CQC report explained · a nursing home
What the CQC found at St Thomas
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, February 2023
Rated Good overall, but inspectors found the home was not always safe and rated Safe as Requires Improvement.
This was an unannounced focused inspection on 1 and 14 December 2022. Inspectors reviewed care plans, medicines records, training records and other documents. They spoke with people, relatives and staff, and observed care and mealtimes.
People and relatives said they felt safe. Risks were usually assessed and managed, medicines were generally given as prescribed, and incidents were reported and investigated. However, information about dietary risks in the kitchen was unclear, some medicines records lacked detail, and some mealtimes were rushed.
The home was rated Good for Effective and Well-led. Inspectors found good support with healthcare, food, communication, consent and staff training. They also found a positive management team, strong quality checks and a clear plan for further improvements.
The overall rating improved from Requires Improvement to Good. This inspection only looked at Safe, Effective and Well-led. Ratings for Caring and Responsive were not reviewed and carried over from the previous inspection.
Risks were usually managed
People had detailed risk assessments covering areas such as falls, choking, skin damage and malnutrition. Staff understood these risks and care observed reflected the plans.
“People's individual risks were assessed, and detailed risk management plans were in place.” from the report
Learning from incidents
The home had improved how it reported and investigated incidents. It looked for patterns, shared learning with staff and took action.
“Incidents were reviewed for themes and trends, and staff were supported with supervision and training if required.” from the report
Staff training
Training compliance had improved significantly. Staff showed a good understanding of dementia, mental capacity and communication needs.
“Staff had access to training and there had been a significant improvement in training compliance, which was very high.” from the report
Positive leadership
Inspectors found the management team open, supportive and focused on improvement. People, relatives and staff were encouraged to give feedback.
“People, relatives and staff were involved in how the service was run, and were invited to feedback their experiences.” from the report
Unclear dietary risk information
needs fixingKitchen information about allergies and modified food textures was confused or incomplete. Inspectors did not see evidence that anyone received unsuitable food, but the home was asked to put a more reliable system in place.
“information displayed about people's needs and risks in the kitchen area was confused or incomplete.” from the report
Medicines records
needs fixingSome records did not show enough detail about timed medicines and medicine patches. There were also missing risk assessments for flammable creams. The home said these issues had been corrected by the second visit.
“Some recording of medicines administration was lacking detail.” from the report
Rushed first-floor mealtimes
needs fixingMealtimes on the first floor were more task-focused and rushed, with limited interaction between staff and people. The manager agreed to address this.
“Staff deployment for mealtimes on the first floor, which accommodated people who required support to eat, could be improved as this was more rushed and task focussed with different staff supporting each course.” from the report
Recruitment records
minorOne staff file did not show evidence about conduct in a previous relevant role. The recruitment procedure also did not fully reflect reference requirements.
“We identified 1 staff member did not have evidence of their conduct in 1 previous relevant role” from the report
- 01How do you now make sure kitchen staff have clear, up-to-date information about allergies and modified food textures?
- 02What checks are now in place to make sure timed medicines and medicine patches are recorded and monitored correctly?
- 03How have you changed staffing and support during first-floor mealtimes?
- 04How do you check that the improvements identified at this inspection have been maintained?
- 05What were the previous Caring and Responsive ratings, and when will these areas next be reviewed?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected and their previous ratings carried over. This explanation was written from the published report of 22 February 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, May 2020
St Thomas was rated Requires Improvement; inspectors found kind, personalised care but concerns about medicines, oral care, staffing visibility and management checks.
This was an unannounced inspection over four days. Inspectors spoke with people living in the home, relatives, staff and visiting professionals. They observed care and checked care plans, risk assessments, medicines records, staff files and management records.
The home was rated Requires Improvement overall. Safe, Effective and Well-led were also rated Requires Improvement. Caring and Responsive were rated Good. This means inspectors found several important areas working well, but they could not be confident that care and management were consistently safe and effective.
People were generally protected from abuse and avoidable risks, and staffing numbers usually met the home's own calculations. However, staff were not always visible or available when people needed help. Medicines records, oral care records and some care plan information were incomplete or inconsistent.
The previous overall rating was Good, published in August 2017. The ratings for Safe, Effective and Well-led had gone down to Requires Improvement. The provider took immediate action on several issues during or after the inspection, but the inspectors said they would continue to monitor the home.
Kind and respectful care
People and relatives said staff were kind. Inspectors saw staff offering choices, respecting privacy and supporting independence.
“People and their relatives told us staff were kind and caring.” from the report
Personalised care
Care plans included people's needs, preferences and life histories. This helped staff provide activities and support based on what mattered to each person.
“People's care plans were person centred and contained detailed information of people's needs and approaches staff should take to support them.” from the report
Activities and social contact
The home offered daily group and one-to-one activities, including sessions for people cared for in bed or in their rooms.
“Activities were scheduled daily and included group sessions people could join and one-to-one sessions for people, such as those who were cared for in bed or remained in their room.” from the report
Safeguarding and risk management
Staff knew how to report abuse. Risk assessments gave staff guidance on issues such as pressure areas, equipment and emergency evacuation.
“There were appropriate systems in place to protect people from abuse.” from the report
Medicines records
seriousRecords did not show consistently that prescribed toothpaste was administered or that skin patches were applied in line with guidance. The provider introduced new recording tools after inspectors raised this.
“The provider could not demonstrate it had been administered in line with the prescriber's advice.” from the report
Staff availability
needs fixingRelatives and staff said carers were not always visible or available, especially in communal areas. Inspectors saw one person wait for help with a drink and another person calling for assistance.
“However, we received a high volume of feedback from relatives, professionals and some staff that staff were not always accessible or visible, particularly in communal areas of the home.” from the report
Oral care
needs fixingThe home had oral care plans, but daily records did not clearly show what support had been given and when. The manager took immediate action after this was raised.
“The provider could not demonstrate people's oral health care was always effectively managed in line with best practice guidance.” from the report
Dementia-friendly environment
needs fixingSigns and colours were not consistently designed to help people living with dementia find their way around or identify doors and handrails.
“There was a lack of accessible signage to support people living with dementia to orientate around the home.” from the report
Weak quality checks
needs fixingAudits had not found several problems with medicines, care records and staffing information. One action about escalating incidents outside the organisation was still incomplete.
“Systems and processes to monitor service delivery were not always effective.” from the report
- 01How do you now make sure staff are visible in communal areas and respond promptly when people need help?
- 02How are prescribed toothpaste and transdermal patches recorded, and can we see evidence that this is checked?
- 03How do you record and monitor each person's daily oral care?
- 04What changes have been made to signage, colour contrast and the layout to support people living with dementia?
- 05How do your audits now identify and correct gaps in care records, staffing assessments and incident reporting?
This was an unannounced comprehensive inspection covering all five CQC questions; Safe, Effective and Well-led deteriorated from Good, while Caring and Responsive remained Good. This explanation was written from the published report of 6 May 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of St Thomas
5 rated inspections over 8 years: the service has improved, from Requires improvement to Good.
- February 2023Goodcurrent ratingup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2020Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- August 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- November 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- February 2012
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 15 February 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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