CQC report explained · a nursing home
What the CQC found at Thistley Lodge
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- There were enough staff and medicines were managed safely, but the fire risk assessment had not been reviewed since July 2016. Food and fluid records were also not reliable enough to show accurately what some people had consumed.
- Effective?
- Good
- Staff worked within the Mental Capacity Act, sought consent and supported people to make choices. Staff training and links with health professionals had improved.
- Caring?
- Good
- People were treated with dignity and respect and were involved in daily choices and care planning. Staff supported independence, privacy and relationships.
- Responsive?
- Good
- Care plans reflected people's needs, preferences and routines. Staff supported people with interests, activities and access to the community, although more detail in care plans was still needed.
- Well-led?
- Requires improvement
- A new manager and nurse had helped create a more settled and open team. However, quality assurance records, accident and incident monitoring, and checks on improvements needed closer scrutiny.
What inspectors found, August 2019
Rated Requires Improvement; the home left special measures after improvements, but safety and leadership still needed work.
This was an unannounced, focused inspection on 26 and 27 June 2019. Inspectors reviewed care and medicines records, management documents and the home itself. They spoke with staff and sought feedback from people, although people were not able to have full conversations because of their anxieties and mental health conditions.
The home had improved since the previous inspection, when it was rated Inadequate and placed in special measures. Staffing, training, safeguarding, medicines, care planning and support for people's choices had improved. Inspectors rated Effective, Caring and Responsive as Good.
Safety and leadership were still rated Requires Improvement. The fire risk assessment was out of date, food and fluid records were not detailed enough, and quality checks did not always show clearly what had been checked or improved.
The overall rating means the home was not consistently meeting the expected standard. It was no longer in special measures and was no longer in breach of regulations at this inspection, but inspectors said the newer systems needed time and monitoring to prove they would last.
Safer medicines
Medicines were given by trained and competent staff. The nurse checked stocks, administration records and staff competence.
“At this visit we found medicines were managed safely, and people received their medicines as prescribed.” from the report
Enough skilled staff
Staffing levels were based on people's needs, with flexibility for appointments and outings. Nursing cover and management support had improved.
“There were enough skilled staff to meet people's needs.” from the report
Respectful care
People were treated with dignity and respect. Staff supported people to make choices, maintain relationships and develop their independence.
“People were supported to express their views and were involved in planning and reviewing their care.” from the report
Improved safeguarding
Staff had received further safeguarding training and felt more confident about reporting poor practice and escalating concerns.
“Staff knew what and who to report too.” from the report
Out-of-date fire assessment
seriousThe fire risk assessment had not been reviewed since 2016, despite a person at the home smoking. The home said it would contact the landlord, but the provider remained responsible for keeping the assessment up to date.
“The fire risk assessment had not been reviewed since it's completion in July 2016.” from the report
Poor food and fluid records
needs fixingSome records did not consistently record portion sizes, cup sizes or people's goals. This meant the records might not give health professionals an accurate account of what people had consumed.
“The quality of the recording was ineffective. This was because there was no consistency with recording portion and cup sizes and personal goals to be achieved.” from the report
Quality checks needed strengthening
needs fixingSome internal audit records did not clearly show what had been checked or what action had been taken. A first aid box check recorded out-of-date items, but there was no record that they had been replaced.
“Some records of internal quality assurance checks post the last inspection and what was checked, was not always detailed or recorded to show what improvements had been made.” from the report
End of life plans missing
minorThe records reviewed did not contain advance care plans, including plans for end of life care.
“Advance care plans, including end of life care, were not completed in those records we reviewed.” from the report
- 01Has the fire risk assessment been reviewed and updated since this inspection, especially in relation to smoking?
- 02How do you now check that food and fluid charts record portion sizes, cup sizes and personal goals accurately?
- 03What evidence can you show that out-of-date first aid items and other issues found in audits are replaced promptly?
- 04How are advance care plans and end of life wishes discussed and recorded for each person?
- 05How do you check that the improvements made since the previous inspection are still working?
This was a focused inspection covering all five key questions to check the previous action plan and legal requirements; it followed an Inadequate rating and special measures at the previous inspection. This explanation was written from the published report of 10 August 2019 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, April 2019
Rated Inadequate and placed in special measures; inspectors found serious safety, staffing, care planning and management failures.
This was a comprehensive inspection on 4, 7 and 11 December 2018. The first day was unannounced. Inspectors observed care, spoke with people and staff, and checked care records, medicines, staffing, recruitment and quality checks.
The inspection followed a reported incident linked to concerns about risk and safety. A police investigation was continuing, so inspectors did not examine what happened in that incident. They found wider problems, including unsafe medicines management, incomplete risk assessments, gaps in staff skills and too little nursing and management support.
People generally appeared happy and staff were kind in everyday interactions. There were activities, outings and support for independence. However, care records were not reliably up to date, people's choices were sometimes restricted, and the home did not consistently protect people from harm or respond to changing health needs.
The overall rating was Inadequate. Safe and Well-led were Inadequate, while Effective, Caring and Responsive Requires Improvement. The home was placed in special measures and the provider was given conditions on its registration.
Kind everyday care
Staff treated people respectfully and appeared familiar with their lives and preferences.
“Staff members talked about those they supported with respect and fondness.” from the report
Activities and outings
People had choices about how to spend their time, including music, exercise, social activities and trips into the community.
“Throughout this inspection we saw some people engaged in music, exercising and social engagement.” from the report
Privacy and independence
People were supported to maintain relationships, use private areas and develop everyday living skills.
“People were supported to be as independent as they could be in developing and maintaining their living skills.” from the report
Clean environment
The home was generally clean, and staff followed infection control procedures.
“The home was generally clean and free from odours.” from the report
Risks were not managed
seriousImportant risks, including health conditions, behaviours and skin damage, were not always assessed or explained clearly to staff. This could delay help or leave people and staff unsafe.
“Risk assessment procedures were inadequate and failed to identify and manage all the risks to people and staff at Thistley Lodge.” from the report
Medicines were not reliably recorded
seriousMedicine records were incomplete and some required health checks had not been consistently completed. There was uncertainty about whether one person might have received a double dose.
“Staff had not consistently completed the MARs to show people had received their medicines when they should.” from the report
Insufficient nursing and staffing support
seriousThere was no nurse on site each day, and staffing levels and skills were not properly calculated against people's needs. At night, one sleeping staff member was available only in an emergency.
“There were no nurses working at Thistley Lodge when we inspected the service.” from the report
People's choices were restricted
seriousStaff controlled some aspects of one person's cigarettes, food and money without the required authorisation. The report also found that people were not always supported to make their own daily choices.
“People were not always able to choose how they lived their daily lives, as care staff placed unnecessary restrictions on people.” from the report
Care records were out of date
needs fixingCare plans did not always explain current health, behaviour or communication needs. Reviews did not reliably show how people's goals and changing needs were being supported.
“Care records were not up to date, for example, people did not have up to date information in their risk assessments and care records” from the report
Weak management checks
seriousThe provider and managers did not learn enough from incidents, complaints or safeguarding concerns. Problems identified in an earlier internal investigation had not been fully addressed.
“The provider's management systems were ineffective in identifying where improvements were needed.” from the report
- 01How many nurses are now working at the home each day, and how is clinical support provided at night?
- 02How do you check that medicines are given correctly, recorded accurately and monitored for side effects?
- 03What current risk assessments and care plans are in place for my relative's health conditions, behaviours and communication needs?
- 04How do you ensure restrictions on cigarettes, food, money or other choices are lawful and properly recorded under the Mental Capacity Act?
- 05What action has been completed since this inspection, and what independent checks show that the improvements have lasted?
This was a comprehensive inspection covering all five key questions; it did not examine the incident that prompted the inspection because it was subject to a police investigation. This explanation was written from the published report of 5 April 2019 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 Thistley Lodge
4 rated inspections over 4 years: the service has slipped, from Good to Requires improvement.
- August 2019Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2019Inadequatedown from GoodSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- January 2018Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 1 December 2010.
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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