CQC report explained · a nursing home
What the CQC found at Thomas Owen House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, July 2019
Thomas Owen House is rated Good overall, but inspectors found the home was not always safe and rated Safe Requires Improvement.
This was an unannounced inspection over two days. Inspectors spoke with people living in the home, staff and a visiting professional. They also checked care records, medicines, staff files and management records.
The home was rated Good overall. Effective, Caring, Responsive and Well-led were all rated Good. People described kind support, good food, meaningful activities and involvement in decisions about their care.
Safe was rated Requires Improvement. Inspectors found weaknesses in the fire risk assessment, medicines arrangements when people were away from the home, and some training records. The provider took action after the inspection, including updating the fire risk assessment and introducing safer medicines procedures.
The previous overall rating was Requires Improvement, with several regulatory breaches. Inspectors found enough improvement for the provider to no longer be in breach of those regulations, although safety still needed closer attention.
Kind and respectful care
People said staff knew them well, listened to them and supported them with kindness. Staff respected privacy and helped people maintain their rights and interests.
“Our observations showed that staff treated people with kindness.” from the report
Good staffing
People said there were enough staff, and inspectors saw staff throughout the home. People were also involved in recruitment decisions.
“There were sufficient numbers of suitably skilled staff who were deployed throughout the building.” from the report
Food and nutrition
People praised the varied food and had choices at mealtimes. Staff also supported people to try fresh fruit smoothies and met special dietary needs.
“Without exception, people said they enjoyed all of the food on offer.” from the report
Activities and independence
Activities were varied and led by people's interests. People were supported to go out, attend events and take part in activities that improved their wellbeing.
“Activities were a strength of the service as people were supported to live active lifestyles both inside and away from the home.” from the report
Personalised care planning
Care plans included people's preferences, mental health needs and guidance about how staff should respond when they became distressed or agitated.
“Care plans were personalised and gave key information about what people enjoy and action to take if they become agitated.” from the report
Fire risk assessment
needs fixingThe fire risk assessment had not been reviewed robustly, and some information was inaccurate or missing. An updated assessment was provided after the inspection.
“However, the fire risk assessment was not given a robust review.” from the report
Medicines when people are away
needs fixingInspectors raised concerns about how medicines were managed when people went on leave or trips. Safer procedures were introduced after the inspection.
“We raised concerns about the management of medicines away from the home when people were on leave or out on trips.” from the report
Reporting possible abuse
seriousOne incident recorded as a complaint had not been reported as an allegation of abuse to the relevant authorities. Inspectors recommended more thorough checks of complaints records.
“We saw one incident which was recorded as a complaint which had not been passed to the Care Quality Commission as an allegation of abuse.” from the report
End of life wishes
minorEnd of life care plans were in place, but inspectors said they could contain more detail about people's wishes. The manager said action would be taken.
“End of life care plans had been completed, but we found these could be more detailed about people's wishes.” from the report
Survey feedback
minorSatisfaction surveys had positive feedback, but the analysis had not yet been completed at the time of the inspection.
“The analysis of these surveys still needed to be completed.” from the report
- 01What checks are now in place to make sure the fire risk assessment stays accurate and complete?
- 02How are medicines safely managed when residents go on leave or out on trips?
- 03How do you check that complaints which may involve abuse are reported to the relevant authorities?
- 04How are residents' wishes recorded in their end of life care plans?
- 05How is feedback from satisfaction surveys analysed and used to make improvements?
This was an unannounced follow-up inspection covering all five CQC questions, including the care provided and the home's premises, to check progress after the previous inspection. This explanation was written from the published report of 12 July 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, June 2018
Rated Requires Improvement and no longer in special measures; inspectors found caring support and good activities, but medicines and oversight were not always safe.
This was an unannounced inspection on 7 March 2018. Inspectors spoke with 13 people living in the home, three visiting health professionals and staff. They observed care and checked care plans, medicines, records and how the home was managed.
The home had improved since its previous inspection, when it was rated Inadequate and placed in special measures. However, medicines were still not managed safely. Inspectors found problems with storage, missed medicines, records, ordering and some instructions for medicines given when needed. Some premises and equipment also needed safer checks.
People said they felt safe and spoke positively about staff. Inspectors found Good care in the effective, caring and responsive areas. Staffing levels were suitable, people's choices and dignity were respected, food and healthcare support had improved, and activities were a strength. The overall rating was Requires Improvement, while Safe and Well-led were also Requires Improvement.
Kind and respectful staff
People spoke warmly about the staff. Inspectors saw calm support, respect for privacy and dignity, and respect for people's usual routines.
“Throughout our inspection we saw people were treated with dignity and respect.” from the report
Activities and independence
People were supported to develop daily living skills and to spend time in the community. The activities programme included trips, quizzes, music and social events.
“People were actively supported by staff to access the community either independently or with assistance. The activities provision was a strength of the service.” from the report
Suitable staffing
Inspectors found staffing levels were enough to meet people's needs. Rotas were consistently met and staff were usually familiar with the people they supported.
“Staffing levels were sufficient to meet people's care needs.” from the report
Unsafe medicines management
seriousInspectors found expired and unlabelled medicines, fridge temperature problems, missed medicines and incomplete records. Some instructions for medicines given when needed were not detailed enough.
“The management of medicines was not safe as storage arrangements were not sufficiently robust” from the report
Equipment and premises checks
seriousSome window restrictors did not meet safety guidance, hot water had been made hotter without checking it, and three transfer slings had not been thoroughly examined.
“Three slings used to assist people to transfer had not been thoroughly examined to ensure these were safe to use.” from the report
Weak follow-up of audits
seriousAudits identified problems, but records did not show clearly who would complete actions, when they were due or whether they had been completed. This affected oversight of medicine safety.
“There was no evidence of analysis or any actions taken to mitigate the issues which had been found demonstrating they were not fully effective.” from the report
- 01What changes have been made to medicine storage, fridge temperature checks, ordering and records since the inspection?
- 02How do you now monitor people who regularly refuse medicines, and when do you contact their prescriber?
- 03How are medicines given when needed now recorded, including variable doses and instructions for use?
- 04How often are transfer slings, window restrictors and hot water temperatures checked, and where are these checks recorded?
- 05How do you track actions from audits and meetings so that responsibility, deadlines and completion are clear?
This was an unannounced inspection of the overall service, including all five key questions, to check improvements after the previous Inadequate rating and special measures. This explanation was written from the published report of 12 June 2018 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 Thomas Owen House
6 rated inspections over 5 years: the service has improved, from Inadequate to Good.
- July 2019Goodcurrent ratingup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2018Requires improvementup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2017Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Inadequate
- May 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2015Requires improvementup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- October 2014InadequateSafe: InadequateEffective: InadequateCaring: InadequateResponsive: InadequateWell-led: Inadequate
- December 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- June 2012
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 16 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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