Archived: Thornton Manor Homecare

Thornton Manor Homecare is registered as a domiciliary care service to provide personal care for people in their own homes. The service provides care and support for two people.

The service had a registered 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.

At the last inspection on 5 January 2016 we found that a number of improvements were required. People were not always protected from the risk of unsafe care and treatment, consent to care and treatment was not always sought and the registered provider’s quality assurance systems were not effective. We asked the registered provider to take action to address these areas.

After the inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breaches identified. They informed us they would meet all the relevant legal requirements by May 2016. This inspection found that improvements had been made.

Staff were trained in the Mental Capacity Act 2005 (MCA) and showed an improved understanding of the importance of seeking consent from people in their day to day support. The registered manager informed us following our last inspection that relevant applications under the Deprivation of Liberty Safeguards (DoLS) had been completed as required. The registered provider had a policy and procedure on the MCA and DoLS and this was accessible to staff. However, there was limited evidence regarding ‘decision specific’ mental capacity assessments and best interests meetings.

People were protected from abuse. Family members told us that their relatives were kept safe from harm. The service had processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the registered provider’s whistleblowing policy. Staff were confident that they could raise any matters of concern with the registered provider or the registered manager and that they would be addressed appropriately.

People received their medication as prescribed and staff had completed competency training in the administration and management of medication. Medication administration records (MARs) had been signed by staff which showed that people’s medicines had been given as prescribed.

The service had robust recruitment practices in place. Applicants for posts were assessed as suitable for their job roles. All staff received training to enable them to fulfil their roles which included essential subjects such as safeguarding people and medication training. Staff were supported through regular supervisions and team meetings.

Staff worked well with external health and social care professionals to make sure people received the care and support they needed. People were supported with their dietary needs. Where specialist input was required, the registered provider consulted with speech and language therapists to help ensure that people were being supported to safely follow their dietary requirements. People were referred onto the appropriate services when concerns about their health or wellbeing were noted.

Observations showed that people were treated with kindness and respect. Staff were mindful of their privacy and dignity and encouraged them to maintain their independence. Family members told us that they had no concerns about the care that people have been given.

Staff understood how to meet the needs of those individuals they supported. The service ensured consistency in care as a dedicated team of staff supported the same people. This enabled people and their family members to build good working relationships and develop confidence in the support provided.

Support plans were detailed and informative. They provided staff with sufficient guidance to ensure people's specific care needs were met. Risks had been appropriately assessed and staff were provided with guidance on how to protect people and themselves from each identified risk. Support plans were regularly reviewed to ensure information about people was up to date and accurate.

The registered provider’s complaints procedure was robust and accessible to people and their relevant others. Family members told us that they had never had reason to raise a complaint but were confident their concerns would be acted upon.

Quality assurance audits were undertaken by the registered provider to ensure that they service provided was effective and meeting people’s needs. Accidents and incidents were reviewed to ensure that any risks to people were minimised and we were notified as required about incidents and events which had occurred at the service.

Thornton Manor Homecare is registered as a domiciliary care service to provide personal care for people in their own homes. The service provides care and support for two people.

The service has a registered 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 service was last inspected in February 2014 and was not found to be in breach of any regulations.

During this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities 2014) Regulations. You can see what action we told the provider to

take at the back of this report.

Care records were in place which contained details about people’s needs, however we found that this information was not always accurate or up-to-date. We observed care that was not delivered in line with information contained within care records and saw that records were not updated to reflect changes in people’s needs after being reviewed. This meant that people were at risk of receiving inappropriate care and support.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves.

People’s mental capacity was not considered within care records. We saw no evidence that the relevant people had been involved where decisions had been made in a person’s best interest. Referrals had not been made to the court of protection for people using the service in line the Mental Capacity Act 2005. This meant that people were at risk of having their rights infringed.

Care records contained some personalised information, however we found that the information provided about people was out-of-date and in some cases had not been reviewed since 2012. This meant that information was not reliable, and was not reflective of people’s current needs.

Quality assurance systems were not in place to identify where improvements were needed. Neither the registered manager nor the registered provider completed audits of the service, which meant that the service was not able to improve.

Feedback from a questionnaire contained an example where concerns had been raised by a family member, however no formal response or action plan had been implemented. As a result of this it was unclear whether people’s concerns were being dealt with or not.

Records indicated that staff had completed training that was necessary for them to carry out their role. Staff were able to demonstrate a good understanding of how to identify abuse and what procedures they needed to follow to raise their concerns. This meant that people were protected from the risk of abuse.

Staff were respectful and we saw examples of how they worked to maintain people’s dignity and general wellbeing. We observed that people were at ease with staff, and saw that staff spoke kindly to people. People’s confidentiality was maintained, and documents containing personal information were stored securely in a locked cabinet.

Staff supported people to engage in a number of activities, which included spending time in a sensory room and going out for day trips. Relatives confirmed that people were being supported to access the community. This helped ensure that people were protected from social isolation.

We looked at people’s medication records and saw that they had received medication as prescribed. However there was no audit system in place to check for any errors or to ensure that the quantities being stored were correct. We looked at samples of medication and found these to be correct.

When we visited again on 14 February 2014 we found that staff rotas showed details of which members of staff were on duty each day. One member of staff worked in the adjoining nursing home for part of the night shift and this was shown on the staff rotas.

We looked at the care and support plans for the two people who used the service. We found that some information had been written in detail including records of seizures, bowel records, records of medical visits, and daily records of the support provided including hourly checks during the night. People's weights were recorded monthly and were stable. The staff we spoke with were able to tell us in detail how they ensured that people's daily care needs were met.

From our observations the people who used the service appeared relaxed and happy with the staff supporting them. The staff observed had a very caring and patient approach. We could see that they knew the needs of the people who used the service well and how they communicated their needs.

We spoke to two relatives of the people who used the service. They described the service positively. They said the staff were very caring and provided a good standard of care and support. One told us that their relative had continued to make progress since they had lived at the home and were developing new skills. Some comments made were:-

'My relative is happy. The staff care about him. '

'We are happy with the service. The staff are looking after our relative really well.'

We found that staff acted in accordance with people's wishes. People received care that met their needs and they had their nutritional needs supported.

We found that improvements were needed to record keeping to ensure that people were protected from the risks of unsafe record keeping.