Thornhill Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At our last assessment we rated this key question Good. At this assessment the rating had changed to Requires Improvement. This meant people’s needs were not always met. We identified a breach of regulation in relation to person-centred care. People’s care was not person-centred and support was task orientated. People had access to healthcare professionals. People did not have access to information relating to their care. Accessible and easy read information was not available for people living with dementia. People were not involved in their care plans or reviews. Effective processes were not in place to obtain feedback from people and relatives about the service. End of life care plans were in place. However, they needed more detailed information about people’s wishes and arrangements for end of life care.

This service scored 54 (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. Overall, the people we spoke with were satisfied with the care they received. Comments included, “They look after me as much as they can”, “I feel well looked after” and “I feel alright here.”

People’s care was not person-centred and support was task orientated. One staff member said, “We’re set up to fail. We have tasks assigned to be completed for the time we arrive on duty. It’s just not possible.”

Staff said information about people’s needs were available in care records on the electronic care system. However, some staff did not know how to access this information and others said they did not have time to access people’s care plans. The deputy manager showed us care plans could be accessed by staff on the hand held devices but acknowledged this was very difficult to see and staff were not always aware they could do it and had not received training in this regard.

One staff member said information in care plans was not always correct and gave an example where part of the care plan stated a person needed 1 staff to support, yet another part said 2 staff were required.

Our observations showed there was a lack of consistency in the care people received. There was not a person-centred approach to care and we saw staff were led by tasks allocated to them on the electronic care system.

Some staff engaged with people well and knew how to adapt their approach and support to meet individual needs. For example, we saw one staff member assisting a person to stand up from their chair. The staff member quickly realized the person had been incontinent. They calmly, kindly and discretely reassured the person whispering in their ear about going to the toilet and supported the person to the bathroom to get changed. However, we saw other staff did not display a person-centred approach. For example, telling people repeatedly to sit down and ignoring others.

People said they had access to other health professionals when needed. Health professionals were in the service supporting people during our assessment.

The manager said they worked in partnership with other agencies to ensure people received joined-up care.

We did not receive any information from partners in relation to care provision, integration and continuity.

Systems were in place to ensure staff worked together with health and social care professionals so that people received continuity in their care and treatment.

People did not have access to information relating to their care. Accessible and easy read information was not available for people living with dementia.

Staff and leaders had not fully understood and embedded the requirements of the Accessible Information Standard.

The manager told us the provider had communication tools they could access to enable information to be provided in a way people understood. However, they said none were in place as no one needed this currently. Our observations and review of care plans identified there were people who would benefit from information being presented in an adapted format to meet their needs.

Systems and processes did not ensure the Accessible Information Standard was applied for all people, in line with their needs and preferences.

One person’s accessible information standard and supporting communication risk assessment showed they were registered blind, had hearing difficulties and were unable to read or write. Although these communication needs had been identified there was no information in the care plan about the support needed to ensure information and communication was accessible to the person.

Another person had a communication book in their bedroom that their relative had brought in. We asked the manager about the book. The manager said they didn’t know if staff used it. We observed staff did not use the communication book and saw the person struggled to communicate their needs to staff.

The environment did not support people to find their way around the home. There was no signage on bedroom doors to help people find their rooms. There were pictorial signs on some bathroom and toilet doors, however some of these rooms were not clear to access as they were used to store items such as hoists and linen trolleys. Clocks in communal areas and people’s bedrooms were not set to the correct time.

People were not involved in care planning or reviews. There were limited opportunities for people to share their views and provide feedback on their care and treatment and the service overall.

The manager told us there were processes in place to get people's feedback including meetings and surveys and there was guidance if people wished to raise a complaint or concern. However, we found there had been no residents meetings since the manager came into post in June 2024 and only one survey which was about mealtimes.

Systems and processes did not support the involvement of people in their care. People were not involved in their care plans or reviews. Effective processes were not in place to obtain feedback from people and relatives about the service

We asked for minutes of residents’ meetings held since June 2024 and were not provided with any. We saw 19 people had completed a mealtime survey in August 2024, results were mixed but there was no plan to show the actions taken where people had indicated they were dissatisfied. The only outcome given was the home were trying to ensure continuity with agency chefs until the new chef started in post.

A relatives meeting was held in July 2024. There were no details of which relatives attended or how many. Only by reading through the minutes could it be determined there were only 4 families present. In response to a suggestion raised by relatives the manager stated fresh fruit would be offered on the morning tea trolley. We saw no evidence of this on our site visits.

People requiring adaptations did not consistently have equity in accessing this. For example, people with differing communication needs. People told us they were able to access services when they needed to.

The manager and staff supported people to access the services they needed. However, they had not identified or addressed the inequity for some people in communication and accessing information.

We did not receive any negative feedback from partners.

Systems and processes in place were not always effective in ensuring people were supported to experience equality in the care and support they received. For example, information was not always readily available for people in an accessible format, and further improvements were needed to ensure people’s care was person-centred.

The Expert by Experience did not ask people and relatives about this subject.

Staff told us they listened to people's views and wishes. The manager acknowledged they had not always accessed specialist support for people’s specific needs. For example, no advice had been sought from the Parkinson’s nurse in relation to two people until we raised concerns.

Systems and processes in place did not always support equity in people’s experiences and outcomes. Care was not always tailored to meet people’s individual needs and preferences. The provider had an equality, diversity, and human rights policy in place to protect people and staff against discrimination. Staff had completed equality and diversity training.

People and their relatives did not provide any feedback on this topic. However, we found personalised end of life care was not reflected in people’s care plans.

The manager told us there was no one in the home who was currently receiving end of life care.

Information submitted by the provider prior to the assessment stated the service had undertaken the Gold Standard Framework and were awaiting sign off to be accredited as a recognized End of Life Care Provider. A senior manager told us this did not go forward.

End of life care plans were in place but were not person centred and did not reflect people’s wishes and arrangements for end of life care. One person's care records said they had a DNAR in place and said their partner would update staff on their EOL wishes. Another person’s care plan stated they needed support with their end of life wishes and preferences but did not state what these were.