This inspection visit took place on 20 November 2018 and was unannounced.

Thornton House accommodates 45 people across four separate units, each of which have separate adapted facilities. One of the units (Byron) specialised in providing care to people living with dementia. Two units (Keats) provided rehabilitation services and the Wordsworth unit provided mainstream residential care. At the time of our inspection visit on 20 November 2018 there were 32 people who lived at the home.

Thornton House is a 'care home.' People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this 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. When we undertook this inspection visit the registered manager was on extended leave and wasn’t in post undertaking their day to day managerial duties.

At the last inspection on 20, 21, 29 November and 05 December 2017 we asked the provider to take action to make improvements because we found breaches of legal requirements. This was in relation to safe care and treatment, staffing, notifications of other incidents and good governance. We received a provider action plan and the provider said they would meet the relevant legal requirements by 30 April 2018. During our inspection visit on 20 November 2018 we found these actions had been completed.

During the last inspection of the service we found the home in breach of the regulation associated with ensuring the risks to people's health, care and welfare were appropriately assessed. During this inspection we found risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

When we last inspected the service we found the deployment of staff during the night was not always sufficient to meet people's support plan requirements. Checks completed during the night on the services four units were inconsistent. This left frail and vulnerable people unsupervised and at risk of harm. During this inspection we found regular checks were completed and people received the support they required.

At the last inspection we found staff had not received training for maintaining and checking bedrails. Good practice guidance says staff must receive training in relation to the safe use of bedrails. During this inspection we found staff had received the required training.

During the last inspection we identified four serious injuries that had occurred over a seven month period which had not been reported to CQC. During this inspection we did not identify any accidents which the service hadn’t reported to CQC.

When we last inspected the service we found the quality and accuracy of documentation maintained by the service was inconsistent. We found gaps in records and a lack of information about people at risk of losing weight with their dietary intake. During this inspection we found records maintained were accurate and reflected people's needs.

At the last inspection the service used a variety of methods to assess and monitor the quality of the service. However, these had not been effective and had failed to identify the concerns we found during the inspection process. During this inspection we found the service had effective auditing and quality assurance systems in place.

During this inspection people who lived at the home and their visitors told us they were very happy with the care provided at the home and staff were cari

The inspection visits took place on 20, 21, 29 November and 05 December 2017. The inspection visit on 20 November 2017 was unannounced. Thornton House accommodates 44 people across four separate units, each of which have separate adapted facilities. One of the units (Byron) specialised in providing care to people living with dementia. Two units (Keats) provided rehabilitation services and the Wordsworth unit provided mainstream residential care. At the time of our inspection visit on 20 November 2017 there were 41 people who lived 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.

At the last inspection on 05 April 2016 the service was rated Good.

At this inspection carried out 20, 21, 29 November and 05 December 2017 the service was rated Requires Improvement. This is the first time the service has been rated Requires Improvement.

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with CQC about the incident indicated potential concerns about the management of risk of falls from beds. This inspection examined those risks.

We looked at how the service managed risk to keep people safe. We found risk was not appropriately addressed and managed. This placed people at risk of harm. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities, 2014 (Safe care and treatment).

We found the deployment of staff during the night was not always sufficient to meet people’s support plan requirements. Checks completed during the night on the services four units were inconsistent. This left frail and vulnerable people unsupervised and at risk of harm. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Staffing) as the registered provider had failed to ensure staff were effectively deployed at all times.

Staff had been recruited safely, trained and supported. Staff told us they received regular supervision and their work was appraised annually. However staff had not received training for maintaining and checking bedrails. Good practice guidance says staff must receive training in relation to the safe use of bedrails. (MHRA Safe Use of Bed Rails. December 2013). This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014 as the registered provider had failed to ensure staff had the required skills to provide safe care and treatment.

During the inspection we identified over a seven month period one serious injury had not been reported to CQC, one accident where the nature of the injury had not been recorded and two injuries which potentially were reportable. This meant that we did not receive all the information about the home that we should have done. This was a breach of Regulation 18 of the Care Quality Commission Registration Regulations 2009 (Notification of other incidents).

We found quality and accuracy of documentation maintained by the service was inconsistent. We found gaps in records and a lack of information about people at risk of losing weight with their dietary intake. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good governance) as the registered provider had failed to ensure records maintained were accurate and reflected people’s needs.

The registered manager used a variety of methods to assess and monitor the quality of the service. However these had not

This inspection was carried out on the 5 April 2016 and was unannounced. We last inspected Thornton House Home for Older People in November 2013 and identified no breaches in the regulations we looked at.

Thornton House Home for Older People is registered to provide personal care and accommodation for up to 44 older people. Care is provided on a 24 hour basis, including waking watch support throughout the night. The home is divided into four areas. Two providing rehabilitation care. One dementia care and one residential care. At the time of the inspection there were 42 people living at the home.

Accommodation is provided over two floors, with a lift providing access to the first floor. There are a range of communal rooms, comprising of a lounges, dining rooms and kitchen areas. There are garden areas with seating for people to use. Car parking is available at the home.

The home is managed by a registered manager. A registered manager has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they were happy living at Thornton House Home for Older People and the care met their individual needs. People described staff as ‘wonderful’ and ‘thoughtful’ and told us they were involved in their care planning.

There were systems in place to protect people at risk of harm and abuse. Staff were able to define abuse and the actions to take if they suspected people were being abused.

We found individual risk assessments were carried out and care plans were developed to document the measures required to reduce risk. Staff were knowledgeable of the measures in place and we observed these were followed these to ensure peoples’ safety was maintained.

We found medicines were managed safely. We saw people were supported to take their medicines in a dignified manner and there were systems in place to ensure medicines were stored securely.

We found appropriate recruitment checks were carried out. This helped ensure suitable people were employed to work at the home. We found there were sufficient staff to meet people’s needs. People were supported in a prompt manner and people told us they had no concerns with the availability of staff.

Staff received regular support from the management team to ensure training needs were identified. We found staff received appropriate training to enable them to meet people’s needs.

Processes were in place to ensure people’s freedom was not inappropriately restricted and staff told us they would report any concerns to the registered manager.

We found people were offered a variety of foods and people told us they liked the meals at Thornton House Home for Older People.

People were referred to other health professionals for further advice and support when assessed needs indicated this was appropriate. We spoke with four visiting health professionals who voiced no concerns with the care provided at the home.

Our observations during the inspection showed staff treated people with respect and kindness. People told us they considered staff were caring and we saw a positive rapport between staff and people who lived at the home.

Staff knew the likes and dislikes of people who lived at the home and delivered care and support in accordance with people’s expressed wishes. During the inspection we noted people were supported to carry out activities which were meaningful to them.

There was a complaints policy in place, which was understood by staff. Information on the complaints procedure was available in the reception of the home.

We walked around the home and spent time with people in the lounges and dining areas. This helped us to observe the daily routines and gain an insight into how people`s care and support was being managed. One said, "The staff know my relative very well, and I feel confident that they look after them in the the best possible way." There were infection control policies and procedures in place which had been developed in line with Department of Health guidance. The manager had appointed a lead person for infection control and they had a role in maintaining links with external professionals and ensuring that the home’s procedures were updated with any changes in national guidance or best practice. The way the staff interacted with people was seen to be positive. Staff knew people well and were aware of their individual needs. We saw people approach staff and engage in conversation, or ask for something and staff responded promptly to these requests. We saw a variety of audit reports undertaken by the registered managers and others.We looked at a sample of the service's policies and procedures. We found the policies and procedures to be detailed, clearly written and easy to understand.

During our visit we observed staff treating people in a friendly and respectful way. We observed people being offered choices and being supported in a way that respected their privacy and encouraged their independence. We spoke with four people who lived at the home. They told us they were happy with the care and support they received. One person said, "I am happy here; I'm well looked after and it’s a lovely place".

People who lived at Thornton House, and their relatives, were encouraged to express their views and opinions of the service. Their views were used to improve and develop the service.

We found new staff were recruited safely and all staff received regular training to give them the skills and knowledge to look after people properly. We spoke with three staff. They told us they would feel confident to speak out against poor practice if needed. People living in the home said, “I am treated very well” and “Everyone is very kind and patient”.

People were happy with the staff team. Comments included, “Staff are lovely; absolutely brilliant” and “Staff help with a smile and kind manner”. Staff told us they were happy working in the home.