Thorn Springs

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

There were some improvements that needed to be made to the systems in place to monitor and record accidents and incidents. People’s care records were not being reviewed to pick up on potential safeguarding concerns meaning opportunities to take action to keep people safe were sometimes missed. There were enough staff to support people safely. However, we observed throughout our site visit that staff deployment was not always as efficient as it could be leading to some missed opportunities for staff to interact with people. Some people went for a long periods of time without interactions that were not essential care tasks and there were limited social engagement opportunities for some people. Medicines were not always being managed safely and some key processes in relation to the management of medicines were wither not in place or were not robust. The management team started taking action immediately to address these concerns. People and relatives told us they felt safe living at the service. Staff completed checks to make sure the environment at the service and equipment people used was safe. The service was clean and staff followed good infection prevention and control measures. Risk assessments and care plans were mostly detailed and gave a good overview of how to support people to stay safe and mitigate risks they faced as far as possible.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives gave us mixed feedback about whether or not actions were taken in response to incidents and accidents happening. One person said, ‘‘Some staff talk very quicky and I can’t understand them. I bought this up and it gets better for a bit but then goes back to how it was again. I am not sure what is being done about it.’’ A relative said, ‘‘I think things are OK but I have bought a few things up in relation to [family member’s] care and staff being more trained in [health condition]. As far as I can see nothing much has happened as a result of this.’’ Other people were more positive about lessons being learned. One person said, ‘‘Whenever I bring something up [staff] make some changes to keep me happy. They cook the food how I want and this must be difficult to please everyone.’’ A relative told us, ‘‘If we have any problems we tell the staff and improvements happen quickly.’’

Staff were not being consistently supported with supervisions to discuss lessons that could be learned from incidents. Some staff members told us they had not been trained to properly use the systems in place record incidents and accidents. They felt that this hindered and stopped them from easily keeping track of actions that could be taken to improve people’s experiences based on incidents that had happened. However, staff told us they attended staff meetings and also had some opportunities to speak to senior members of the team about what actions to take in response to incidents. We spoke with the management team about the current system in place to monitor incidents and promote lessons being learned and they agreed that some aspects of it were difficult to use. The provider told us they would be reviewing the system and making sure that all staff were trained and competent to use this.

Processes were not always robust in relation to promoting a learning culture. Systems used to record incidents and accidents and take actions to improve practice were not being consistently used to identify where improvements could be made. The system made it difficult to pinpoint actions that needed to be taken in relation to specific accidents and the management team were not using the system to effectively make sure actions were taken. Staff were not being supported to take part in regular discussions to talk about actions and lessons that could be learned. The management team too our feedback seriously and began making changes to ensure systems in place to support a learning culture were efficient. This included changing the system in place to record actions on the system and ensuring that these actions were monitored and signed off when they were completed. The registered manager showed us evidence of this and we were assured the processes in place would be more thorough going forward.

People and their relatives told us their needs were assessed when they started using the service. One person said, ‘‘[Staff] talked me through what routines I wanted and what I liked when I first moved in.’’ A relative told us, ‘‘[Family members] needs were discussed when they first came to the home. They have changed a lot and I think the staff stay on top of any changes.’’ People and their relatives told us they were supported to see other health professionals if this support was needed. One person said, ‘‘The GP comes round once a week but if I need anything else the staff organise appointments for me.’’. A relative said, ‘‘Never had a problem with [family member] seeing health professionals. I think the staff are very alert to anything they need.’’

The registered manager told us about the assessment process at the service. They made the effort to visit people in their homes before they came to live at the service so they could assess their needs and help ensure living at the service was best for them. One relative told us, ‘‘[Registered manager] was very involved from the start.’’ Staff told us they were supported to get to know people when they started living at the service by reading their assessment plans and spending time with them. Staff were confident and knew how to request support from health professionals if people needed this. They also said they had a good working relationship with the local GP who was able to visit people regularly.

We did not receive any specific feedback from professionals as part of this inspection. However, people’s records showed that professionals were regularly consulted to support people.

Whilst people did have support from health professionals, any advice or changes in care needs as a result of this support was not always recorded clearly in their care plans. On some occasions updates were not made to care plans in a timely manner and in some cases updates were added in away that made it unclear as to whether a persons needs had changed or not. We fed this back to the management team who took immediate actions to improve how effectively changes to people’s support needs were recorded in their care plans. There were effective processes in place to help ensure people’s needs were thoroughly assessed before they started living at the service. Assessments focused on people’s preferences as well as their essential support needs. The registered manager and staff team had built up a good rapport with health professionals such as GP’s and had no concerns in getting health related support for people if this was needed.

People told us they felt safe living at the service. Their comments included, ‘‘Yes I feel very safe and even if I didn’t I would just speak to [management team] and this would all be sorted out.’’ and, ‘‘I am as safe here as I can be. Certainly, don’t have any problems and I can do whatever I want knowing [staff] are there to help me.’’ Relatives also told us they felt their family members were safe living at the service. Their comments included, ‘‘I would say [family member] feels safe in the home. I do not think they would say if they felt unsafe but [staff] are pretty good at noticing if they are unhappy and I can always approach the management team as well.’’ and ‘‘It is very reassuring to me that [family member] lives at the service as they are so much safer with the help of the staff team.’’

The staff team spoke with us about some of the concerns they had in relation to the number of people who now lived at the service. Whilst staff did not feel they were not keeping safe, they told us people may be at more risk of boredom and social isolation as a result of not being spoken with as regularly which in itself was a safeguarding issue. Some staff members we spoke with were not sure who they could report safeguarding concerns to outside of the organisation, such as CQC or the local authority safeguarding team. We told the management team about the feedback from staff members and they took actions to start to work on some improvements in this area. For example they created a supervision competency assessment to complete with the staff team. They also told us they would be reviewing people’s care and support needs to help ensure staff deployment kept people safe from social isolation. We discuss this further in the staffing quality statement.

We observed that staff deployment sometimes meant people were not always completely safeguarded from potential harm. For example, one person who showed how they were feeling by attempting to harm other people was walking around the service and in to other people’s bedrooms without staff being present to make sure they and other people were safe. One person said, ‘‘I do feel safe here but I do sometimes worry about people coming in to my room. It happens every now and then and I know it is not their fault but it would be good if it stopped happening.’’ We fed this back to the management team who took action to support this person. We also observed that at some times of the day staff deployment meant some people were left alone for long periods of time. This had the potential to be unsafe for people and put them at possible risk of social isolation. We discuss this further in the Staffing quality statement. We also observed staff supporting people safely with their needs such as eating and drinking and moving around the service. One person said to a staff member, ‘‘You are an angel. I feel so much better when you are with me.’’

Processes were not always in place or robust enough in relation to safeguarding people at the service. For example, staff were making notes in daily records about potential safeguarding incidents, such as a person being unkind to another person or a person having an unwitnessed fall. However, staff were not consistently reporting these as safeguarding concerns using the systems in place to monitor this. The management team were not consistently reviewing people’s care records and as a result some potential safeguarding concerns may have been missed. We fed this back to the management team who took immediate action including implementing regular checks of people’s care records and completing more observations of staff deployment. The management team had processes in place to report safeguarding concerns to CQC and the local authority safeguarding team. The safeguarding policy at the service was robust and information about how to report safeguarding concerns was readily available for people, their relatives and the staff team.

We received mixed feedback from people and their relatives about how they were supported with the risks they faced. One person said, ‘‘I don’t like it that sometimes I can not see any [staff] for a while. Who would see me if I had a fall?’’ Another person told us, ‘‘I have noticed staff don’t always take as much time as they used to when helping me with [support]. Makes me feel a little rushed.’’ One relative said, ‘‘As [family members] health needs have changed I feel staff have struggled to keep up. Their focus is on promoting independence which is all well and good but I think they need more training to support [family member] to understand what is in their best interests.’’ People and their relatives also told us they had not been asked to feedback or be involved in discussions and creation of risk assessments. One person said, ‘‘I don’t think I have ever seen my care plan.’’ A relative told us, ‘‘We were asked to be involved in the creation of risk assessments at first but haven’t been asked to do this as [family members] needs have changed.’’ Other people, and relatives were more positive about being supported with their known risks. One person said, ‘‘[Staff] all know what they are doing and I feel safe being with them.’’ A relative told us, ‘‘I can be assured that staff know how to support [family member] and I know the staff are trained to help them with everything they need.’’

Staff were knowledgeable about the risks people faced. They explained to us in detail how they would support people with aspects of their support such as supporting them to walk, to eat and drink and to stay safe whilst taking part in daily tasks. Staff told us they would raise any changes relating to the risks people face with the management team and any changes would be put in place immediately. The management team explained how they supported the staff team to stay up to date with people’s changing risk assessments by having handover sessions every day. The management team reviewed people’s risk assessments and care plans regularly. We spoke with the kitchen staff who were dedicated and passionate about ensuring people had a positive meal time experience and enjoyed the meals served to them. They were knowledgeable about people’s dietary needs and ensure food was prepared for them in line with these. One person said, ‘‘We all want different things all cooked in different ways but this doesn’t seem to be a problem for [kitchen staff]. They are excellent.’’

We observed staff members supporting people in line with their risk assessments during our visit to the service. For example, staff were able to safely support people using moving and handling equipment. One person said to us whilst being supported, ‘‘[Staff] are so good with all of this aren’t they?’’ We observed staff supporting people to eat and drink safely in line with their risk assessments.

The management team reviewed risk assessments and care plans in place for people regularly. However, sometimes when peoples needs changed risk assessments or care plans were not updated in a timely manner or updates were not made clear in the risk assessments. Some care plans and risk assessments would have benefitted from some more detail to help make sure risks to people were mitigated as far as possible. We fed this back to the management team who told us they would review processes in place to update care plans and risk assessments. They also told us they would implement a system where care plans and risk assessments would all be fully updated in the near future to make sure they had a good level of detail for staff to follow.

People and the relatives told us the environment at the service was safe and that equipment they used was kept in good working order. People’s comments included, ‘‘The building is very safe and secure. I can sleep knowing that.’’ and, ‘‘[Maintenance staff] are always out and about fixing things- it doesn’t take long to have things put right again.’’ A relative said, ‘‘One thing that I am always happy with is the way the service looks. It has been open a couple of years now but still looks like it just opened. Its great to have [family member] living in such a homely environment.’’

Staff did not raise any concerns with us about the environment of the service and told us they were able to safely support people with all the equipment that was needed. The maintenance staff member spoke with us about the measures they took to keep the environment at the service safe such as ensuring annual and monthly checks of equipment was completed. Staff spoke confidently about how they would support people in an emergency such as a fire. The management team reviewed health and safety at the service in relation to the environment regularly and showed us the audits they used to monitor this.

We observed the environment to be safe and that all the equipment people used had been checked regularly to ensure it was safe to use. We observed good fire safety practices in place at the service such as fire fighting equipment being checked to ensure it was safe to use. The kitchen area was kept in good working order and staff told us they had the equipment the needed to prepare food and drink for people safely. One person said to us as we were walking around the service, ‘‘There is so much room isn’t there? It makes it much easier to walk around by myself.’’

Processes were effective in helping to ensure the environment at the service was safe. The maintenance and staff team completed regular health and safety checks on the environment at the service and of the equipment people used. The management team completed audits to monitor the health and safety of the service and took action if any areas for improvement were found.

Some people and relatives told us they did not think there were enough staff to fully support them with all their support needs. One person said, ‘‘There are a lot of new staff so I don’t know a lot of the faces anymore. I hear a lot of staff saying their isn’t enough of them. I have had to wait a lot longer recently as I think more people need more help than me.’’ Another person told us, ‘‘There are not enough staff. They work their socks off but there just isn’t enough of them now lots of people need two staff to help them.’’ A relative said, ‘‘There are certain times where I do not think there are enough staff. [Family member] used to do lots of activities but not now- staff do not have the time.’’ Another relative told us, ‘‘As more people have started living at the service, staffing levels have not kept up. [Family member] gets their basic needs met but staff do not have time to talk to do other things with them like they used to.’’ Other people and relatives gave us more positive feedback about staffing levels. One person said, ‘‘I have no concerns with staff. They all seem friendly and whenever I call for help staff come quickly.’’ A relative told us, ‘‘There always seems to be plenty of staff about and [family member] always looks like they have what they need.’’

Some staff fed back they did not feel there were enough staff to support people with their needs. Staff told us that staffing levels had not kept up with the number of people who now lived at the service or the changing needs of people already living at the service. They explained how they used to have time to support people with their interests and support them to do things like leave the service and access the community or do activities in the service. However, they no longer had the time to do this as people required more support with their personal and essential care needs and there were now more people with care needs that required more support. Staff said they had raised this with the management team. However, staff were positive about their training and told us this was useful to them in their job role. The management team accepted our feedback about staffing levels and understood how people and staff members were feeling. They told us that as more people started living at the service the amount of time staff had to spend with people may have been impacted, however they had not discussed this at length with people’s relatives or the staff team. They assured us they would do this and use their findings to help inform staffing levels going forward.

We observed that there were enough staff to support people safely with their essential support needs such as personal care and eating and drinking. Staff responded to people’s requests for help and to call bells in a timely manner, meaning people did not have to wait a long time for support. One person said. ‘‘Can’t fault how quick the staff help me out. Just press the button and they come running.’’ However, during our observations we noted people went for long periods of time without interaction from staff, meaning they were at an increased risk of experiencing social isolation or boredom. There were missed opportunities for staff to interact with people. For example, several staff members completed tasks such as washing up or cleaning, where as one staff member could have done this whilst other staff spent time with people. We also noted staff members congregated in one area of the service together, rather than spending time with people and speaking with them. Whilst there were staff dedicated to spending time with people and supporting them with social past times, there was limited activities on offer for people throughout the day. One person said, ‘‘It is impossible for staff to do anything with us. There are three floors so how can one person be split across this. We used to go out for walks and things like that but there is no time for that anymore.’’ We also observed staff speaking with people in kid and friendly manner as they were supporting them with their support needs. Where people did take part in an activity organised by the staff team, they appeared to enjoy this. One person said, ‘‘[Staff] really are so good aren’t they?’’

Processes were sometimes not in place or were not effective in identifying where staffing levels could be improved. Audits were not being completed to monitor staff deployment or to support staff to identify when they were able to spend time with people during their working day. There was a tool in place at the service being used by the management team to help monitor people’s needs and how many staff were needed. However, this had not aways been updated in relation to the changing needs of people and did not focus on making sure people were supported to have regular social engagement as well as having their physical needs met. The management team were not supporting staff with supervisions and competency assessments in line with their policy. This reduced the opportunities to support staff to feed back their thoughts about staffing levels hand how interaction with people could be more prioritised. The management team took our feedback seriously and took action to start addressing issues about staff deployment. This included reviewing the tools in place to monitor staffing levels and introducing audits and checks to help ensure staff deployment meant staff had the time to spend speaking with people outside of their essential care needs. The provider had systems in place to help ensure new staff were suitable to work at the service.

People and relatives told us the service was kept clean and that staff followed good IPC practices. People’s comments included, ‘‘[Staff] are always in my room keeping things clean and tidy. It is lovely walking around the place seeing how clean it is.’’ and, ‘‘Oh yes, it is very clean here. Staff do a great job.’’ A relative said, ‘‘The staff do a brilliant job keeping the service clean.’’

Staff told us they had the equipment and the time they needed to keep the service clean and free from IPC concerns. The management team told us they completed audits to monitor the cleanliness of the service and take action if any improvements were needed.’’

We observed the service to look and smell clean and that good IPC measures were being followed by the staff team. We observed staff whose main role was keeping the service clean, had also taken the time to get to know people and have friendly conversations with them whilst they worked. One person told us, ‘‘That staff member brightens up my day.’’

The management team completed audits to monitor the IPC practices at the service. These were thorough and effective in addressing any concerns.

People told us they were supported safely with their medicines. One person said, ‘‘[Staff] are always on time with my medicines.’’ A relative said, ‘‘I can trust the staff with all the medicines and am confident they know what they are doing.’’ However, people and relatives gave us mixed feedback about their involvement in discussing and understanding what their medicines are for. One person said, ‘‘Lots of different staff do the medicines and I am not sure what any of them are for anymore. I used to know but not anymore.’’ A relative told us, ‘‘I cant really talk about medicines as I am no longer sure what medicines [family member] takes. I know there have been changes but these are not always communicated with me.’’ Despite our findings, people were not always safe in relation to the processes in place to manage medicines as discussed in the rest of this quality statement.

Staff were confident about how to support people and administer medicines. They were able to explain how best to support people in their preferred ways and understood the importance of making sure medicines were checked and recorded as they were administered. However, staff told us they were not receiving regular supervisions to discuss medicines practice. They were also not aware that several key policies and procedures were not in place to support safe medicines administration practice at the service. We discuss this more in the rest of this quality statement. The management team had not ensured policies and procedures were in place for all aspects of medicines administration. They assured us and showed us evidence that these would be put in place immediately based on our inspection feedback.

There were several key processes in relation to medicines administration that were not in place and were not in line with the providers policy. There were no policies and procedures in place in relation to medicines that needed to be disposed of. We found several topical medicines in people’s rooms which were very out of date. Some medicines used to help make people’s drinks safe were not being stored securely in communal areas. Stock checks of controlled drugs were not being completed regularly. Weekly stock checks were not being completed for people who self-administered their medicines, in line with the providers policy. There were no processes in place to manage and deal with medicines alerts. We also found that senior staff members were signing for topical creams administered by staff members. We fed this back to the management team who started taking action to address these issues. We also found that despite our findings there were no concerns with the process of supporting people with their medicines and ensuring this had been done correctly.