This unannounced inspection took place on 16 and 21 February 2017.

The Thorns Retirement Home is situated in Hest Bank village in Lancaster. The home provides accommodation for a maximum of fifteen people who are 65 and over. Accommodation is provided in 11 singles and 2 double bedrooms over two floors. A lift is available for use between floors. The double rooms are used as singles, unless occupied by couples who want to share. En-suite facilities are available. The home is set within its own grounds, including a designated car park. At the time of the inspection visit there were nine people residing at the home.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We last carried out a comprehensive inspection of the service 07 and 12 October 2015. At this inspection we rated the service as requires improvement as we identified concerns within the environment. We also found processes were not in place to ensure CQC was notified of all significant events. We carried out a focussed inspection in May 2016 to ensure all improvements had been made. We found the service had made all required improvements.

At this inspection carried out in February 2017, people and relatives spoke positively about the care delivered. People told us staffing levels were conducive to meet their needs. We observed staff being patient and spending time with people who lived at the home.

Staff treated people with kindness and compassion. We observed staff being patient with people and offering reassurance when required. People who lived at the home and relatives all commended the caring nature of the staff team. We noted there was an emphasis on promoting dignity, respect and independence for people who lived at the home.

People told us they felt safe and secure in a homely environment. Arrangements were in place to protect people from risk of abuse. Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns.

Suitable arrangements were in place for managing and administering medicines. The registered manager carried out audits of medicines to ensure systems were being followed correctly by staff. We noted action had been taken by the registered manager when areas for improvement were identified.

Recruitment procedures were in place to ensure the suitability of staff before they were employed. Staff told us they were unable to start their employment without all the necessary checks being in place.

People’s healthcare needs were monitored and managed appropriately by the service. People told us guidance was sought in a timely manner from health professionals when appropriate. Relatives praised the ways in which people were supported to maintain good health.

Care plans were in place for people who lived at the home. Care plans covered support needs and personal wishes. People who lived at the home and relatives said they were involved in the care planning process. Plans were reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required.

Feedback on the quality of food provided was extremely positive from both people who lived at the home and relatives. People were happy with the variety, quality and choice of meals available to them. People’s nutritional needs were addressed and monitored.

There was a variety of social activities on offer. The registered manager had established links with various community groups who frequented the home and provided entertainment. Cultural needs were recognised and addressed by the registered manager.

People who lived at the home praised the living standards of

We carried out an unannounced comprehensive inspection of this service in October 2015. At this inspection breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Thorns Retirement Home on our website at www.cqc.org.uk

This unannounced focussed inspection took place on 03 May 2016.

The Thorns Retirement Home is situated in Hest Bank village near Lancaster. The home provides accommodation for a maximum of fifteen people who are 65 and over. Accommodation is provided in 11 singles and two double bedrooms over two floors. A lift is available for use between floors. The double rooms are used as singles, unless occupied by people who want to share. Ensuite facilities are available within some of the rooms. The home is set within its own grounds and has a designated car park.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the inspection we were informed the registered manager was in the process of retiring and they were inducting a new manager who was intending to start the registration process. We spoke with the manager as part of the inspection process.

There were thirteen people living at the home at the time of the inspection.

The service was last inspected on 07 and 12 October 2015. At this inspection we found the registered provider was not meeting all the fundamental standards. We identified a breach to Regulation 17 the Health and Social Care Act 2014 as the registered provider did not have systems in place to assess, monitor and improve the safety of services provided. We also identified a breach to Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 as the registered provider had failed to report notifiable events to the Care Quality Commission.

Following the inspection in October 2015, we asked the registered provider to submit an action plan to show what changes they were going to make to become compliant with the appropriate regulations. The registered provider returned the action plan to demonstrate the improvements they intended to make. We used this inspection to look to see if the action plan had been completed and to ensure all fundamental standards were now being met.

At this focussed inspection carried out in May 2016, we found improvements had been made.

Highlighted environmental concerns had been actioned to promote safety of the people who lived at the home.

Systems had been implemented to ensure all notifiable incidents were relayed to the Care Quality Commission in a timely manner.

Portable appliance testing had been carried out to demonstrate that appliances used within the home were suitable for use.

An expired fire risk assessment had been reviewed and updated by an external fire safety company.

However we found evidence the risk assessment had not been reviewed by the management of The Thorns Retirement Home. Immediate action was taken by the registered provider once we had highlighted these concerns. We have made a recommendation about this.

We spoke individually with the manager and four staff at The Thorns. We also discussed standards of care with two people living at the home and two relatives. We observed staff interactions with people in their care. We reviewed care records, staffing rotas and the home’s safeguarding procedures. We also checked policies and procedures, as well as various audit processes.

We observed staff interacting with people in a very supportive and respectful manner. This matched their related care plans. Care records were person-centred and reviewed regularly. One person told us, “I’m very pleased with the home, the staff and the level of care I receive”.

The Thorns had effective procedures in place to safeguard people from potential abuse. We additionally observed that the home had appropriate staffing levels and staff skill mixes. Suitable systems were in place to monitor the quality of the service provided.

We spoke individually with four people living at The Thorns Retirement Home. We asked people to tell us about their experiences of living at the home. People told us they were happy living there. We were also told that the staff team were patient and kind.

One person told us “I feel like it’s my home. Staff support me in ways that best suit me”. Another individual told us “The staff are very caring and visitors can come and see me at any time”

We observed the interaction between the staff and the people who used the service. The staff were respectful of people and treated them with dignity. For example, we saw staff knocking on people's bedroom doors before entering. We also saw staff offer assistance with personal care needs in a discrete and dignified manner.

We spoke with a relative who told us “I’m confident that the care and support provided for mum is very good and I have no concerns”.

This unannounced inspection took place on 07 and 12 October 2015.

The Thorns Retirement Home is situated in Hest Bank village near Lancaster. The home provides accommodation for a maximum of fifteen people who are 65 and over. Accommodation is provided in 11 singles and two double bedrooms over two floors. A lift is available for use between floors. The double rooms are used as singles, unless occupied by people who want to share. Ensuite facilities are available within some of the rooms. The home is set within its own grounds and has a designated car park.

There were twelve people living at the home on the day of inspection.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected on 8 January 2014. We identified no concerns at this inspection and found the provider was meeting all standards that we assessed.

At this inspection, feedback from relatives and visitors was positive and people who lived at the home spoke highly about the quality of service provision on offer. Staffing levels were conducive to meet people’s needs. We observed staff being patient with people and meeting their needs in a responsive manner.

Arrangements were in place to protect people from the risk of abuse. People told us they felt safe and secure. Staff had a sound knowledge of safeguarding and were aware of their responsibilities for reporting any concerns. However processes in place were inconsistent to ensure that all safeguarding alerts were communicated to the Care Quality Commission (CQC.)

Robust recruitment procedures were in place to ensure staff were correctly vetted before being employed.

The registered manager had suitable arrangements in place for managing medicines. Medicines were safely kept and appropriate arrangements for administering them were in place. The registered manager carried out regular audits of medicines to ensure systems in place were being followed correctly by staff.

People’s healthcare needs were monitored and referrals were made to health professionals in a timely manner when people’s health needs changed.

People were happy with the variety and choice of meals available to them. Regular snacks and drinks were available to people between meals. Mealtimes were seen as a social occasion for people who lived at the home. Relatives and visitors were made welcome and were encouraged to eat with people who lived at the home. Feedback on the quality of food provided was positive from both people who lived at the home and relatives.

Risks to people who lived at the home were sometimes appropriately managed. Systems were in place to manage people at risk of falls, people at risk of pressure ulcers and other health related conditions. However risks presented within the environment were not always appropriately managed. We noted a fire risk assessment completed by an external specialist agency for the registered provider had not been acted upon and was out of date. The registered manager also failed to identify that portable appliance testing was also out of date. We identified a hot water tap that was not temperature regulated. This placed people at risk of harm of being scalded from the hot water.

The registered provider kept a detailed log of all accidents and incidents that had occurred at the home. However during the course of the inspection we identified two serious incidents that had not been reported, as required to the Care Quality Commission.

The home provided a good array of social activities for people who lived at the home. Family members and friends were encouraged to participate in activities. Consideration was taken to ensure people who chose not to interact within groups were supported in their rooms. Cultural needs were also recognised by the registered provider.

Detailed care plans were in place for people who lived at the home. Care plans covered their support needs and personal wishes. We saw plans had been reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required.

Staff were positive about their work and confirmed they were supported by the registered manager. Staff received regular training to make sure they had the skills and knowledge to meet people’s needs.

You can see what action we told the provider to take at the back of the full version of the report.