Archived: Thurlestone House

Updated 21 October 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 7, 12, and 13 September 2017; the first day of the inspection was unannounced. One adult social care inspector carried out this inspection.

Prior to the inspection, we reviewed the information held about the home. This included previous inspection reports and statutory notifications we had received. A statutory notification is information about important events, which the home is required to tell us about by law. Before the inspection, the provider completed a Provider Information Return (PIR). This form asks the provider to give some key information about the home for instance, what the home does well, as well as any improvements they plan to make.

During the inspection, we spoke with seven people individually and met with most people who used the service. On this occasion, we did not conduct a short observational framework for inspection (SOFI) because people were able to share their experiences with us. SOFI is a specific way of observing care to help us understand the experiences of people who could not communicate verbally with us in any detail about their care. However, we did use the principles of this framework to undertake a number of observations throughout the inspection.

We looked at care records for five people to check they were receiving their care as planned as well as how the home managed people's medicines. We reviewed staff recruitment, training and supervision files for eight staff including the newly appointed manager. We looked at the quality of care and support provided, as well as records relating to the management of the home. We spoke with seven members of staff, the manager, two senior managers and one of the company directors. We looked around the home, including some people’s bedrooms with their permission, as well as the grounds. We spoke with two relatives of people currently supported by the home. Following the inspection, we sought and received feedback from two health and social care professionals who had regular contact with the home.

Updated 21 October 2017

Thurlestone House is registered to provide accommodation and personal care for up to 26 people who may be living with a dementia, physical frailty or have needs relating to their mental health. People living at the home are older people, and at the time of the inspection there were 19 people living at the home. The home offers both long stay and short stay respite care. Thurlestone House does not provide nursing care. Where needed this is provided by the community nursing team.

This inspection took place on the 7, 12, and 13 September 2017; the first day of the inspection was unannounced.

Thurlestone House has been inspected four times, since April 2015. There have been three comprehensive inspections and one focussed inspection. At each of these inspections we found breaches of regulation and the service were rated ‘Requires Improvement’.

Although people are happy living at the home, the risks to them are not sufficiently well managed. Governance systems have not been sufficiently robust over a period of three years to identify and bring about the required improvements.

In April 2015 the service was rated as requires improvement. In June 2016 we judged the service as requires improvement again. We served a Warning Notice, telling the provider what action they needed to take in relation to safe care and treatment.

In September 2016, we found action had been taken to address the issues identified in the Warning Notice. However, the service still required improvement in some areas.

At this inspection we identified improvements were still required. We found four breaches of Regulations with repeated breaches of Regulation 12 (safe care treatment) and Regulation 17 (good governance). We found the provider had not taken sufficient steps to assess, monitor or mitigate risk to people living at the home and quality assurance systems had not been established or operated effectively to ensure compliance with the regulation.

The home did not have a registered manager, although this person's name will show on this report as they have not deregistered with the Commission. The registered manager had resigned from their position four weeks prior to this inspection. A new manager had been appointed and had been working alongside the registered manager. They have not made application to the CQC for registration, and are referred to in this report as the manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The home’s quality assurance and governance systems were not effective. Although some systems were working well, others had not identified the concerns we found during this inspection and there was a lack of management oversight.

Risks to people health and wellbeing were not always managed safely. For example where people had been identified as being at risk of malnutrition, we saw people’s food and fluid intake were not always recorded in sufficient detail, recorded correctly, totalled, or analysed. We found staff were not following the Malnutrition Universal Screening Tool (MUST) guidance were people had been identified as high risk of dehydration or poor nutrition.

Where risks had been identified, action was not always taken to minimise these risks. For example one person’s falls diary indicated they were at high risk of falls and directed staff to refer this person to the specialist falls team for further assessment. Records showed this had been identified by the homes quality assurance systems in July 2017; however at the time of the inspection this referral had not been made. We asked for the referral to be made, and the manager confirmed this had been done.

Staff displayed a good understanding of the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguarding (DoLS). People were encouraged to make choices and were involved in the care and support they received.

People can only be deprived of their liberty to receive care and treatment when this is in their best interest and legally authorised under the MCA. Records showed the registered manager had made six applications to the local authority for authorisation to deprive people of their liberty. This was because people were not all free to leave the home if they wished, due to safety considerations and because they were under constant supervision by staff.

Four of the six people we looked at had not had their capacity to consent to these arrangements assessed prior to applications being made. Another person assessment did not contain sufficient information as staff failed to complete the assessment in full and therefore were unable to determine the person’s level of capacity or their ability to consent to these arrangements

A system was in place to monitor the status of DoLS authorisations and DoLS applications that were in progress. We found these systems and process had failed to identify that people were potentially having their rights restricted unlawfully.

People received most of their prescribed medicines on time and in a safe way. However quality assurance systems had failed to ensure people’s medicines were managed safely or administered by appropriately trained staff. People’s MAR’s were not accurate and therefore staff were unable to assure themselves people were receiving their medicines as prescribed. This meant people may have been placed at risk as staff were not able to tell if people had received their medicines as prescribed by their doctor.

People told us they were happy living at Thurlestone House. One person said, “I choose to live here, I was able to pick my room and although it’s not my own home I’m happy here,” Another said, “The staff are really kind, caring and very helpful, especially [Staff name] she always seems to go out of her way to make sure that I’m ok and have everything I need.” Relatives we spoke with told us they were happy with the care and support people received.

People told us staff treated them with respect and maintained their dignity. Throughout the inspection, there was a relaxed and friendly atmosphere within the home. Staff spoke about people with kindness and compassion.

People and relatives told us they were involved in identifying their needs and developing the care provided. People's care plans were informative, detailed, and designed to help ensure people received personalised care.

People told us they enjoyed the meals provided by the home, describing them as "very good.” One person said, "there's always a choice and if you don’t like something all you have to say and they will make you something else.” Another said “I don’t have any concerns about the food or the quality”.

People spoke positively about activities at the home and told us they had the opportunity to join in if they wanted. The home had a programme of organised activities that included arts and crafts, music sessions, exercise classes, quizzes and regular trips out to local places of interest.

People, relatives, and staff spoke highly of the management team and told us the home was well managed. Staffs described a culture of openness and transparency where people, relatives and staff, were able to provide feedback, raise concerns, and were confident they would be taken seriously.

The home maintained a high standard of cleanliness and steps had been taken to minimise the spread of infection. We saw the premises and equipment were clean and staff had been provided with aprons and gloves. Equipment used within the home was regularly serviced to help ensure it remained safe to use.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.