separate units, each of which have separate adapted facilities. One of the units (Byron) specialised in providing care to people living with dementia. Two units (Keats) provided rehabilitation services and the Wordsworth unit provided mainstream residential care. At the time of our inspection visit on 20 November 2017 there were 41 people who lived at the home. There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 inspection on 05 April 2016 the service was rated Good.
At this inspection carried out 20, 21, 29 November and 05 December 2017 the service was rated Requires Improvement. This is the first time the service has been rated Requires Improvement.
The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.
However, the information shared with CQC about the incident indicated potential concerns about the management of risk of falls from beds. This inspection examined those risks.
We looked at how the service managed risk to keep people safe. We found risk was not appropriately addressed and managed. This placed people at risk of harm. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities, 2014 (Safe care and treatment).
We found the deployment of staff during the night was not always sufficient to meet people’s support plan requirements. Checks completed during the night on the services four units were inconsistent. This left frail and vulnerable people unsupervised and at risk of harm. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Staffing) as the registered provider had failed to ensure staff were effectively deployed at all times.
Staff had been recruited safely, trained and supported. Staff told us they received regular supervision and their work was appraised annually. However staff had not received training for maintaining and checking bedrails. Good practice guidance says staff must receive training in relation to the safe use of bedrails. (MHRA Safe Use of Bed Rails. December 2013). This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014 as the registered provider had failed to ensure staff had the required skills to provide safe care and treatment.
During the inspection we identified over a seven month period one serious injury had not been reported to CQC, one accident where the nature of the injury had not been recorded and two injuries which potentially were reportable. This meant that we did not receive all the information about the home that we should have done. This was a breach of Regulation 18 of the Care Quality Commission Registration Regulations 2009 (Notification of other incidents).
We found quality and accuracy of documentation maintained by the service was inconsistent. We found gaps in records and a lack of information about people at risk of losing weight with their dietary intake. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good governance) as the registered provider had failed to ensure records maintained were accurate and reflected people’s needs.
The registered manager used a variety of methods to assess and monitor the quality of the service. However these had not been effective and had failed to identify the concerns we found during the inspection process. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good governance).
The service had not discussed with people and documented their preferred end of life wishes.
We have made a recommendation about this.
We spoke with 16 people who lived at the home and two people visiting their relatives. People who lived at the home told us they were happy, safe and well cared for. One person said, “The staff are really nice and are looking after me well. I have found them very helpful.”
People visiting the home told us they were made welcome by friendly and caring staff and had unrestricted access to their relatives. They told us they were happy with the care provided and had no concerns about their relatives safety.
The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.
Medication procedures observed protected people from unsafe management of their medicines. People received their medicines as prescribed and when needed and appropriate records had been completed.
We saw there was an emphasis on promoting dignity, respect and independence for people who lived at the home. People told us staff treated them as individuals and delivered person centred care. Support plans seen confirmed the service promoted people’s independence and involved them in decision making about their care.
We looked around the building and found it had been maintained, was clean and hygienic.
The design of the building and facilities provided were appropriate for the care and support provided.
The service had safe infection control procedures in place and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.
People had been 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.
Staff knew people they supported and provided a personalised service in a caring and professional manner.
People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. Catering staff had information about people’s dietary needs and these were being met.
People who lived at the home told us they enjoyed a variety of activities which were organised for their entertainment. These included exercise classes, bingo, quizzes, pamper sessions and arts and crafts.
People told us staff were very caring towards them. Staff we spoke with understood the importance of high standards of care to give people meaningful lives.
The service had information with regards to support from an external advocate should this be required by them.
The service had a complaints procedure which was made available to people on their admission to the home and their relatives. People we spoke with told us they were happy and had no complaints.
During the inspection the management team were receptive to feedback and worked with us in a positive manner. They provided information we requested and took prompt action to address any concerns.
You can see what action we have asked the registered provider to take at the back of the full version of the report.