Background to this inspection
Updated
8 July 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by one inspector, an Expert by Experience and a specialist advisor in nursing.
An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Thornton Manor Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced on day one and two then announced on day three.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection-
We spoke with two people who used the service and ten relatives about their experience of the care provided. We spoke with seven members of staff including the registered manager, manager, nurse, support workers and a housekeeper. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at five staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with three support workers by telephone.
Updated
8 July 2021
About the service
Thornton Manor Nursing Home is a care home that is set in its own grounds and located close to a rural village of Thornton-le-Moors between Ellesmere Port and Chester. The service is based over two floors and is registered to provide nursing and personal care for up to 47 people. At the time of our inspection there were 40 people living at the home.
People’s experience of using this service and what we found
There were a lack of robust systems to demonstrate quality assurance was in place and effectively managed. Governance systems in place had failed to identify the concerns we found and whilst regular checks and audits were in place, they were not effective at driving improvement.
People’s care plans and risk assessments were not all up to date and did not always reflect their up to date needs. Language within care records was not always dignified or person centred.
Some areas of the environment were unsafe due to items that needed to be replaced or disposed of. The registered manager immediately addressed these issues.
The provider had commenced a refurbishment programme. However, we found multiple areas within the service where paintwork, flooring and furniture was damaged.
Safe recruitment procedures were in place. A clear training plan was in place to ensure staff revisited all mandatory training due to this not being up to date.
The staff and management team worked closely with health and social care professionals to ensure good outcomes for people.
Medication was managed safely by trained and competent staff. Medicines policies and procedures were available for staff along with best practice guidance. Medicines trolleys were stored securely.
People were protected from the risk of abuse. Safeguarding policies and procedures were in place and staff had received training to understand how to keep people safe. Staff told us they felt confident to identify and raise any concerns they had about people's safety. They believed the management team would take action.
Family members told us they felt their relatives were safe living at the home. They spoke positively about the staff that supported their relatives. People appeared happy with the care home and the staff that provided their care.
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.
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 3 December 2020) and there were two 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 not been made and the provider was still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
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 COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Thornton Manor Nursing Home on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.
We have identified breaches in relation to environmental risks as well as risks to people and also a lack of robust systems to identify areas for development and improvement at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
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.