Archived: Thornbury Care Centre

Thornbury Care Centre is registered to provide nursing or personal care for up to 44 people. At the time of our inspection there were 35 people living at the home, some of whom were living with a dementia.

The home had a registered manager. 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 registered provider had breached regulations 9 and 17 of the Health and Social Care Act 2008. This was because people’s care plans did not reflect their current needs and preferences. Care for people living with dementia needed to be improved. In particular, meaningful engagement for people to help reduce the level of behaviours that challenged. Actions and improvements identified during quality assurance audits were not completed in a timely manner.

You can see what action we told the provider to take at the back of the full version of the report.

Most people and family members were happy with the care provided at the home. People said they were treated with dignity and respect from kind and caring staff. One person said, “They look after me okay.” Another person said, “They look after me well.” One family member said, “Looks fine to us. [My relative] is always looked after well. I have never seen anything to bother us.”

People told us they were safe living at Thornbury Care Centre. One person said, “I feel safe enough, [there is] nothing to worry us.”

Staff had a good understanding of safeguarding adults and the registered provider’s whistle blowing procedure. They also knew how to report concerns. One staff member said, “I have not needed to use it [whistle blowing procedure]. If I needed to I would definitely use it.”

Medicines records were usually completed accurately. There were a small number of gaps in signatures on medicines administration records (MARs). Medicines were stored safely and securely.

We received mixed views from people and family members about whether there were sufficient staff on duty. People said there were enough staff but some family members said there weren’t enough. All of the staff we spoke with felt staffing levels were appropriate to meet people’s needs.

Staff were recruited in line with the registered provider’s recruitment and selection procedures.

We observed a significant number of people did not have access to their ‘buzzer’ to allow them to call for help if needed.

Environmental improvements were on-going. One family member said, “They have improved it. It is clearly on-going. They could do with brightening up the paintwork.”

Regular health and safety checks were carried out to help keep people safe. This included checks of fire safety and equipment staff used to support people.

Accidents and incidents were logged regularly and action had been taken to help prevent the situation happening again.

All staff members told us they were well supported. One staff member said, “Anything you go to Diane [registered manager] with is really dealt with. Diane has been totally supportive.”

The registered provider followed the requirements of the Mental Capacity Act 2005 (MCA). Deprivation of Liberty Safeguards (DoLS) authorisations were in place for relevant people. Staff knew how to support people with decision making and understood the importance of gaining people’s consent before providing care. Formal consent within care records was inconsistent, as some people who were able to had not signed their care plans and other documents.

Most people we spoke with said they were happy with their meals. Although people generally experienced a pleasant lunchtime, people in the downstairs dining room waited a long time before served their meal. Staff ensured people were offered choices, such as a choice of drinks and meals.

People were supported to access the healthcare they needed. One person commented, “I see my doctor if I need to.” Care records evidenced regular input from a range of health professionals.

Although people said there were opportunities to take part in activities, some activities advertised for the day of our inspection did not take place.

Some family members felt communication with the home could be improved. People and family members had opportunities to give their views about the care provided at the home. Regular meetings were held and family members had given mostly positive feedback following consultation in December 2015.

Family members said they could visit the home anytime. One family member said, “We can come when we want.” Staff described the home as having a good atmosphere. One staff member told us, “I have always said it is a really friendly home.”

Staff had opportunities to give their views about the home, through questionnaires and regular staff meetings.

Significant events were monitored to identify trends, including accidents, incidents, hospital, admissions, weight loss and pressure sores.

An inspector and an expert by experience carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found.

The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report. This is a summary of what we found:

Is the service safe?

Some aspects of the service were not safe. Some people had been prescribed ‘as and when required’ (PRN) medication to assist with managing behaviours that challenge. We found the provider did not have protocols in place to guide staff as to the strategies to use to avoid the use of this medication and to ensure that these medicines were only administered when required.

The service relied on agency nurses to ensure that there were enough qualified staff to meet people’s needs. We undertook specific observations and saw there was always one member of staff in the communal lounge areas to supervise people.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager was aware of the recent Supreme Court ruling on the scope of DoLS. She told us that one application in relation to DoLS had recently been submitted.

People were assessed, using recognised tools, against the risks of poor nutrition and skin damage.

The provider had systems in place to ensure people received their medication on time. However, there were gaps in signatures on people’s medication administration records (MARs).

Is the service effective?

Some aspects of the service were not effective. We found that people did not always have sufficient interaction from staff to ensure they had appropriate stimulus and engagement to promote a good quality of life and enhance their wellbeing.

We viewed the care records for five of the 37 people who used the service. These confirmed that people, or relative’s on their behalf, had been asked to sign their care plans to show consent to their care. We saw examples of other formal consent, such as for sharing information and using people’s photograph.

Information gathered during the initial assessment was used to develop people’s care plans. We found care plans clearly identified specific aims and objectives for people to aim for.

Staff had not recently had regular supervision with their manager.

Is the service caring?

Whilst some of the practice at the home was not caring, we found that staff interacted positively with people and were caring. However, we found people were left for long periods of time without interaction from staff. We observed care being delivered during the lunch-time. We found that people had to wait an unreasonable time before receiving their meal.

People who used the service and their family members all gave positive feedback about the service and the staff members who delivered the care. People commented: “I like it here, it is nice and relaxed, and you can have breakfast when you want, even in your room”; “I am highly satisfied with the entire set up here”; and, “I am very happy and the staff are good.”

Is the service responsive?

Some aspects of the service were not responsive. Most care plans we viewed were not up to date. They had not been evaluated each month to ensure they reflected people’s current needs.

We saw examples within people’s care records of action taken to respond to people’s changing needs, such as referring people to specialists including dietitians and the ‘falls clinic.’

Is the service well-led?

Some aspects of the service were not well-led. We found quality checks were ineffective in identifying gaps in people’s MARs and ensuring action was taken to address these gaps. We also found that food and fluid charts were not completed in a timely manner and were completed from memory.

The manager carried out a monthly analysis of accidents and took action to respond to issues of concern. For example, we saw that two people had been re-assessed for the risk of falls and one person had been referred to the behaviour team and was waiting to be assessed.

We found people who used the service understood the care and treatment choices available to them. People's needs were assessed, and the planning and delivery of care and treatment met their needs and protected their rights.

Comments from people who live at Thornbury Care Centre included "I like it here I used to live on my own but its nicer here". "I don't join in with the activities because I like to read in my room and watch TV. My family visit me often, I like to see them".

"I haven't been here very long but I really like it. I attend all the classes and help set the tables. I have my hair done every week".

"The food is good here and it's nice. I have no complaints".

Overall people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care however the provider did not provide evidence of consent of people in relation to the care and treatment provided for them.

Comments from relatives included "I have never had any concerns but I think it's improved with the new manager". "I am happy with my relatives care". "The girls are really nice".

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them.

The provider had an effective system to regularly assess and monitor the quality of service that people received. They also had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service.