Archived: Thornton Hall and Lodge

Updated 8 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 16 and 18 October 2017 and was unannounced. The inspection team included four adult social care inspectors, a pharmacist inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. In this instance, their experience was in relation to supporting people living with dementia.

Before our inspection we reviewed the information we held about the service. This included the statutory notifications sent to us by the provider about incidents and events that had occurred at the service. A notification is information about important events which the service is required to send to us by law. We also contacted the commissioners of the service and the local safeguarding teams to gather their views of the service.

We used all of this information to help plan how the inspection should be conducted.

During the inspection we spoke with the new manager, two managers from the provider’s improvement team, the chief executive officer, 11 members of the care staff, eight people living in the home, five relatives and the activity coordinator.

We looked at the care files of eight people receiving support from the service, six staff recruitment files, 22 medicine administration charts in detail and other records relevant to the quality monitoring of the service. We also observed the delivery of care at various points during the inspection.

We also used the Short Observational Framework for Inspection (SOFI) on two occasions during the inspection. SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 8 December 2017

This inspection took place on 16 and 18 October 2017 and was unannounced.

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. During the inspection, there were 79 people living in the home.

At the last inspection in March 2017, we identified breaches of 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. During this inspection we looked to see whether improvements had been made but found many of the same concerns and the warning notices had not been met.

At the last inspection we found that medicines were not always managed safely. During this inspection we found that sufficient improvements had not been made and the provider was still in breach of regulation regarding this. Medicines were not always stored appropriately as the temperature of the clinic rooms was too high and that some items requiring refrigeration were not stored in the fridge. We found discrepancies in the stock balance of controlled medicines and systems to ensure medicines were always available, were not effective. Some people’s allergies were not clearly recorded and guidance was not always in place for medicines prescribed as and when required.

Records we viewed showed and staff confirmed that they had completed medicine training and had been assessed as competent to administer medicines in the home.

At the last inspection we identified concerns regarding risk management. During this inspection we looked to see if improvements had been made; however we found the same concerns and the provider was still in breach of regulation regarding this.

We saw that risk assessments had been written but not all identified that risks had been fully assessed and clearly recorded and not all had been updated, as people’s needs changed. Some emergency evacuation plans were not accurate and the environment was not always safely maintained as not all fire doors closed properly and chemicals were not always stored securely.

In March 2017 we found that consent was not always sought in line with the principles of the Mental Capacity Act 2005 (MCA). During this inspection we found that adequate improvements had not been made and the provider was still in breach of regulation regarding this. We found that assessments were not always completed when required, such as when people were receiving covert medicines. It was not always clear that relevant people had been involved in best interest decisions and records indicated that it was not assumed people had capacity until an assessment showed otherwise. We did however observe staff seeking consent from people before providing support.

At the last inspection we found the provider was in breach of regulation as care plans 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 that insufficient improvements had been made and the provider was still in breach of regulation regarding this. Not all care plans provided sufficient, consistent information to enable staff to support people effectively and were not always updated as people’s needs changed. This meant that staff may not have sufficient information to enable them to support the person safely and effectively.

At the last inspection we identified a breach in regulation regarding how the service was managed. During this inspection we looked to see if improvements had been made and found there were still concerns regarding the management of the service. Completed audits did not identify all of the concerns highlighted during inspection and when audits did identify areas that required improvement, it was not always clear whether actions had been addressed. This showed that the audit systems in place were not effective and the provider was still in breach of regulation regarding this.

We found that there was not always sufficient numbers of staff on duty to meet people’s needs in a timely way and the provider was in the process of recruiting more staff.

Meetings took place to enable people and their relatives to provide feedback regarding the service, however people did not feel that action was always taken based on their views. Questionnaires were available but there was no evidence when these were last completed.

We made a recommendation regarding this in the main body of the report.

Staff files evidenced that not all safe recruitment practices were adhered to, however all staff had a disclosure and barring service check to help ensure they were suitable to work with vulnerable people.

Staff were knowledgeable about adult safeguarding and how they would report any concerns and people told us they were supported to stay safe in the home.

A system was in place to ensure that applications to deprive people of their liberty were made and monitored appropriately.

New staff completed an induction that was in line with the requirements of the care certificate and regular training was available to all staff. A schedule of supervisions had been implemented to help support staff, but not all staff had received an appraisal.

People were supported by the staff and external health care professionals to maintain their health and wellbeing. People told us they received appropriate care from health professionals in a timely way.

We looked at how people’s dietary needs were met within the home and found that staff were knowledgeable regarding people’s needs and specialist aids were available to assist people to eat independently. People living in the home told us they liked the food available to them and they had a choice of meals.

People spoke highly of the staff and told us staff were kind and caring and treated them with respect. Most relatives we spoke with agreed that staff were caring. Although feedback regarding the approach of staff was positive, the provider had failed to address issues within the service which had been raised at previous inspections and continued to pose risk to people living in the home.

We observed people’s dignity and privacy were respected by staff in a number of ways, such as staff knocking on people’s door before entering their rooms. If people were presenting with behaviours that could compromise their dignity, staff quickly supported them to somewhere more private.

People also told us that they were encouraged to maintain their independence and most staff knew the people they were caring for well, including their needs and preferences. People told us they were supported to meet their religious needs.

Relatives we spoke with told us they were kept informed of any changes to their family members needs and were involved in reviewing their plan of care. Care files included information on people’s preferences in relation to their care. This helped staff to get to know people and provide support based on their preferences.

Feedback regarding activities was mixed. An activity coordinator was employed in the home and we saw an activity schedule on display. Records showed that although people’s preferred activities were known, they were not always met by the service.

People had access to a complaints procedure within the home and we found that complaints made had been investigated and responded to.

There had been a frequent change in the management team at Thornton Hall and Lodge over the previous two years and it was clear that this had had an impact on people living in the home and staff. A new manager had started in post on the first day of the inspection and had begun the process to register with the Commission. 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.

The provider had notified the Care Quality Commission (CQC) of events and incidents that had occurred in the home in accordance with our statutory requirements. We also saw that the rating from the last inspection was clearly displayed within the home and on the provider’s website as required.

Many of the concerns identified during this inspection had been raised with the provider at previous inspections. This showed that the provider had failed to take appropriate action that would mitigate these risks and maintain improvements.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept un