Thornhill Nursing Home

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At our last assessment we rated this key question Good. At this assessment the rating had changed to Requires Improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect. We identified a breach of regulation in relation to dignity and respect. People said, and we saw, that staff were kind and caring. However, we also observed times when people’s dignity was not maintained and they were not treated with respect. People said they were offered choices. Activities were available but limited to when the activity organiser was on duty. Some people were isolated in their rooms with little evidence of activities being offered to them. People told us of delays in staff responding to their calls for assistance.

This service scored 55 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People described the staff as kind, caring and nice and felt they were treated with respect and dignity. Comments included, “Most of them are kind, some are cheeky and think they are somebody”, “If you feel a bit sad they will sit and talk to you”, “They’re very caring” and “I’ve been treated well here.”

Relatives also praised the staff. One relative said, “The staff are really good and [family member] sees them as family.”

However, one relative told us, “I notice sometimes [family member] has dinner down them and I would like staff to change them. A couple of weeks ago [family member] had hair on their face which they would not have liked as [family member] likes to look nice and is very proud.” Other relatives said they sometimes found their family member wearing other people’s clothes and saw other people wearing their family member’s clothes.

Staff had received training in dignity and respect and said managers carried out observations of their practices and gave feedback. Although no concerns were raised by staff and leaders our observations found staff were not always compassionate and people were not always treated with dignity and respect.

We did not receive any negative feedback from partners in relation to people being treated with kindness, compassion and dignity. However, our observations found people’s dignity was not always respected.

We saw some staff did not always treat people with respect or maintain people’s dignity. For example, staff commenting loudly in communal areas when people had been incontinent or needed their catheter bag changing. One person, who staff said had just been washed and changed, smelled strongly of urine.

People did not always appear to have been well supported with their personal hygiene and grooming. We saw men had not been supported to shave and people's hair had not been attended to. People were unsupported with their meals which resulted in them struggling and spilling food down their clothing.

We observed staff lacked the skills and knowledge to care and support people living with dementia. Staff did not listen or act upon people’s requests and dismissed what people had to say. For example, one person asked to go outside and was repeatedly told to sit down.

People told us they were offered choices. People and their relatives told us visitors were welcomed and there were no restrictions on when people could visit. Comments included, “My daughter visits and when she comes she brings me books” and “I can have a shower when I want to.”

However, comments made by relatives suggested people’s individual needs were not always met. One relative told us their family member liked to read a magazine and was often left without their glasses which they needed to read. They said, “If you go in the lounge they are often just staring and not doing anything.”

Staff told us people’s choices were respected and this included when people wanted to get up or go to bed. However, staff also said staffing levels and the electronic care system often impacted on people’s choices as they had set tasks to complete in a certain time.

The manager said the activity organiser planned activities to meet individual needs including group activities such as singing and dancing and visits from children from a local nursery. They said the activity organiser also arranged video calls for people with their family and provided 1:1 time.

Our observations showed staff were kind and well-meaning but lacked a person-centred approach, focusing on completion of tasks. Our discussions with care staff indicated they did not routinely read people’s care plans.

People’s care records were not always person-centred and did not reflect their needs, wishes and preferences. People were not given the opportunity to contribute to their care and express their preferences.

People felt they had some choice and control over their care and daily lives. Comments included, “You can go outside depending on the time of the year” and “We have a sing song.”

People told us they were supported to keep in touch with family and friends. Comments included, “I have good contact with my family and my [spouse] comes to visit me” and “My [relative] rings up and I talk to them and have videos on the phone.”

One relative said, “The activity co-ordinator is marvellous there is always plenty to do. There is not much on a weekend. They have been on trips to Ponderosa, Greenhead park and a picnic.” Another relative said, “I think there is a new activity lady as they are doing different things.”

The manager told us of recent activities and events that had taken place and further activities were planned for Christmas including a visit from reindeers and a Christmas Fair.

Staff told us they would like to be able to spend more quality time with people and take people out but were not able to do so due to the staffing levels. Staff told us they had taken one person to Tesco recently and the person “had loved it.”

We saw some people enjoying activities which were organised by the activity organiser. For example, people enjoyed an arts and crafts session and attended a church service. However, activities were limited to when the activity organiser was on duty. We saw some people were isolated in their rooms with little evidence of one-to-one activity being offered to them.

We did not observe people on the dementia care unit being involved in any activity. On one occasion a person picked up a jigsaw box from the dining table. A member of staff took the box from them and told the person to sit down. People were not routinely offered choice. For example, the television or radio was playing without anybody being asked what they would like to watch or listen to. People were told to sit down whenever they stood up from their chairs. One person told us they would like to go outside because the sun was shining and stood up to walk from the room. When a member of care staff told them to sit down we told the staff member the person wanted to go outside. The staff member told the person they could go and lie on their bed and took them to their room.

A board in the entrance hall showed activities planned for the week. This information could not be seen easily by people who used the service. There was limited information in people’s care records about their interests.

Care records lacked evidence of people's history, lifestyle preferences, interests or social needs. For example, the care plan for a person born overseas did not include any detail about their heritage or cultural needs or preferences.

We had a conversation with a person about their favourite sport and the team they had actively supported all their life. The person was knowledgeable in this area but staff were unaware of their interest and there was no mention of this in their care records

People told us of delays in staff responding to their calls for assistance. Comments included, “When I call for them it usually takes ten minutes”, “Last night I waited half an hour after pressing the bell for help” and “If they have time, they will talk to you.”

A relative told us their family member’s call bell was out of reach.

Staff told us they tried their best to respond to people’s needs as promptly as possible but were not always able to do this in a timely way due to the staffing levels. Staff described situations where they were attending to one person’s needs and then had to leave them to attend to another person who was calling for help as there were no other staff around.

The manager and deputy manager told us they had repeatedly raised concerns about staffing levels with senior managers.

We saw people’s needs were not always met in a timely way. We observed communal areas where people gathered were often left without a staff presence. This included mealtimes. We saw a staff member, who was on their own on the dementia care unit, attending to one person in their room and then had to leave them to attend to another person who was calling for help. We saw a staff member on their own on the nursing floor trying to support people who required 2 staff with care and respond to others.

We saw the call bell display board showed a person had been ringing for assistance for 23.43 minutes. No staff had responded even though 3 staff were present in offices in the area where the call bell was ringing. Staff responded when we asked them to attend.

Staff gave positive feedback about the manager and deputy manager who they described as approachable and helpful. One staff member told us how much they appreciated the caring support they had received from the deputy manager when they had been unwell. Another staff member said of the manager, “If you need any support they’ll do what they can to help.”

Processes were in place to ensure staff received support from the management team, through an open-door policy and supervision.