Thorn Springs

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Audits were sometimes not in place or were not effective in monitoring the quality of the service and putting measures in place to make improvements. Areas such as incident reporting, the reviewing of people’s care records, the reviewing of staff deployment, medicines management and ensuring staff training had been effective were not being audited effectively. This put people using the service at potential risk of harm. It was sometimes unclear how feedback was being collected from people and their relatives to help improve the service. Some staff raised concerns with us about not being able to support people in a person-centred way now the service had more people living there. People’s care plans were not always updated in a timely manner in line with their changing support needs. However, the management team acted immediately on most of our concerns and started to put measures in place to make and sustain improvements. Despite our findings, the management team were passionate about providing a good quality of care to people. They took our feedback seriously and sent us evidence they were taking actions to start making and sustaining improvement at the service. Staff mostly felt well supported by the management team. People were positive about the way the service was being managed and the management team made efforts to be present in the service so people and staff knew they could approach them at any time.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us they did not always have regular supervisions to discuss how aspects of the service could be improved. Staff were unable to tell us about what lessons had been learned as a result of incidents or accidents happening at the service as this was not being shared with them on a regular basis. Staff also felt that sometimes their ideas and thought about what could be done to help drive improvements at the service were not always acted upon and the management team did not consistently let them know what would happen as a result of their feedback. Staff also told us they found it more difficult to keep up with actions in place to improve the service because they were now too busy supporting the number of people living at the service and their changing needs. The management team were open and honest when it came to some aspects of the systems, they had in place not supporting a learning culture as well as they could have. For example, the management team stated they knew improvements needed to be made to the system in place to put actions in place following incidents at the service. They also stated audits did not always cover everything that was needed to learn lessons at the service, such as staff deployment. They told us what they would do to rectify this. However, the staff and management team were passionate and motivated about learning lessons and making people’s experiences of care the best they could be. They had a shared commitment to try and learn lessons and continually improve the service.

We received mixed feedback from people and relatives in relation to the learning culture of the service. One person said, ‘Not many changes here really. I know there was talk about improving things, but it all seems much the same to me.’’ A relative told us, ‘‘I do not think the service [family member] is getting is quite worth the money we are paying. It seems there is more focus on filling beds than making sure people get the personalised service they used to get.’’ However, another relative told us, ‘‘I trust [staff] to make improvements if something bad happens and this has happened a few times now.’’ Processes were not always effective in promoting and driving a learning culture. Staff were not receiving supervisions on a regular basis to discuss their practice and make improvements if necessary and were not having their competency checked in all key areas of their job roles. Actions to improve the service were noted in audits competed by the management team but were not consistently shared with the staff team or monitored to ensure they had been completed successfully. The management team took our feedback seriously and started to put improvements in place to address this. We were assured that systems would soon be implemented or improved upon.

Most staff members told us they felt well supported by the management team and could approach them for support at any time. The management team were present at the service and spent time with people and the staff team throughout the day. Staff told us this made them feel more comfortable to speak with the management team when they needed support. The management dealt with issues raised by staff in an open and honest way and with compassion. People told us they felt the management team were easy to speak with and available at all times. One person said, ‘‘[Manager] really is so good. Nothing is too much trouble.’’ However, the management team did not have fully functioning processes in place to monitor the quality of the service as discussed in the rest of this quality statement.

The management team were passionate about the service and clearly wanted what was best for people. However, some audits were not in place to fully monitor the quality of the service and they were not picking up on some of the issues we found during this assessment. For example, audits were not identifying the issues we found with medicines, staff deployment, the monitoring of incidents and accidents or care plans being updated in a timely fashion when people’s needs changed and being sufficiently detailed. The management team had processes in place to support staff and had an ‘open door’ policy where people and the staff team could speak with them at any time. One relative told us, ‘‘I think [registered manager] has a very good work ethic and really tried to do their best for [family member].’’

Although staff members told us they did not have frequent formal supervisions, they did tell us they were able to speak with the management team whenever they needed to and felt comfortable doing this. Staff were encouraged to speak up to other organisations such as the local authority if they were worried about anything. The management team told us they felt well supported by the provider and were able to raise issues with them. People and relatives said they felt able to speak up. One person said, ‘‘I don’t have any problems at the moment, but I know I could speak with any staff member if I did.’’ A relative told us, ‘‘I think the home is well managed and the management team are very easy to speak with.’’

Processes were in place for people to speak up. The management team made sure people knew how to speak up and raise concerns in multiple ways. They also supported relatives by having an open-door policy and responding to relatives request for support in a timely manner. One relative said, ‘‘I can be confident that we can speak up to the management team at any time or indeed let the staff members know and they will pass messages on.’’

Staff told us they were well supported in their job roles and could raise concerns with the registered manager. The registered manager and provider told us how they supported staff with flexible working requests as far as possible and welcomed staff with varying levels of experience.

The provider’s recruitment process was fair and equitable. The provider had processes in place for staff to request time off for events that were important to them or to accommodate staff requests. Staff were asked for their feedback regularly both formally and informally.

Staff were mostly knowledgeable about their job roles. One relative said, ‘‘I think the staff are well trained and know what they are doing.’’ However, some staff found it more difficult to tell us about some aspects of their training such as safeguarding or the mental capacity act and competency assessments were not in place to check and make sure this training had been effective. Staff told us they felt it was more difficult to give people person centred and individualised care as more people now lived at the service. They felt governance systems were not strong enough to identify where this could be improved. Staff also told us they were not kept informed about actions resulting from audits the management team completed which would have helped them take part in making improvements at the service. The management team were passionate and knowledgeable about their role and responsibilities. However, they were not aware of the issues we found at this assessment as the processes and audits they had in place were not completely effective in identifying issues. Some of our findings and feedback were a surprise to the management team where as other findings such as in relation to the system in place to monitor incidents and accidents were not. The management team accepted our findings and feedback and started taking action to make improvements.

The registered manager and provider had audits in place to monitor the quality of the service. However, these were not always effective or sometimes were not in place to help in identify where improvement could be made as we found during this assessment process. This included the issues we found in relation to medicines management, daily records not being audited, the system in place to monitor incidents and accidents not being effective, staff deployment, care plans not being detailed or updated in a timely manner or people not always being supported to not feel socially isolated. We noted that people’s care plans were not always clearly updated or sometimes lacked detail to help guide staff how to support people in the best way possible. Care plans were being audited however these were not picking up on this. People and relatives told us staff had less time to spend speaking with them or supporting them with their interests however audits were not being completed to capture this. One person said, ‘‘[Staff] used to do lots of things with us. We used to go out and about a lot but not so much anymore.’’ A relative said, ‘‘It is a shame but I do not think anyone is making sure [family member] is motivated anymore. They need to be doing more.’’ However some audits such as those relating to health and safety were effective and being used to effectively govern the service. The management team and provider took our feedback seriously and started implementing actions to improve the service immediately.

People and relatives gave us mixed feedback about how they were consulted about their care and care planning. One person said, ‘‘I know I have got a care plan, but I have never seen it and staff haven’t spoken with me about it.’’ Relatives comments included, ‘‘We have never seen [family members] care plan and am not even sure they have one.’’ and, ‘‘I am really not sure what is in the care plan and have never been asked for my thoughts on this.’’ However one relative said, ‘‘We had a review 3 months ago to discuss some changes to the care plans.’’ People and relatives were invited to meetings to feed back about the service. However these were poorly attended and dd not meet everyone’s needs. One person said, ‘‘I know sometimes there are meetings but I like my own company. I don’t get asked what I think.’’ A relative told us, ‘‘We are invited to meetings but they are never at a time when we can make it and we do not get any minutes from the meeting or anything like that so we can have some input.’’ People and relatives also told us they had not been supported to access the community as much as they used to be since more people now lived at the service. One person said, ‘‘I remember when staff would take us out for the day but this has not happened for a while and there isn’t really much going on any more.’’ A relative told us, ‘‘It is a shame as I think [family member] would want to be more active but staff do not take them out as much anymore.’’ However, people and relatives told us they were able to speak with the staff and management team on an informal basis. One person said, ‘‘If you ever have a problem you just go and speak with the staff.’’ A relative said, ‘‘I don’t feel like we really need lots of meetings as we can just chat with staff whenever we visit.’’

Staff gave us mixed feedback about how they were involved to give feedback about the service. Whilst staff were supported and told us they could speak with the management team informally whenever they needed to, they also told us they were not being supported with regular supervisions. They also told us that other than medicines and moving and handling competency assessments, the management team did not support them with other observations of their competency in other areas of their job roles. Staff told us they had team meetings to discuss how things were at the service. However, they also told us actions resulting from these were not always shared with them to help them work together with the management team to drive and share improvements. Staff members also told us they tried their best to support people to access the community regularly however found this more difficult now more people lived at the service and people needed more support with their care needs. Staff told us they tried to support people out in to the community for walks and for visits to the shops or local café’s if they had the opportunity. The management team acknowledged how staff were feeling and spoke about their plans to start supervising staff more frequently and also making sure staff were involved in any actions that were taken as a result of feedback. They also said they would review how often people were able to be supported to leave the service to follow their interests and pastimes.

We did not received specific feedback from partners as part of this assessments. However, professionals made it clear in people’s daily records and care plans that they had no concerns. The local authority were positive about the service and the support that people received.

The management team and providers had processes in place to collect feedback from people, relatives and the staff team. This included meetings, informal discussions and the opportunity for people to submit feedback in writing. The management team acknowledged these systems could be improved and assured us this would happen. One person said, ‘‘I know there are meetings you can go to but it is not really necessary as you can talk to staff whenever you want.’’ A relative told us, ‘‘I think communication is good at the service and we can speak to someone whenever we need to.’’ Despite our findings around people’s access to the community and staff feeling they do not have the time to do this anymore we were shown evidence of people accessing the community and enjoying this. One person said, ‘‘[Staff] take me out and about and I get a lot out of this. I like to be in the sunshine.’’

Staff told us they were not being supported with regular supervisions and were not always kept up to date with actions taken to improve the service. Staff did not feel that the service was improving and some staff felt that people’s experience was not what it used to be as more people started living at the service. Staff found it difficult to explain to us what was being done or what plans were in place to improve the service. However, staff were passionate about supporting people to achieve good outcomes and spoke about how they had supported people to have good experiences of care. One relative told us, ‘‘Since [family member] has lived at the service their health has been much better and [staff] seem to get the best out of them.’’ The management team were open and honest with us in relation to our findings at this assessment and accepted they did not always have systems in place to ensure actions were completed to help improve the service. They told us about their plans to make sure actions were followed up and completed in a timely fashion and sent us evidence this had started to be effective.

Processes were not always effective in making sure improvements were made and sustained at the service. It was not always clear how actions were monitored to make sure they were completed so improvements could be made. Whilst audits at the service did note actions to be taken these were not always completed in a timely manner, or if they were completed, the impact this had on the service was not being monitored. The management team took our feedback and findings seriously and started putting plans in place to improve in this area. They sent us evidence to show how effective this had been in a short time frame.