About the service: Thornton Hall and Lodge is a care home providing personal care for up to 96 older people. The home is purpose built and the accommodation is in four units over two floors. Two of the units within the home are designed to support people living with dementia. At the time of the inspection there were 72 people living at the home.

There was a change of legal entity for the service in December 2017. However, the senior management team remains the same as the previous legal entity. We therefore considered the previous ratings and breaches from both providers when planning and conducting this inspection.

People’s experience of using this service: People were not receiving care that was fully safe, effective, caring, responsive to their needs and well-led. The service is now judged to be inadequate in providing effective care as well as being inadequately well-led.

Before the inspection we had received a number of concerns regarding staffing levels and the quality of care. During the inspection, we observed caring and respectful interactions between staff and people living in the home.

Prior to the inspection we also received some concerns regarding inappropriate lifting techniques which had the potential to cause harm to people. There were two incidents we discussed with the manager during the inspection. These incidents had been dealt with appropriately by the provider.

Staffing levels during the inspection appeared adequate. Staff could respond to people’s support needs in a timely way. However, we raised concerns regarding the deployment of staff across the home. Staff told us one part of the home was under staffed. Staff would leave the floor they were working on to support the busier floor. We asked the manager to address this. Since the inspection, the manager has told us extra carers have been allocated to the busier floors.

People living in the home told us they felt safe. They felt there were enough staff to meet their needs. However, some relatives and staff told us there was not always enough staff and at times staffing levels had been unsafe. People acknowledged the provider was trying to address this with various recruitment incentives.

The management of medicines had improved since the last inspection. However, we still found some issues that needed to be addressed by the provider. We made a recommendation about this.

Safe recruitment practices were in place for permanent staff.

A high proportion of agency staff were used. Not all agency staff had the appropriate induction. The manager had not always had sight of agency profiles to ensure those staff were suitable to work with people living in the home.

Care plans were inconsistent and lacked detail. The service had recently moved from paper care files to electronic versions. The care plans we saw were not adequately completed and not effective at planning appropriate support for people.

Risk assessments were not fully completed or adequate for the management of people’s risks.

The service was not compliant with the Mental Capacity Act (MCA) 2005. People had not always had an appropriate assessment when they were deemed to lack capacity for a specific decision. People were being restricted without the lawful process being followed.

People told us they had enough to eat and drink. We saw drinks and snacks being offered throughout the day. However, staff told us there were limited food provisions available during the night. This was being addressed by the manager.

The quality assurance processes were inadequate. Issues raised at previous inspections had not been acted on. There have been repeated breaches of regulation.

Rating at last inspection: Requires Improvement (Report published 12th July 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports af

This inspection took place on 22 & 23 May 2018 and the first day of the inspection was unannounced.

Thornton Hall and Lodge 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.

Thornton Hall and Lodge is registered to provide residential care and support for up to 96 people. The home is purpose built and the accommodation is in four units over two floors. Two of the units within the home are designed to support people living with dementia. The home has aids and equipment to help people who are less mobile and the first floor is accessible by a passenger lift and staircase. Since the last inspection there has been a change of legal entity for the service however the senior management team remains the same as the previous legal entity. We therefore considered the previous ratings and breaches when planning and conducting this inspection.

During the inspection, there were 68 people living in the home. Twenty eight people were residing on “The Lodge” and 36 on “The Hall”. Following the last inspection, the provider took the decisions to stop admissions to the service to enable them to concentrate on making improvements. Prior to the inspection the service commenced a phased admission process; this was in light of the improvements they have made and following a review by the local authority to assess standards. The admission process is being carefully monitored by the registered manager and senior management team to support the service.

At the comprehensive inspection in March 2017, we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations in relation to how consent to care and treatment was sought, the management of medicines, risk management, care planning and systems in place to monitor the quality and safety of the service. The service was rated as 'Requires improvement' and we issued warning notices in relation to Regulation 12; safe care and treatment and Regulation 17; good governance. A Warning Notice was served in relation to Regulation 12, of the Health and Social Care Act 2008, Regulated Activities Regulations 2014, by way of unsafe medicine management.

We returned in October 2017 to carry out a comprehensive inspection and found the service had not improved and there were further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service had been unable to demonstrate sustained compliance with standards of quality and safety and there was a failure to sustain improvement. We found areas of continued breach and new breaches. We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations in relation to Regulation 12, the safe management of medicines; risks to people’s safety, the equipment and environment; Regulation 18; staffing levels, Regulation 11; consent in accordance with the Mental Capacity Act 2005 and Regulation 17; people’s plan of care and governance of the service. Following the inspection in October 2017 the service was rated as Inadequate and placed in Special Measures.

Special measures:

The overall rating for this provider is 'Inadequate'. This means that it has been placed into Special measures by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements