Archived: Thurleston Residential Home

Thurleston Residential Home is a residential care home in one adapted building and can provide personal care for to 37 older people. At the time of the inspection 28 people were using the service. Some of these people were living with dementia and the service does not provide nursing care.

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

There had been changes in the management of the service since our last inspection. The key questions Safe and Well-led were rated good at our last inspection. At this inspection, Well-led remained good but Safe had deteriorated from good to requires improvement.

Staff informed us they had been trained and understood their responsibilities in keeping people safe from harm and abuse and records in staff files confirmed this information. However, the service was unable to locate the service safeguarding policy and there was no safeguarding log of reported safeguarding incidents. We did see records that safeguarding incidents had been reported to both the Local Authority and Care Quality Commission in 2020.

Risks to people were assessed and actions to reduce the risks had been recorded in peoples care plans which were reviewed and updated every month or as the result of incident.

Sufficient staff were on duty which meant staff were available when people needed support and staff were recruited safely. People’s health care and nutritional needs were assessed and met. 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.

People received their medicines when they needed them. Medicines management was monitored on a daily basis and relatives informed us they had no concerns about people receiving their medicines as prescribed. However monthly auditing of medicines management was not being recorded.

The current infection control systems in place reduced the risks to people.

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 good (published 13 March 2020).

Why we inspected

We inspected due to the recent swift changes in management at the service.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service remains good. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Thurleston Residential Home 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.

Thurleston Residential Home is a residential care home providing personal care to 26 older people at the time of the inspection in one adapted building. Some of these people were living with dementia. The service can support up to 37 people.

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

Risks to people were assessed and systems were in place to mitigate them. Staff were available when people needed support and staff were recruited safely. Medicines were managed well, and any shortfalls were identified and addressed. Infection control processes reduced the risks of cross infection. The registered manager had systems to learn lessons and use these to drive improvement.

Staff received training and support to meet people’s needs. People’s health care and nutritional needs were assessed and met. 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. There was signage in the service to assist people to independently navigate around. There were plans to improve the environment, this was because some areas in the service were tired and needed redecorating.

People received a caring service from staff who were respectful and knew them well. People’s rights to privacy, dignity and independence were promoted and respected.

People’s needs were assessed, planned for and staff received guidance on how these were to be met. People’s views about how they wanted to be cared for were valued and used to plan their care, this included their end of life decisions. People had access to social activities which reduced the risks of loneliness and boredom. There was a complaint procedure in place and people concerns and complaints were investigated and used to drive improvement.

There were governance systems which assisted the registered manager to assess and monitor the service people received. People were asked about their views and these were used to develop and improve. The service worked with other professionals involved in people’s care.

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 good (published 20 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

At the last inspection on 15 October 2015 the service was rated Good; at this inspection we found the service remained Good.

On the first day of our inspection there was no manager in post. The previous registered manager had left the week before our inspection, the new manager, who was the services’ deputy manager, was in post for the second day of our inspection. The new manager had initiated the first steps to become the registered manager of the service.

The people who lived in the service told us that they felt safe and well cared for. There were systems in place which provided guidance for care workers on how to safeguard the people who used the service from the potential risk of abuse. Staff understood their roles and responsibilities in keeping people safe. There were processes in place to ensure the safety of the people who used the service. These included risk assessments which identified how the risks to people were minimised. There were sufficient numbers of trained and well supported staff to keep people safe and to meet their needs. Where people required assistance to take their medicines there were arrangements in place to provide this support safely.

Both the manager and the staff understood their obligations under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager knew how to make a referral if required. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and access healthcare services.

We saw many examples of positive and caring interactions between the staff and people living in the service. People were able to express their views and staff listened to what they said and took action to ensure their decisions were acted on. Staff protected people’s privacy and dignity.

People received care that was personalised and responsive to their needs. The service listened to people’s experiences, concerns and complaints. Staff took steps to investigate complaints and to make any changes needed.

The manager was supported by the organisation during the run up to them taking up their position as manager. People using the service and the staff they managed told us that the manager was open, supportive and had good management skills. There were systems in place to monitor the quality of service the organisation offered people.

Further information is in the detailed findings below

The registered manager had left the service prior to our inspection. There was an acting manager managing the service. They had not, as at the time of our inspection, applied to the Care Quality Commission to be registered as the manager.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

We saw that the service did not carry out assessments in accordance with the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that we could not be sure that people’s personal choice and liberty were safeguarded.

People's care records showed that care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare. Two people did not have a care plan. This meant that staff were not aware of the care to be provided to meet people's needs safely and effectively.

We spoke with the manager about the two people who did not have care plans in place. They assured us that these would be put in place the following day. We have since received copies of these care plans.

We saw that people’s medication was managed appropriately.

Is the service effective?

People told us that they did not always get the care they required and that staff were very busy. One person told us, “They just give you your dinner and go away.” People using the service and their relatives told us that the service was not always clean.

There was no formal system in place to ensure that staffing levels were decided based on people's needs and level of dependency.

The service did not carry out regular audits to monitor the standard of the service provided.

Is the service caring?

We saw that some staff interactions were kind and respectful. However, we noted that some were not. We saw one person taken from the dining room in their wheel-chair with no explanation of where they were going.

Is the service responsive?

We saw that there was a mix of male and female staff. However, care plans did not identify if a person preferred a male or female carer.

Care was provided in a task based and not person centred manner. Carers received a list of tasks at the beginning of their shift.

Is the service well-led?

Staff told us that when they raised concerns they did not feel that the management addressed them.

There was a lack of understanding of good quality assurance principles demonstrated by the lack of audits. This meant the service lacked any drive for improvement.

To help us assess people's wellbeing we spent time sitting with them, observing the care they received. We saw that staff were attentive and that they interacted with the people in a friendly, respectful and professional manner. We saw that staff sought people’s agreement before providing any support or assistance.

We saw that people were provided with suitable and nutritious food and drink and that, if they needed extra support to maintain their weight, people had been referred to the dietician and their advice was followed.

The building was comfortable, clean and well maintained. We saw that the service had taken precautions to protect people from the risk of Infection and that staff had received appropriate training in infection control.

We found that the staff received supervision and training necessary to effectively care for older people. We also saw that checks were made before they started to work in the service to ensure that they were suitable to work with vulnerable people.

The records we looked at, including people's care records and staff records were accurate and up to date.

After our inspection the registered manager had sent us an action plan telling us what they were going to do to rectify our concerns. We found that they had carried out all of the actions they had proposed and that the service was compliant with regulation 15.

We did not talk to people who used the service on this occasion. When we visited the service in November 2012 the people living in the service that we spoke with told us that they liked living there, that the care staff showed them respect and worked hard to look after them. One person told us that they were comfortable in the service, saying that the staff were, “Always kind.” Another person said that the service was, “Clean and homely.”

The people we spoke with told us that they were consulted about the care and support they were provided with and that the staff listened and acted on what they said. One person said that the staff, "Never rush me, I have to take my time." Another person told us, "They feed you to a fashion, but always plenty and it tastes good.”

We saw that staff received training to support them in caring for older people and when talking to them we found that they were knowledgeable about safeguarding adults. People told us that they felt safe living in the service.

People told us that they were comfortable living in the service and they told us that they had not needed to make a complaint.

The building was comfortable and mostly clean and, overall, the building was well maintained. However, we identified some areas within the premises that needed improvement to maintain people’s safety and wellbeing.