This was an unannounced inspection carried out on the 01 December 2015.
Thornton Lodge Care Home provides 24 hour nursing and or personal care for up to 33 older people, including care for people living with dementia. It is close to local amenities with good access to public transport and motorway networks.
At the time of our visit, there was no registered manager in place, though the current manager had been in post since April 2015. 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.
When we last inspected this service in March 2015, we found the service had breached three regulations relating to the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. As part of this inspection, we checked to see what improvements had been made.
During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
We found that care plans did not always accurately reflect people’s current needs. We looked at a number of risk assessments including nutrition, oral health, bed rails, skin integrity where monthly reviews had been undertaken. However, we found relevant issues relating to people’s care were not always being updated in care files.
We found that issues noted in the diary were not always transferred to the person’s clinical records, for example we found one entry where a referral had been made to the Abbott PEG (Percutaneous Endoscopic Gastrostomy) nurse. The reason for the referral was also recorded in the diary, but this information had not been included in the person’s care plan.
We saw that in one instance the tissue viability nurse had been advising on a PEG site for a person who used the service, however staff were not recording on-going improvements as they happened or monitoring for prevention of the problem. We found there was an informal ‘change of syringe’ used for PEGs every Friday by the nurse, but again this was not documented.
This is a breach of Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 (Part 3), good governance, because the service had failed to maintain accurate and complete contemporaneous records for people who used the service.
During our last inspection in March 2015, we found that people who used the service had not been protected from the risks associated with the safe recruitment of staff. We found the provider had made improvements and was now meeting the requirements of regulations in relation to employment of fit and proper persons. People were now protected against the risks of abuse, because the home had appropriate recruitment procedures in place.
During our last inspection we found that people had not protected from the risks associated with not having sufficient numbers of suitably qualified staff on duty. During this inspection, we found the provider had made improvements and was now meeting the requirements of regulations in relation to ensuring there were sufficient numbers of staff on duty to meet people’s needs and keep them safe.
We found the service undertook a range of risk assessments to ensure people remained safe. Risk assessments provided guidance to staff as to what action to take to ensure people remained safe.
On the whole, we found people were protected against the risks associated with medicines, because the provider had appropriate arrangements in place to manage medicines safely. We observed staff checking people’s medications with medication administration records (MAR) and calling people by their name before offering the tablets.
During our last inspection in March 2015, we found that people who used the service had not been protected from the risks associated with the appropriate support, training and professional development of staff. As part of this inspection, we found the provider had made improvements and was now meeting the requirements of regulations in relation to the professional development of staff.
Staff we spoke with said they received an induction when they started working at the home, had enough training available to them and felt well supported to undertake their roles. We confirmed this by looking at training records.
All staff we spoke with confirmed they received supervision and appraisals, which we verified by looking at supervision records and an electronic supervision matrix.
From reviewing care files, we found that written consent from people who used the service or their representatives was not always obtained. We spoke to the manager who told us they would review all care files and ensure that the appropriate written consent was recorded.
When we undertook our last Inspection in March 2015, we found the home environment was in need of redecoration and upgrading. On the day of our visit, we found that the environment remained significantly unchanged, however a large team of decorators were in situ decorating the communal hallway throughout the home. Significant improvements were still required around flooring and furniture, which we were told formed part of the improvement programme.
We have made a further recommendation on environments.
We found people had access to healthcare professionals to make sure they received effective treatment to meet their specific needs. Care plans contained professional communication records, which detailed engagement with other health care professionals such as bladder and bowel, speech and language therapist (SaLT), dieticians, GP’s, district nurses and tissue viability teams.
We found that individual nutritional needs were assessed and planned for by the home.
People and relatives told us staff were kind and the quality of care provided was good.
Throughout our inspection, where we observed interaction between staff and people who used the service, we found it kind and respectful.
People and relatives told us they were involved in making decisions about their care and were listened to by the service.
The home was part of the North West End of Life Care Programme known as Six Steps to Success. This programme was intended to enable people to have a comfortable, dignified and pain free death.
During our last inspection in March 2015, we made a recommendation that the service seek advice and guidance from a reputable source to ensure people had opportunities to take part in activities they enjoyed and met their personal preferences. We found that the service now employed a full-time activities co-ordinator. Throughout our visit, we saw the activities co-ordinator enthusiastically engaging in activities with people who lived at the home.
Care plans provided guidance on a number of areas of care and treatment, including consent and mental capacity, mobility, nutrition, skin integrity, communication and incontinence. Though people told us that they were involved in determining the care their loved one’s received, this was not clearly documented in their care plans.
We found that the service routinely listened to people to address any concerns or complaints. We found the provider had effective systems in place to record, respond to and investigate any complaints made about the service. We also looked at minutes from bi-monthly resident and relatives meetings that took place.
During our last inspection in March 2015, we found the registered person did not have appropriate arrangements in place to monitor the quality of service provision or regularly seek the views of people who used the service. During this inspection we found that the service was on the whole meeting the requirements of this regulation, however not all audits undertaken were effective.
We found the service undertook a range of audits and checks to monitor the quality of services provided. These included regular fire systems checks, weekly medication audits, environmental checks, infection control, monthly falls audit, safeguarding and supervision. However, we found that care file audits failed to identify our concerns around maintaining accurate and complete contemporaneous of records of people who used the service.
Both people who lived at the home together with their relatives and staff consistently told us that the service was well managed following the appointment of the manager.
The home had policies and procedures in place, which covered all aspects of the service. The policies and procedures included; safeguarding, whistleblowing, behavioural management and medication.