Thornhill Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last assessment we rated this key question Good. At this assessment the rating had changed to Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. People were not involved in planning their care. They didn’t have access to their care plans and had not always been involved in assessments or reviews. Relatives were consulted in care planning and reviews, however, staff had not gained consent from people to do this. Mental Capacity Act legislation and guidance was not always implemented and best interests decisions were not always in place where people lacked capacity for a particular decision. People did not always receive the support needed to ensure their nutrition and hydration needs were met. Communication systems were not effective in ensuring staff were informed of important changes or updates about people’s needs. People’s outcomes were not monitored effectively as there was poor oversight of the electronic care system and people’s clinical needs

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not involved in care planning or reviews of their health, care, wellbeing and communication needs. People did not have access to their care plans. One person said, “They don’t discuss my care plan [with me].”

Relatives said they were involved in care planning and reviews. One relative said, “They discuss his care plan with me regularly.”

The manager and deputy manager were aware that care plans were in need of review. The deputy manager said they had started this process by consulting with people's families, although they acknowledged they had not sought consent from people to do this.

We found people's needs were not always assessed or reviewed effectively or in a timely manner. There were variations in the level of detail included in care plans and some lacked consistent or up to date information. For example, one person's care records said they were unable to walk unaided when they were able to do so.

Communication care plans were in place but lacked person-centred detail. For example, the communication care plan for a person living with dementia said, 'Staff should encourage active and effective communication allowing (person) time to process and answer, give clear reasons and explanations and offer reassurance when (person) is not understanding.” Very similar wording had been used in other communication care plans

Care plans were not always in place for people's needs. For example, a person living with Parkinson's disease did not have a care plan relating to this. Another person who was experiencing discomfort due to a skin condition had not had a care plan developed to inform staff how to manage this. Handover records showed another person had a condition causing pain and swelling in their joints and needed to keep their feet elevated. There was nothing in their care plan about this.

Care plans did not always reflect people's interests and social needs.

People gave mixed feedback about the food and drink provided. Some people felt they did not get enough food. One person said, “The food is scarce we don’t get enough.” However, other people said they got plenty of food and enjoyed it.

Some people said they got a choice, others said they didn’t. One person said, “I like cornflakes, but they never have any.” Another person said, “Yes, it’s nice food. You can choose more or less, but sometimes you cannot.”

The manager and deputy manager acknowledged significant improvements were required to meet best practice guidance in the provision of care and treatment.

Our discussions with the chef identified a lack of knowledge about people’s dietary requirements. They were unable to explain how they fortified meals for people who were nutritionally at risk and did not know whether people needed drinks in beakers or in cups. We asked for a hot drink for one person and the chef gave it to us in a cup. The person was bed bound and required their drinks to be given in a beaker.

Processes were not in place to support the collaborative planning and delivery of evidence-based care and treatment. Recognised assessment tools including nutrition and skin integrity assessments were in place, however these were not always accurate. One person's assessment identified they were at medium risk of malnutrition and needed their food fortified and high calorie snacks. The person's records and our observations showed their dietary needs were not being met.

People did not receive the support needed to ensure their nutrition and hydration needs were met. Some people struggled with their meals and did not receive support they required from staff. People were not given the opportunity to have extra helpings as the food trolley was removed from the unit whilst people were still eating. One person said they could eat more but the food trolley had already been taken to the lift and staff had not offered any seconds. People living with dementia were served their meals on small side plates whereas on the other floors larger plates were used. Although we raised this on the first day of the inspection this had not changed when we returned for a second day.

There was very little evidence of staff following best practice in relation to supporting people living with dementia. The environment was not dementia friendly and did not meet best practice guidance from the Department of Health: Dementia-Friendly Health and Social Care Environments. There was limited signage to help people find their way around and locate their rooms.

People told us they could not always understand what some staff were saying. We saw there were times when people struggled to understand what staff were saying to them.

Staff spoke about communication issues and how this impacted on the way they worked together as a team and the support they provided to people. Staff said they were not always updated when people’s needs changed

Comments included, “We used to have handovers and walkarounds at the start of every shift with the night staff, but they’ve stopped now. All the staff used to be involved but they’re not any more so if you’re a care assistant you don’t know what’s happened on the previous shift. The handovers are just for the nurses and senior carers now, not for all staff. It’s really affecting the care staff, especially when a new resident comes in. We need to know about them and we don’t, it should be changed back.”

Some staff told us they had not received any training on the electronic care system and had had to learn from colleagues. One staff member said they could not access people’s care plans.

In our discussions with some staff they struggled to understand what we were saying and we struggled to understand what they said. A senior manager said they were aware of some communication difficulties with staff and were supporting staff to have further training and would follow this up in supervisions.

The local authority commissioners last visited the service in March 2023 and no concerns were raised. A recent visit to the service by the local authority infection control team identified improvements were needed.

Communication systems were not effective in ensuring staff were informed of important changes or updates about people’s needs. For example, handover information was recorded in books as well as on the electronic care system. However, changes recorded in the books were not reflected on the electronic care system which staff accessed. This placed people at risk of not receiving the care and support they required to meet their needs. For example, the handover book noted one person had developed a skin infection, yet there was no reference to this in the person’s care records.

Twice weekly manager walkarounds and daily flash meetings had been set up. However, records we reviewed showed these were not always carried out. The last manager walkaround was dated 18 September 2024 and flash meetings had not taken place daily with the last one recorded on 4 November 2024.

No concerns were raised by people or relatives about accessing health care support. People told us they were supported to access the health care services they needed. One person said, “If I was ill, they would get a doctor for me.”

The manager said the GP surgery carried out a weekly ward round, district nurses visited residential clients and other health and social care specialists were accessed as and when required. The deputy manager told us arrangements were in place for people to access chiropodist, optician and dental services when needed.

Care records included evidence of referrals to health care professionals including the GP, district nurse and dietician. However, we did not see evidence of a referral to an appropriate professional for a person experiencing problems with catheter management. There was no evidence of the involvement of a Parkinson's nurse for 2 people living with this condition.

Most people and relatives told us they were happy with the care provided, although some concerns were raised about staffing levels, the food and people’s clothing.

The manager and staff raised concerns about staffing levels and told us how this impacted on the care they were able to provide. The manager said they were in the process of reviewing and updating care plans and felt this, and an increase of staff, would improve outcomes for people.

Effective processes were not always in place to monitor people’s care and treatment. People’s outcomes were not monitored effectively as there was poor oversight of the electronic care system and people’s clinical needs. Reviews of care plans gave an update of events relating to the area of care but did not evidence a review of the effectiveness of the care plan.

Food intake records did not always reflect the detail in the care plan. For example, one person's nutritional care plan said they required a fortified diet and high calorie snacks. This was not reflected in their food intake records with most snacks recorded as 'biscuit'.

One person’s care plan showed a pressure ulcer was to be redressed every 3 days. Wound charts showed this was not happening with the dressing having been changed on 7/11/24 and 11/11/24 and no dressing done since. This had not been identified until we raised it.

People felt they were consulted about things and were able to make choices. Comments included, “Most of the time I can choose when I get up or go to bed” and “Oh yes, I can make my own choices.”

Staff understood the need to gain consent before carrying out any care or support. We saw this happened in practice. For example, we saw staff asked people if they could put a clothes protector on them before a meal and asked others where they would like to sit.

However, we also found consent was not sought in relation to other matters. The deputy manager said she had been discussing people’s care plans with their relatives. We asked if she had gained consent from people to speak with their relatives about their care plans. She said not but would do that now.

Processes were in place to ensure people's consent was sought. However, these were not always implemented. Where people lacked capacity, the principles of the MCA were not always followed. Capacity assessments were not completed and where people lacked capacity best interest assessments were not in place for relevant areas. For example, sensor mats were in place for 2 people to alert staff when the person mobilized. There was no record of consent or capacity assessment or best interest decision for the use of this equipment.