This comprehensive unannounced inspection took place on the 5 and 12 March 2018.

Thorn Hall is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is located in Thorngumbald, in the East Riding of Yorkshire. It has accommodation for a maximum of 19 older people, some of whom may be living with dementia. During this inspection there were seven people using the service.

The service had a registered manager in post. 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 and associated Regulations about how the service is run.

At our previous comprehensive inspection on 28 November 2016, the service was given an overall rating of requires improvement. Caring was rated as good. Safe, effective, responsive and well-led were rated as requires improvement. We issued two requirement notices for breaches in Regulation 17, good governance and Regulation 18, staffing. You can read the report from our last inspections on our website at www.cqc.org.uk. The provider completed an action plan to show what they would do to meet the requirements of the regulations.

Although we found some improvements had been made during this inspection visit, we identified continued breaches of Regulations 17 and 18, and an additional breach of Regulation 11, need for consent, of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. The providers systems for assessing and monitoring the service were not consistently identifying where improvements were needed. Staff had not completed the required training to ensure their skills and knowledge were up to date to carry out their role and meet people’s individual needs. Consent to care and treatment was not always sought in line with legislation and guidance. There was a lack of evidence that the Mental Capacity Act (MCA) legislation had been followed for two people.

This is the third time this service has been rated requires improvement.

Staff had been supported through the regular use of supervision. The service had a training matrix in place. We saw not all staff had been trained in control of substances hazardous to health (COSHH), nutrition, mental capacity act, equality and diversity, food hygiene, infection control and first aid. Staff files we reviewed showed five of those had no induction present.

Staff had developed good relationships with people using the service. Staff were aware of the importance of ensuring people's privacy and dignity was respected at all times, however we observed a number of occasions where they had failed to do this.

People lived in an environment that was suitable for their needs and checks on the services equipment were up-to-date. There was a programme of building work planned to change and improve the layout and facilities at the home. The environment was sufficiently hygienic however; the laundry room did not have any hand wash facilities. The provider told us there were plans in place to create a new laundry facility. We saw one bath had a part of enamel that had rubbed away and two toilet floor coverings had holes in them. This meant that any spills would be able to leak under the floor and would prevent the area from being cleaned effectively, increasing the risk of infection. Cleaning schedules had not been consistently completed. The registered manager updated us after this inspection with appropriate actions in response to these findings.

Staff had a good knowledge of what people could do, how they communicated and where they needed help and support. People were supported to make choices and decisions about how they spent

This inspection took place on 28 November 2016 and was unannounced.

At our last inspection of the service on 15 October 2015 the service was rated as ‘requires improvement’ and we identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the premises and health and safety equipment within it were not safe for use or used in a safe way. We issued a requirement notice. As part of this inspection we checked if the registered provider had made improvements.

Thorn Hall in the village of Thorngumbald is a care home without nursing. It provides accommodation and care in single and shared rooms to 19 older people who may be living with dementia. There are communal lounges, a dining room, several bedrooms and bathroom and toilet facilities on the ground floor. There are also bedrooms and bathroom facilities on the upper floor, which is accessed by a stair lift. Grounds to the side of the house provide seating in the summer months. There is parking for eight cars. At the time of the inspection there were 13 people using the service, five of whom were living with dementia.

The registered provider is required to have a registered manager in post and on the day of the inspection the manager who was employed at the home was registered with the Care Quality Commission (CQC). 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.

Recruitment was on-going to ensure enough care staff were employed to meet the needs of people who used the service. However, there was an expectation from the registered provider that care staff also filled the roles of activity person, cleaning and laundry staff and kitchen duties at tea-time. The staff team worked well together to ensure the needs of people were not affected by any dips in staffing levels and there was a good atmosphere in the service. We raised concerns with the registered manager about the impact the levels of staff were having on cleanliness of the service, activity levels and record keeping.

We found the staff training programme was not robust and did not include all necessary subjects to ensure that people who used the service were supported by staff with the right competencies and skills to meet their needs and keep them safe from harm. Although people who used the service and relatives told us they were satisfied with the quality and quantity of food and drinks being served, we found that the recording of nutritional needs and specialist diets could be better.

People knew how to make a complaint and those who spoke with us were happy with the way any issues they had raised had been dealt with. People had access to complaints forms if needed and the registered manager had investigated and responded to the complaints that had been received in the past year. However, these actions were not well documented.

We saw evidence that care plans were not always accurate or up to date. This meant that staff did not have access to complete and contemporaneous records in respect of each person who used the service, which potentially put people at risk of harm.

Quality assurance and record keeping within the service needed to improve. There was a lack of effective auditing within the service.

People who used the service told us that they received their medicines on time and were happy with the way they were administered by the staff. However, there were a few minor issues around record keeping that we discussed with the registered manager on the day of our inspection. These were considered by us to have a low impact on people who used the service. We have made a recommendation in the report about medicine management.

We found that the servi

This inspection took place on 15 October 2015 and was unannounced. We previously visited the service in September 2013 and we found that the registered provider met the regulations we assessed.

The service is registered to provide accommodation and care for 19 older people, some of whom may be living with dementia. There are two communal lounges, a dining room and several bedrooms on the ground floor, with the remaining bedrooms on the first floor. None of the bedrooms have en-suite facilities. The first floor is accessed by a stair lift.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager in post who was registered with the Care Quality Commission (CQC). 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.

During this inspection we identified a breach of regulation; this related to the risks associated with the safety of the premises. You can see what action we told the provider to take at the back of the full version of the report.

The home had not been maintained in a safe condition; on the day of the inspection we found that the gas safety certificate and the electrical installation certificate had expired. The roof in one area of the home was leaking and there were two large red buckets in the middle of the floor that created a trip hazard. The environmental risk assessment had identified areas of risk and we recommended that the registered provider reviewed the risk assessment to ensure people’s safety was protected.

However, people told us that they felt safe living at the home. We found that people were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding issues. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Staff confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them. The training records evidenced that most staff had completed training that was considered to be essential by the service and that some staff had achieved a National Vocational Qualification (NVQ). Medicines were administered safely by staff who had received appropriate training.

New staff had been employed following the home’s recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people had been employed. We saw that there were sufficient numbers of staff employed to meet people’s individual needs.

People told us that staff were caring, pleasant and helpful, although we received comments to indicate that some staff were considered to be more caring than others.

People commented that they would like to have more activities to keep them occupied, and we made a recommendation to the registered provider in respect of providing more social stimulation.

People told us they were happy with the meals provided at the home and we saw a picture menu board had been obtained to assist people with cognitive difficulties to choose their meals.

There were systems in place to seek feedback from people who received a service, although quality assurance systems would have been more effective if feedback had been analysed to identify any improvements that needed to be made. Complaints received by the service had been investigated appropriately.

The quality audits undertaken by the registered provider were designed to identify any areas that needed to improve in respect of people’s care and welfare. We saw that, on occasions, incidents that had occurred had been used as a learning opportunity for staff.

People told us they usually had an exchange of information with staff regarding any support they needed and that staff asked people about the tasks they needed help with. People said this happened on a daily basis so they gave consent to their needs being met. We saw people had signed their care plans to agree to the support they were given.

We found that peoples' needs were met according to the information detailed in their care plans and risk assessments. People spoke well of the staff and we saw there were supportive relationships between people and staff. They said, "We are well looked after. The food is good", "The girls always help me" and "The staff are very good, they support me very well and their intentions are good”.

People told us they were happy with the arrangements to handle their medication. They said, “The medication is managed by the staff, that’s all right with me” and “The girls give us our medication so we don’t forget to take it”. We saw that systems to manage and administer medicines were safe.

We saw that while the environment was clean, homely and comfortable there were some areas that had not been upgraded for some years. The manager had personally been redecorating bedrooms and some new furniture and carpets had been purchased. The programme of upgrading was on hold at the time we visited.

We found that some areas of the service performance were audited and people were surveyed and although these had been analysed the information had not been collated to produce an overall performance statement as feedback to people and relatives.

Complaints were satisfactorily handled and resolved though there were no records to view for the last two years as no complaints had been made to the service. People said they knew how to complain and the procedure was clearly accessible.

We spoke with three people that used the service and with a relative that was visiting one of them.

People that used the service told us they enjoyed a good level of privacy and that their dignity was well respected.

People told us they liked living at Thorn Hall and that they were well cared for.

One person said, "We are well looked after. We have good food, clean beds and the staff are always willing to help."

People also told us they knew who to talk to if they felt unhappy or unsafe in any way. They said they would talk to the manager or the staff.

One relative told us they would speak up if they thought the home was not meeting peoples' needs.