Thorne House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

During our site visit we observed some practices which did not always promote people's safety. These were brought to the attention of staff during the visit and immediately rectified. We also found some concerns regarding the management of medicines which were also actioned immediately. People’s care records had recently been transferred onto the new electronic system. We found some areas of care records on the new system were not detailed or information in all the relevant sections. This was also reflected in some risk assessments and information related to mental capacity and best interest decisions. Some checks were also not being recorded at the frequency identified by the care plan. The manager informed us that a review of all records was already underway and care records on the new system were being revised to ensure detailed information was in place for each person. There were enough staff available to meet people's needs. However, we received feedback from people, families and partners raising concerns about the consistency of staff and agency usage. Recent recruitment drives had been successful, and the number of vacancies was reducing. People were safeguarded from abuse and avoidable harm. Staff told us they were supported by the new management team and felt confident to raise any concerns. Staff were able to recognise possible signs of abuse and knew how to report such concerns promptly. Staff received regular training to ensure their skills and knowledge were up to date and enable them to provide safe care.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us their family members were safe and they felt confident in the support they received from Thorne House and were confident any concerns would be appropriately responded to. One relative said, “yes, I feel listened to.’’

Staff were aware of how to respond to accidents and incidents which included how to record and report incidents. The manager confirmed that incidents were reviewed and discussed monthly, “We have a safeguarding meeting with the head of operations and look at themes.”

The provider had policies in place which were readily accessible to staff. There were monitoring systems in place to ensure that lessons were learnt from incidents such as accidents and incidents, complaints, concerns, whistleblowing, and investigations.

Relatives commented on the positive impact on their relative of moving to Thorne House. We saw examples of joint working where people had needed increased support to be in place. The provider was responsive to meeting their needs to ensure safe support through discussions with partners about their care.

Staff were aware of the importance of continuity of care and their role in supporting a person to transition from one service to another. One staff described how one person was supported with their move to Thorne House. “When [name] was due to move into service, staff from Thorne House would spend a couple of days shadowing and spending time with [person] in [persons] own environment, to get to know [person] and be gradually introduced.”

We saw the provider had successfully worked with partners and had been involved in discussions with them about people care needs. One professional commented, “I have found that staff are open and honest at Thorne House and if support is required then they will ask where to find this.” However, one professional raised concern related to inconsistent monitoring of one person’s health issues and another the skill set of staff in fully meeting the needs of one person to become more independent.

The provider had processes in place to monitor safe systems, pathways and transitions were maintained. This included a comprehensive needs assessment which was completed prior to support being provided. However, we found some concerns relating to medicines management and care plans and risk assessments for some people lacked detail. Some health checks were also not always completed at the intervals identified by the care plan.

Relatives spoken with felt their family member was safe. Overall, people felt safe at the home and with the staff who supported them and felt confident they could raise concerns if they needed to. One person when asked whether they were safe living at Thorne House replied, “I am, yes.”

Staff had received training on safeguarding and abuse and understood their responsibilities on how to keep people safe. All staff were confident that any issues raised would be fully investigated to make sure people were protected. One staff commented, “People’s interests are the utmost part of it. Keeping them safe at all times. If any incidents, report to manager.”

During the site visits we saw kind and respectful interactions between people and staff. Staff were seen to offer people choices and seek consent before supporting.

Staff had completed safeguarding training and the provider’s safeguarding policy guided staff about different types of abuse and how to raise a concern to ensure people were protected. Any safeguarding concerns were recorded appropriately and reviewed to ensure the relevant professionals were notified. There were monitoring systems in place to ensure that lessons were learnt from incidents.

Overall people and their relatives told us they felt safe and were supported to understand and manage risks. People and their relatives were involved in the assessment of their needs and the management of their risks where able.

Staff promoted people's safety and wellbeing. People’s care plans were regularly reviewed and in response to any change in needs. One member of staff commented, “If something changes, this is reflected in the pcs [electronic recording] system.”

When people communicated their needs, emotions, or distress, we saw staff manage this in a positive way that protected their rights and dignity. Staff were vigilant when people were moving around or undertaking activities and made sure people remained safe.

Risks were identified and were regularly reviewed and updated where there was a change in need. However, some care records including risk assessments on the new electronic recording system required more detail and for information to be across all relevant sections. For example, for one person it refers to a special mattress and repositioning in one section, but no detail was recorded in the section related to skin integrity. We also noted that checks for some people were not always being recorded in daily notes at the frequency identified in the care plan. We discussed this with the manager who agreed to action immediately.

We received mixed views from people and relatives about the environment at Thorne House. One person told us about issues with the heating system, “The water system is up and down and often not working.” One relative also commented, “It’s not well maintained. It’s an old house. They do the best with what they’ve got. His room is lovely. The carpets look a bit worn. The toilets have always been cleaned.” People’s rooms were personalised, and most people told us they liked living at Thorne House. One person said, “I like to go on scooter now (round the garden).”

The provider monitored and reduced any risks in relation to safe environments and staff were aware of safety and had received a range of training to support them keep people safe. One staff commented about the environment, “Needs improvement. It is safe enough but could do with improvements, new carpets, decorating, windows with double glazing. Ageing population, how will we support people’s mobility in the future.”

Emergency systems were not robust. Different versions of summary information relating to Personal Emergency Evacuation Plans (PEEP’s) were present in the grab bag and fire folder providing conflicting information. Fire checks had also not been carried out weekly until recently. The manager confirmed that the infrequency of fire checks had been picked up and actioned and were now being completed weekly. An up-to-date PEEP summary sheet was also actioned and placed immediately in the emergency grab bag. In one apartment an unlocked cupboard containing Coshh (Control of Substances Hazardous to Health) and other items of risk was left open placing people at risk of harm. When highlighted, the cupboard was immediately locked, and a reminder given to staff. At the time of assessment, the home needed extensive refurbishment across the whole building and was not meeting the guidelines for ‘Right support, right care, right culture’. Decoration in communal areas was scuffed and tired and some areas such as bathrooms appeared clinical and lacked personalisation. Carpets were faded and worn and held together in places with tape to alleviate tripping hazards. Some windows were difficult to see out of and one window had a broken restrictor on one side and another a broken catch and could not be closed. Both were addressed immediately by the manager. A plan of works including replacement of windows was also underway with kitchens areas already completed. People were supported to do the things they wanted to do, and staff helped them to do this safely. We saw staff supporting people safely around the home and out to activities in the community or to day services. Staff were patient and supported people at their own pace around the home.

The systems in place to monitor the safety and upkeep of the premises required improvement. Although regular health and safety checks were completed by the provider some risks had not been picked up by the systems in place. However, the provider was responsive to all concerns raised and they were actioned immediately.

People and their relatives told us staff were always available when they needed help or support. However, we received concerns from people and relatives regarding consistency and the number of agency staff used. One person said, “Staffing changes frequently all the time.” A relative commented, “They can’t tolerate agency staff because [person] cannot communicate. They need regular staff that understand what they want. Agency staff are not suitable.”

Staff told us they felt well supported in their role and received relevant training. Staff told us there were safe staffing levels at the service. We saw evidence that recent recruitment drives had been successful with the number of available staff vacancies decreasing. The manager advised that once all new staff were in post the use of agency staff would reduce.

There were appropriate staffing levels in place. People did not have to wait for support from staff when they needed this. Staff were seen to regularly checked in on people who chose to spend time in their rooms or in quieter spaces around the service to make sure people were well and ask if they needed anything.

Recruitment procedures were in place, so people were cared for by suitably qualified staff who had been assessed as safe to work with people. However, it was noted that some areas of the process needed closer scrutiny. For example, to ensure there were no gaps in a staff member's work history. We shared this information with the manager who took immediate action. Staff had not received the number of supervisions and appraisals in 2023 as identified by the providers policy. However, the supervision tracker in place for 2024 showed more frequent supervisions now taking place. There were enough staff deployed to meet the needs of people using the service. However, concerns were raised by people, partners, and families about staff consistency and agency usage. The provider was working hard to fill vacancies and reduce agency usage. Staff underwent an induction and shadowing period prior to commencing work. They had regular updates to their training to ensure they had the skills and knowledge to carry out their roles. Staff had undertaken specialist training to meet the individual needs of people using the service. For example, autism awareness, positive behaviour support and epilepsy awareness.

Feedback from people and relatives did not highlight any concerns about cleanliness and hygiene at the service or how staff minimised the risk of infection.

Staff had received appropriate training in infection prevention and control and were aware of safe hygiene practices. No concerns were raised about the availability of personal protective equipment (PPE). One staff member told us, “Have access to PPE. Some available in units, most stored in COSHH (Control of Substances Hazardous to Health) cupboards.”

Staff followed current practice when supporting people and used personal protective equipment (PPE) when required. However, the home was not well maintained which was impacting on overall cleanliness. Planned works were underway which should make infection, prevention, and control (IPC) measures more effective once complete.

The provider had policies and procedures in place regarding IPC and had systems in place to monitor practices. The home knew how to respond to risks and signs of infection and how to make sure infection outbreaks at the service would be effectively prevented or managed. There were arrangements in place to make sure the environment was cleaned by staff at regular intervals.

Relatives spoken to told us they had no concerns regarding the administration of medication. One relative said, “There are always 2 people administering the medication. One watches and the other administers. The support they get makes them feel more relaxed.”

Staff told us they received training and competency assessments to ensure they were safely administering medicines. One staff said, “I first observed medicines being provided, then was observed 3 times by management and asked questions about medication before being signed off as competent.”

The processes in place for ensuring records were accurate and up to date was not always effective. When people were prescribed medicines to be taken ‘when required’ (PRN) the guidance to support safe administration was not always person-centred. This meant staff did not have enough information to tell them when someone may need the medicine or how much to give. For example, for one person it was not clear when medication for bowel management should be given. Some gaps in recording and conflicting information were also noted on the bowel recording chart and the Medication Administration Record (MAR). This concern was also raised previously by a visiting professional. Some people’s creams and bottles were not always labelled with date of opening and inconsistent coding was used to record administration of some PRN medication. Room and fridge temperatures were not always recorded or were recorded inconsistently across different apartments. The manager actioned these concerns immediately and clarified with the GP regarding when PRN medication for one person should be administered. The provider understood and implemented the principles of STOMP (stopping over-medication of people with a learning disability, autism or both) and ensured people's medicines were reviewed by prescribers in line with these principles.