Thornhill Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

At our last assessment we rated this key question Good. At this assessment the rating had changed to Inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care. We identified a breach in relation to good governance There was a lack of effective, consistent management of the service which had impacted on the quality of people's care. Staff said they felt able to speak up if they had any concerns or worries. However, staff told us they had repeatedly raised concerns about the staffing levels and felt their voices had not been heard. Quality audit processes were not effective in improving service delivery. Although some issues were identified, actions were not always completed and themes were repeated. Partnership working and joined up care were not always implemented effectively. Systems in place to ensure continuous learning and improvement at the service were not effective in improving outcomes for people.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Our discussions with managers and staff showed they shared the provider’s vision and values to provide individualised care focused on people’s needs. However, they said insufficient staffing levels often impacted on their ability to provide individualized care.

Comments included, “I always look after people as if they were my mum or dad and how I would want them to be cared for” and “I do think this is a caring place, we’re all about caring. But extra staff would make such a difference to how we work and how we can support our residents.”

The provider’s statement of purpose sets out the organisation’s values and philosophy of care. However, we found evidence that people's care was not always provided in a person centred way due to the provider's failure to ensure sufficient staffing levels and training. Ineffective and inconsistent management of the service had also impacted on the quality of people's care and had a detrimental impact on staff.

We found there was a lack of inclusive leadership at all levels. The manager, deputy manager and staff shared concerns with us about staffing levels. They described how this impacted negatively on the care people received. Managers and staff said they had raised concerns repeatedly with senior leaders but had not been listened to as the situation had not improved. Quality assurance processes were limited and not robustly implemented.

There was a lack of effective and consistent management of the service which had impacted on the quality of people's care and had a detrimental impact on staff. The home had been without a registered manager since October 2023. The deputy manager started in April 2024 and the manager in June 2024, both left the service before Christmas 2024.

Staff described the manager and deputy as supportive and approachable and said they listened to staff, which had not been the case with some previous managers. One staff member said, “If you need any support they’ll do what they can to help. I think they know what needs to improve in the home and they’re fighting for us.”

Processes of delegation were unclear so it was not always evident who was responsible and accountable for all responsibilities. For example, the home had a nurse who was designated clinical lead as neither the manager or deputy manager were nurses. However, the clinical lead was not clear about their role, what it entailed or what was expected of them. They had not received any clinical supervision since starting in post.

A regional manager visited and provided support and guidance to the manager and staff in the home. Though the manager told us they had not received supervision since starting in post.

Staff told us they were aware of the Whistleblowing Policy and would feel able to speak up if they had any concerns or worries. The manager told us they had an ‘open door’ policy whereby staff could raise any concerns. However, staff told us they had repeatedly raised concerns about the staffing levels and felt their voices had not been heard.

There was a Whistleblowing Policy in place which formed part of staff induction. However, staff told us they had spoken up about their concerns regarding staffing levels and the provider had not taken action.

Staff told us they felt supported and encouraged by the home’s management team. They said they were asked their opinions on improving the service. One staff member said, “[Manager] is always helpful to us, giving us solutions if we have problems. But [manager] asks for our opinions as well so that we can all make the service better and better.”

The provider had an up-to-date recruitment policy and employed a diverse staff team. There was evidence of staff meetings, handovers, flash meetings and supervisions to show staff were included in decision making.

The provider had a ‘Star of the Month’ scheme whereby people using the service, relatives or staff could nominate a staff member for going above and beyond. The staff member was presented with a certificate and given a gift.

The manager’s oversight of the quality assurance processes and procedures was limited. They were not robustly implementing checks and identifying areas requiring improvement.

The deputy manager told us there was a weight log which showed people’s monthly weight and whether there had been a gain or loss. However, there was no system in place to analyse this information or show what action had and was being taken in response to low weight or weight loss. They said they would put this in place.

Staff were not always clear about their roles and accountabilities. Not all staff had received training or felt competent in using the electronic care management system.

The provider's systems and processes were not established or operated effectively to assess and monitor the service, or to ensure continuous learning and the improvement of the quality of care. For example, accident and incident management, safeguarding, infection prevention and control, risk management and the safety of the premises and equipment.

Internal processes had failed to address issues relating to person-centred care, medicines, staffing and training found during the assessment. Audits systems in place were not effective in improving and sustaining the quality of care. We saw audits identified some issues, however, actions required were not always completed.

Provider reports were detailed and identified issues and actions to be taken. However, although reports from June 2024 onwards showed some actions had been completed, many actions hadn’t and were carried over and new actions added. Our review of these reports showed repeated themes which indicated improvements were not sustained and the provider had failed to take action to address these shortfalls.

Collaboration with stakeholders and agencies needed to improve to ensure better outcomes for people. People were not involved in planning and reviewing their care. We found no evidence of residents’ meetings or reviews taking place to involve people in their care. No concerns were raised about accessing healthcare appointments.

The manager and deputy manager understood significant improvements were needed to improve the quality of the service and ensure better outcomes for people.

The local authority infection prevention and control team had carried out an audit in November 2024 and found significant shortfalls.

Processes were in place to promote partnership working and joined up care, however these were not always implemented effectively. For example, there was no evidence to show specialist advice had been sought for people with Parkinson’s disease prior to our intervention. Where specialist advice had been given this was not always followed by staff. For example, wound care treatment for a person with a pressure ulcer.

The manager and leadership team acknowledged significant improvements were needed to ensure continuous learning and achieve a good quality of life and outcomes for people.

There were not effective systems in place to ensure continuous learning and improvement at the service. Our assessment found widespread and significant shortfalls which the provider had not identified and addressed through their quality management systems. The leadership team took action to start to address some of the issues we raised during the assessment. Improvement plans were put in place and shared with us.