Thornton Hall & Lodge

Thornton Hall & Lodge is a residential care home that provides personal care and accommodation to people aged 65 and over. The service is registered to support up to 96 people over 2 floors. At the time of our inspection there were 93 people using the service.

People’s experience of using this service and what we found

There was a positive culture at the care home. People told us staff were attentive to their needs and showed flexibility in meeting their requests. People's relatives told us staff at the home communicated and worked in partnership with them and involved them in putting together people's care plans. Staff members told us they enjoyed working at Thornton Hall and Lodge; they felt appreciated and well supported by the registered manager and provider.

We found inconsistent information recorded in some people’s care plans with regards to their assessed needs. We made a recommendation about this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We saw consent was sought and recorded in line with the principles of the Mental Capacity Act 2005.

People had care plans in place which were person centred, and accompanying risk assessments which enabled staff to care for them safely. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 03 February 2023).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the domains of 'effective, 'responsive' and' well-led’.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Thornton Hall & Lodge on our website at www.cqc.org.uk.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed to good based on the findings of this inspection.

Recommendations

We have made a recommendation around the way the provider manages care records to ensure information contained in people’s care records is consistently accurate and up to date.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Thornton Hall & Lodge is a residential care home providing personal care and accommodation to 86 people aged 65 and over at the time of the inspection. The service is registered to support up to 96 people over 2 floors.

People’s experience of using this service and what we found

Medicines were managed safely. However, some improvement was needed to ensure time sensitive medicines were consistently given at the required times, and with appropriate time between doses. We made a recommendation about this.

There were enough staff to support people safely. The provider had robust recruitment systems to ensure staff were safely recruited. Staff spoke knowledgeably about the systems in place to safeguard people from abuse.

People were supported by kind and caring staff who treated people as individuals and with dignity and respect.

People told us they felt safe. Risks to people’s health and welfare were identified and managed. Risks were regularly reviewed to ensure people’s changing needs were safely managed. Infection control measures were in place to prevent cross infection. Staff wore appropriate PPE and the home was clean throughout. Visiting was safe and followed current guidance.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The management of the home promoted a person-centred service. There was an open and transparent culture and good partnership working with others. The quality and safety of the service was monitored through regular checks.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 20 May 2021).

Why we inspected

We received concerns in relation to the management of medicines, staffing levels and management of people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Thornton Hall & Lodge on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation about the management of some medicines. Please see the Safe section of this report for more details.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Thornton Hall & Lodge is a residential care home providing personal care and accommodation for up to 96 people, including people living with dementia. There were 66 people living at the home at the time of this inspection.

People’s experience of using this service and what we found

At our last inspection the provider had failed to effectively manage individual and environmental risk and ensure medicines were administered safely. There were failings in relation to good governance as the provider had repeatedly failed to achieve a rating of good and systems to monitor the quality and safety of service were ineffective. We also made a recommendation to improve the provider’s documentation and approach to safe staffing levels. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

People received their medicines safely and as prescribed. Robust measures and monitoring had been put in place to ensure the issues found at the last inspection did not happen again. People had personalised risk assessments which gave staff the information needed to safely manage the risks associated with people’s care. The environment was safe and well-maintained. The home was clean and effective infection prevention and control measures were in place.

There were enough staff at the home to meet people’s needs. People told us they felt were enough staff at the home. One person said, “The staff are great, they’re always there if I need help.” Staff were visible around the home and were readily available to support people when needed. Staffing levels were monitored, reviewed and amended when needed by the manager.

People were safeguarded from the risk of abuse. People told us they felt safe living at the home and relatives also said people were safe at the home. One person said, “The staff are great, wonderful; they make me feel safe after I lost my confidence at home.” Staff had received safeguarding training and understood their role in recognising and reporting safeguarding concerns. The provider had appropriate systems in place to manage concerns of a safeguarding nature.

The effectiveness, organisation and accuracy of quality assurance processes at the home had improved significantly. Staff had responded positively to feedback from the last inspection and action had been taken to address the issues identified.

There was a kind and caring culture amongst staff at the home. Staff knew the people they were supporting and we observed many positive interactions throughout our inspection. People living at the home spoke positively about the staff. One person commented, “The staff are marvellous.” People and relatives spoke positively about how staff kept them involved. One relative said, “I’m happy with the way they’ve kept me in touch. They’ve always told me when [Relative] went to hospital; that’s been spot on.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 25 December 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 2 November 2020. Breaches of legal requirements were found and a Warning Notice in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was served. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance at the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements and the Warning Notice. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We also looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Thornton Hall & Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Thornton Hall & Lodge is registered to provide residential care to up to 96 people with a variety of health needs. At the time of our inspection 72 people were living at the service.

People’s experience of using this service and what we found:

At our last inspection the provider had failed to ensure medicines were safely administered. We also made a recommendation to improve governance systems. Not enough improvement had been made at this inspection and the provider was still in breach of Regulation 12. The recommendation from the previous inspection had not resulted in sufficiently robust governance systems and the provider was in breach of Regulation 17.

Systems in relation to fire safety and essential equipment had not been consistently and safely managed. Staff did not consistently adhere to the relevant guidance for the use of personal protective equipment (PPE). Risk was not always robustly reviewed following incidents and accidents. Staff had not received recent training to ensure they could safely intervene when people were at risk of harm. Action was taken by the provider when these concerns were shared.

The service did not have robust and effective systems in place to monitor, assess and improve the safety and quality of service being provided. This placed people at unnecessary and avoidable risk of harm. Some records were not sufficiently completed. Some aspects of the service had improved since our last inspection but, further improvement is still required to meet regulations.

Some people expressed concern regarding staffing levels. Documentation did not clearly demonstrate safe staffing levels were always maintained. We made a recommendation regarding this.

Staff demonstrated kindness and respect in their interactions with people. It was clear they provided care in an individualised manner. Most people spoke positively about the management of the service.

The people we spoke with and their relatives told us they felt the service was safe. Staff were safely recruited subject to the relevant checks.

Rating at last inspection and update:

The last rating for this service was requires improvement (published 5 November 2019). The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last four consecutive inspections.

During the last inspection we found a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection not enough improvement had been made and the provider was still in breach of regulations. We have identified an additional breach of Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected:

We carried out an unannounced comprehensive inspection of this service on 25 September 2019. A breach of legal requirements was found.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Thornton Hall & Lodge on our website at www.cqc.org.uk.

Enforcement:

We have identified breaches in relation to the safety and management of the service.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will meet with the provider to discuss our findings and how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Thornton Hall and lodge is a residential care home providing personal care to 72 people at the time of the inspection. The service is registered to support up to 96 people in one adapted building. There are two sides to the home, the Lodge which mainly supports people dementia, and the Hall which is mainly a residential unit.

People’s experience of using this service and what we found

We found some concerns with the management of medicines. Staff were not always following guidance regarding covert medication, meaning this was not always administered safely and some people did not receive time specific medicine at the correct time. During the inspection we saw some improvements to the administration of medicines.

Although governance systems had improved since the last inspection and more thorough audits were in place, we found there was still a lack of appropriate and effective planning to ensure sustained improvements were made in a timely way. We made a recommendation about this.

At this inspection we found there had been improvements with people’s care plans. Most care plans we saw contained person-centred information and enough detail to ensure risks to people were managed safely. There were still some care plans that had not been reviewed since the last inspection, and the details in these were insufficient. The manager told us these would be reviewed immediately to ensure they met the same standard.

Some records were disorganised in the way they had been set up. Some people’s care plans were blank, but information relating to their support needs and risks were found in other documents within the care record. Staff were able to view all these records, but some staff told us it could be confusing knowing where to look sometime. The manager told us this would be addressed with the care plan reviews.

There were enough staff to meet people's needs safely. We saw people had good relationships with the staff that supported them. A high proportion of agency staff continued to be used to fill gaps in the care staff rota, as was the case at the last inspection. Some people told us they would prefer more permanent staff, but they didn't feel the use of agency staff affected the quality of care they received. The manager used consistent agency staff where possible to ensure continuity of care.

People were treated with dignity and respect. Staff supported people to be as independent as possible and express their views about the service and their care.

Since the last inspection extra administrative hours had been agreed for the home to support with front of house and reception duties. We found this had a positive effect, especially with the door and phone calls being answered in a timelier way.

Safe recruitment procedures were followed and staff were appropriately trained.

At our last inspection the provider had failed to ensure appropriate checks were completed with agency staff prior to working the home. At this inspection we saw satisfactory improvements were made. The provider had put measures in place with an agency to provide more effective oversight of the agency staff and ensure they were providing high quality and safe care.

People told us they felt safe living at the service and risks to people's health and welfare had been appropriately assessed. Plans were in place to reduce risks to people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff understood their role and had confidence in the manager. Staff told us they worked well together as a team, and there was good morale amongst them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 31 July 2019).

This service has been in Special Measures since 30 July 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the management of medicines at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the safety of medicines management. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a change of legal entity for the service in December 2017. However, the senior management team remains the same as the previous legal entity. We therefore considered the previous ratings and breaches from both providers when planning and conducting this inspection.

People’s experience of using this service: People were not receiving care that was fully safe, effective, caring, responsive to their needs and well-led. The service is now judged to be inadequate in providing effective care as well as being inadequately well-led.

Before the inspection we had received a number of concerns regarding staffing levels and the quality of care. During the inspection, we observed caring and respectful interactions between staff and people living in the home.

Prior to the inspection we also received some concerns regarding inappropriate lifting techniques which had the potential to cause harm to people. There were two incidents we discussed with the manager during the inspection. These incidents had been dealt with appropriately by the provider.

Staffing levels during the inspection appeared adequate. Staff could respond to people’s support needs in a timely way. However, we raised concerns regarding the deployment of staff across the home. Staff told us one part of the home was under staffed. Staff would leave the floor they were working on to support the busier floor. We asked the manager to address this. Since the inspection, the manager has told us extra carers have been allocated to the busier floors.

People living in the home told us they felt safe. They felt there were enough staff to meet their needs. However, some relatives and staff told us there was not always enough staff and at times staffing levels had been unsafe. People acknowledged the provider was trying to address this with various recruitment incentives.

The management of medicines had improved since the last inspection. However, we still found some issues that needed to be addressed by the provider. We made a recommendation about this.

Safe recruitment practices were in place for permanent staff.

A high proportion of agency staff were used. Not all agency staff had the appropriate induction. The manager had not always had sight of agency profiles to ensure those staff were suitable to work with people living in the home.

Care plans were inconsistent and lacked detail. The service had recently moved from paper care files to electronic versions. The care plans we saw were not adequately completed and not effective at planning appropriate support for people.

Risk assessments were not fully completed or adequate for the management of people’s risks.

The service was not compliant with the Mental Capacity Act (MCA) 2005. People had not always had an appropriate assessment when they were deemed to lack capacity for a specific decision. People were being restricted without the lawful process being followed.

People told us they had enough to eat and drink. We saw drinks and snacks being offered throughout the day. However, staff told us there were limited food provisions available during the night. This was being addressed by the manager.

The quality assurance processes were inadequate. Issues raised at previous inspections had not been acted on. There have been repeated breaches of regulation.

Rating at last inspection: Requires Improvement (Report published 12th July 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: You can see the action we told the provider to take towards the back of this report.

Follow up: The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

Thornton Hall and Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Thornton Hall and Lodge is registered to provide residential care and support for up to 96 people. The home is purpose built and the accommodation is in four units over two floors. Two of the units within the home are designed to support people living with dementia. The home has aids and equipment to help people who are less mobile and the first floor is accessible by a passenger lift and staircase. Since the last inspection there has been a change of legal entity for the service however the senior management team remains the same as the previous legal entity. We therefore considered the previous ratings and breaches when planning and conducting this inspection.

During the inspection, there were 68 people living in the home. Twenty eight people were residing on “The Lodge” and 36 on “The Hall”. Following the last inspection, the provider took the decisions to stop admissions to the service to enable them to concentrate on making improvements. Prior to the inspection the service commenced a phased admission process; this was in light of the improvements they have made and following a review by the local authority to assess standards. The admission process is being carefully monitored by the registered manager and senior management team to support the service.

At the comprehensive inspection in March 2017, we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations in relation to how consent to care and treatment was sought, the management of medicines, risk management, care planning and systems in place to monitor the quality and safety of the service. The service was rated as 'Requires improvement' and we issued warning notices in relation to Regulation 12; safe care and treatment and Regulation 17; good governance. A Warning Notice was served in relation to Regulation 12, of the Health and Social Care Act 2008, Regulated Activities Regulations 2014, by way of unsafe medicine management.

We returned in October 2017 to carry out a comprehensive inspection and found the service had not improved and there were further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service had been unable to demonstrate sustained compliance with standards of quality and safety and there was a failure to sustain improvement. We found areas of continued breach and new breaches. We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations in relation to Regulation 12, the safe management of medicines; risks to people’s safety, the equipment and environment; Regulation 18; staffing levels, Regulation 11; consent in accordance with the Mental Capacity Act 2005 and Regulation 17; people’s plan of care and governance of the service. Following the inspection in October 2017 the service was rated as Inadequate and placed in Special Measures.

Special measures:

The overall rating for this provider is 'Inadequate'. This means that it has been placed into Special measures by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

At this inspection in May 2018 we found a number of improvements had been made to improve the service. The service is no longer rated as Inadequate and has been removed from Special Measures. The rating for the service is now Requires Improvement.

We looked at medicine management. Although we found some improvements we found people were still not fully protected against the risks associated with medicines because the provider’s arrangements to manage medicines were not consistently followed. For example, some stock balances were incorrect and medicines had not been administered as prescribed. These areas were discussed with the registered manager and Head of Improvement and they took swift action to look into the concerns we raised. This included contact with external professionals, arrangements for advanced medicine training for staff and increasing the frequency of the safety checks and overall governance of medicines.

Areas of improvement for medicines included protocols for medicines prescribed as and when required (PRN). The protocols were detailed and provided staff with person specific information to help ensure they knew when to administer these medicines, even when people were unable to inform staff when they required them and the management of covert medicines with the right permissions was being obtained in accordance with the Mental Capacity Act 2005.

At the last inspection we found the provider was in breach of regulation as people’s plan of care did not always provide sufficient detail regarding people's care needs and were not always updated when people's needs changed.

During this inspection we found some improvements around recording people’s care needs though we found anomalies for three people’s care plans. Care records lacked information to help staff deliver care on how to meet people’s needs safely and well. We brought this to the registered manager’s attention and action was taken to update the care records.

At this inspection we looked at systems and processes to mitigate risks and assure the quality of the service. We found some improvements however, we saw examples, particularly around the medicines, where analysis had not led to immediate action to prevent reoccurrence, to learn from what had gone wrong. We also found the governance arrangements needed to be more effective in other areas, as we found anomalies with the recruitment files, care records and risks analysis for incidents. The service’s governance arrangements were therefore still not robust. This brought into question the effectiveness of the tools used to assess aspects of the service, maintain standards and drive forward improvement.

At the last inspection we identified concerns regarding risk management. This included risks to people’s safety and within the environment. During this inspection we looked to see if improvements had been made.

People had risk assessments which now correctly identified risks to their health and wellbeing. These helped to ensure people’s ongoing safety and welfare. We saw emergency evacuation plans were now in place and apart from one these were accurate. The registered manager took appropriate action to rectify this. Previously fire doors had not closed properly and chemicals were not stored safely. Actions had been taken to address this. We found the environment to be safe and well maintained therefore this breach had been met.

At the last inspection we identified concerns regarding the staffing levels. This was because there were not always sufficient numbers of staff on duty to meet people's needs in a timely way. During this inspection we looked to see if improvements had been made.

At this inspection we found the staffing levels were satisfactory. We observed staff supporting people in accordance with their individual needs and when requested. The support was given in a timely and responsive manner; the staffing rotas evidenced consistent staffing numbers with good deployment of staff across the home. Feedback from people living at the home, relative and staff confirmed staffing had improved. This breach had been met.

At the last inspection we identified concerns in that consent was not always sought in line with the principles of the Mental Capacity Act 2005 (MCA). During this inspection we looked to see if improvements had been made.

We saw specific assessments were now completed, along with key decisions relating to care, treatment and use of bed rails. These were recorded following best interest meetings and people, relatives and/or representatives were involved with these decisions. This breach had been met.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been made to the relevant authorities for people who were assessed as requiring the protection a DoLS could offer them.

People we spoke with and their relatives told us they felt safe in the home. We saw that people who could not express their thoughts and feelings vocally were settled and supported. Staff were o