This inspection was unannounced and took place on the 3 and 10 December 2018.

Thornton House Residential Home 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 care home is registered to accommodate up to 22 people. At the time of the inspection there were 19 people living at the service one of whom was in hospital.

The home is required to have a registered manager. 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 this inspection we found shortfalls in relation to the safety and governance of the service. This was because medication was not always managed and administered safely. Good practice infection control and health and safety guidelines were not always followed and repairs to the emergency lighting identified in as being needed in August 2018 had not been made. The provider had systems in place for assessing the quality of the service but these had not been effective at identifying shortfalls in the quality of the service and driving improvement.

The providers had policies and procedures in place for staff to refer to but these had not been written in accordance with best practice guidelines and held out of date information.

Staff were recruited safely and there were enough staff on duty to respond to people's needs. New staff had completed an induction and were required by the provider to complete a nationally recognised qualification which provided them with underpinning knowledge and an introduction to working in care. However, staff had not always completed the training the provider considered mandatory.

Staff knew what they needed to do if they had any safeguarding concerns about people who lived at the service. They could describe what abuse may look like and knew how to report any concerns.

People's needs had been assessed before they made a decision about moving in. This information had been used to create care plans which detailed the support they needed to meet their health and social care needs.

People had formed positive relationships with staff who they told us were kind and caring. People felt confident they would be listened to if they raised any concerns.

People who needed help to eat were supported appropriately. People enjoyed the food on offer and mealtimes were a social and relaxed occasion.

People found the range of activities on offer stimulating and enjoyable. They also enjoyed trips out to local attractions and the entertainers that visited the service.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and report on what we find. We saw that the registered provider had guidance available for staff in relation to the MCA and had made appropriate applications for the Deprivation of Liberty Safeguards (DoLS). Care records reviewed included mental capacity assessments and best interest meetings.

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

This inspection took place on the 1 and 2 March 2017 and was unannounced.

Thornton House Residential home is registered to provide accommodation and personal care for up to 22 older people. The service also offers a day-care facility and bathing service to people within the local Community. The home is single room accommodation over two floors. Not all rooms have en-suite facilities. The service is close to the village of Little Sutton where there are a range of local shops that people can access. At the time of our inspection there were 20 people living at the service.

The service had a registered manager. 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 last focused inspection on 7 October 2016 we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements were required as the registered provider had failed to protect people from the risk of receiving unsafe care and treatment. After the inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breaches identified. They informed us they would meet all the relevant legal requirements by 30 November 2016. This inspection found that the required improvements had been made at the service.

Individual risk assessments were completed to ensure people supported, relevant others and staff were protected from the risk of harm.

People and staff described the registered manager as ‘approachable and supportive’. Effective systems were in place to monitor the safety and quality of the service and to gather the views and experiences of people and their family members. The service was flexible and responded to any issues or concerns raised. People told us they were confident that any concerns they had would be listened to, taken seriously and acted upon.

The service was accessible, clean and safe. Staff were able to describe their responsibilities for ensuring people were protected against any environmental hazards. Fire safety and all other relevant Health and Safety checks were appropriately completed at the service.

An assessment of people’s needs was carried out and appropriate care plans were developed. Care plans detailed people’s preferences with regards to how they wished their care and support to be provided. Care plans were regularly reviewed and updated to ensure people received the care required to meet their changing needs.

The overall management of medication and associated records was safe. People received their medication on time by staff who had received the appropriate training and competency checks. PRN medication protocols were in place regarding medicines to be taken ‘when required’.

Staff had undertaken safeguarding training and were confident about recognising and reporting suspected abuse. Procedures for minimising the risk of abuse and responding to an allegation of abuse were in place.

Staff had been employed following appropriate recruitment checks that ensured they were suitable to work in health and social care. We saw that staff recruited had the right values and skills to work with people who used the service. There were sufficient levels of staff in place to ensure all people’s needs were met people were kept safe.

Staff communicated with others in a respectful and professional manner. The service worked with healthcare professionals to ensure people’s health and wellbeing needs were met. People received prompt medical and wellbeing services and staff assisted people to follow recommendations in relation to their health.

People are supported to have maximum choice and control of their lives and staff supported them in the lea

We carried out an unannounced comprehensive inspection of this service on 11 January 2016. 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 breaches of Regulation 15 and 17 of the Health and Social Care Act 2008. We issued a warning notice in regards to Regulation 17 (Good Governance) and told the registered provider that they had to be complaint by 1 August 2016.

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 Thornton House Residential Home on our website at www.cqc.org.uk

Thornton House Residential home is registered to provide accommodation and personal care for up to 22 older people. The service also offers a day-care facility and bathing service to people within the local community. The home is single room accommodation over two floors. Not all rooms have en-suite facilities. At the time of this inspection 21 people were living at the service.

There was a registered manager. 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.

We found that action had been taken to improve the overall safety and oversight of the service. However, we identified a further breach of Regulation.

We could not improve the rating for Safe or Well Led from “Requires Improvement" because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

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

The registered provider and the registered manager had implemented a series of audits in order to monitor and review the effectiveness of the service. This looked at key aspects such as care documentation, medicines, health and safety, cleanliness and infection control. Whilst, these audits were now in place, they were not fully effective in highlighting some of the concerns noted on inspection.

Staff did not follow the guidance made available to them on the use or monitoring of pressure relieving matrasses. This meant that people could be at risk of developing a pressure ulcer.

Not all safety checks on water and equipment had been carried out in a timely manner at the time of this inspection. The registered provider confirmed following the inspection that these were now completed.

People told us that they felt safe and that they had no concerns about the care they received. They said that staff were kind, patient and knew them well. The registered manager had identified and informed the relevant agencies about any matters of concern within the service.

People said that the service was homely. They had no complaints about the standard of cleanliness or the building itself. Comment was made that some of the improvements such as the bathroom and lift were taking a long time to come to fruition. People said that they were kept comfortable and staff had the right equipment to be able to care for them safely.

People and their families knew who the registered manager was and felt that they could go to her with any concerns or complaints. They felt that she went over and above to ensure that people were kept comfortable as did all the staff. People and staff had the opportunity to share their views on the service.

We carried out an unannounced comprehensive inspection on 11 January 2016.

Thornton House Residential home is registered to provide accommodation and personal care for up to 22 older people. The service also offers a day-care facility and bathing service to people within the local community. The home is single room accommodation over two floors. Not all rooms have en-suite facilities. At the time of this inspection 21 people were living at the service.

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 a focused inspection on 7 July 2015, breaches of legal requirements were found. These were in regards to the operating of safe and effective recruitment processes and a failure of registered provider to ensure that they had systems in place to ensure that people’s health and welfare were monitored appropriately.

We asked the registered provider to take action and make a number of improvements by 17 November 2015. We found that some improvements had been made but we found a number of additional breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of the report.

The people who lived at Thornton House told us that they felt safe and that staff looked after them well. Staff knew how to identify if people were at risk of abuse and knew what was required to ensure they were protected from harm. However, we found that people were at risk as staff did always not ensure that the equipment was used properly.

The environment in which people lived required repair and refurbishment. It was also not visibly clean in some areas which meant that people were at greater risk of an acquired infection. The registered provider did not have schedule of works in place to demonstrate when improvements would be made and or when they would be completed. Checks had been carried out to ensure that the building and utilities were safe.

People told us that staff came to them when they called but were concerned that staff were “Busier than ever.” We found that the dependency levels of persons who used the service had increased but the registered provider could not demonstrate that this had been taken into account when setting current staffing levels. This meant that they could not assure us that care could be delivered effectively and that people could be kept safe in the event of an emergency. We recommended that they undertook a systematic review of staffing levels and reviewed recognised guidance around fire safety.

Care was provided in a kind and dignified manner. People and their relatives made positive comments about the service and the care received. They said that the care staff and the registered manager were always available and would have no hesitation in going to them with worries and concerns.

Staff encouraged people to do things for themselves and helped them to be as independent as possible and to carry out aspects of their own personal care. People told us, where they were able, that they were given choices, allowed to take risks and staff included them in decision making. Where a person lacked mental capacity to make decisions about their care and treatment, staff had taken into account the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards,

The care plans gave a meaningful and personal picture of the person being supported. They also gave enough information for staff, not familiar with the person, to deliver support. Records kept on a day to day basis, however, did not accurately reflect the care that was being given. This meant that concerns, for example, around nutrition and hydration may not be highlighted. It was recommended that the registered provider review their auditing processes to ensure that records are an accurate reflection of support delivered.

The registered manager had ensured that people received support from staff that had been thoroughly vetted to ensure they were of suitable character and skill to do the job. Staff received appropriate training and support.

The registered provider failed to have in place a robust quality audit system to help them monitor the overall care that people were receiving or issues relating to the service.

We carried out an unannounced focused inspection of this service on 7 July 2015.

Thornton House Residential Home is registered to provide accommodation and personal care for up to 22 older people. The home has single room accommodation over two floors. Communal areas include a dining room, reception room, a lounge and a conservatory. The home is located on the outskirts of Ellesmere Port and is within reach of local services, community and public transport. At the time of this inspection 20 people were living at the service.

Since our previous inspection on 8 January 2015, the manager has registered with the 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.

At our comprehensive inspection on 8 January 2015, breaches of legal requirements were found. These were in regards to the operating of safe and effective recruitment processes and ensuring that suitable arrangements were in place for gaining people’s consent. We asked the registered provider to take action to make a number of improvements. After the inspection, the registered provider wrote to us to say what action they would take in relation to the breaches identified. They informed us they would meet all the relevant legal requirements by 22 June 2015.

We undertook this focused inspection to check that they had followed their action plan and to confirm that they now met legal requirements. On the 8 July 2015, we found that whilst the registered provider had made some improvements, they had not fully met their own action plan; We found a continued breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of the report.

At the last inspection the registered provider was required to ensure that people, who were deprived of their liberty, were done so in accordance with the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Where a person’s liberty was being restricted or they were under continuous supervision, we found that the manager had made the appropriate application to the supervisory body under Deprivation of Liberty Safeguards. Where a person lacked capacity to make a specific decision or choice, staff understood why decisions had to been taken in somebody's best interest and clearly documented this. This meant the rights of people, who were not always able to make or communicate their own decisions, were protected.

However, people were not protected from the risks associated with staff that may not be of suitable character to provide care to them. The registered manager had failed to ensure that the required checks with the disclosure and barring service (DBS) had been carried out prior to staff commencing employment.

This report covers our findings in relation to those requirements and a review of the well led domain. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Thornton House Residential Home) on our website at www.cqc.org.uk

The inspection took place on 8 January 2015 and was unannounced. This meant that the provider did not know that we were coming.

We previously inspected this service on 13 November 2013 and they were compliant in all outcomes inspected.

Thornton House is registered to provide personal care for up to 22 older people. The home has single room accommodation over two floors. Communal areas include a dining room, reception room, a lounge and a conservatory. The home is located on the outskirts of Ellesmere Port and is within reach of local services, community and public transport.

There was not a registered manager. 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 current manager, previously worked as the deputy, and has applied to the care quality commission to become the registered manager.

The people who lived at Thornton House told us that they felt safe and that staff looked after them well. Staff knew how to identify if people were at risk of abuse and knew what to do to ensure they were protected.

We saw that care was provided with kindness. People and their relatives spoke positively about the home and the care that they or their relatives received. They felt that staff and the manager were approachable and they could go to them if they were worried. Everyone had a telephone in their room and were encouraged to keep in contact with friends and family. Staff understood the care that people needed, encouraged them to do things for themselves and helped them to be as independent as possible. They did not rush people and took the time to talk and chat. They also spent time doing activities and helping them maintain their interests. The records that staff kept gave a meaningful and personal picture of the person being cared for.

We found there was a breach of Regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) 2010 because the manager had not followed the appropriate recruitment checks. This meant that they had not made sure that people were receiving their care from staff that had been thoroughly vetted to ensure they were suitable to do the job. However, we found that staff were skilled and provided care in a safe environment. They all understood their roles and responsibilities and wanted to make a difference to the lives of the people they cared for.

People told us, where they were able, that they were given choices and that staff included them in decision making. However, we found that the manager and staff did not have a clear understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). This was a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2010 because, where someone lacked in capacity, the service failed to have suitable arrangements in place to ensure they acted within the law.

The manager had recently taken over this role and was in the process of putting in place quality audit systems to help them monitor the overall care that people were receiving. All staff spoke positively about the support they received from the manager and that they were always approachable and willing to help them out. There was a good level of communication within the home.

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

We saw that people’s wishes and preferences were respected in relation to the care being provided. This had been done with their relative’s involvement were necessary. Care plans contained information about the life history of each person and provided detailed guidance for staff on how people wished to be supported.

People who used the service told us they were happy at the home and had no concerns with the care and treatment provided. The relatives' we spoke with also told us they had no concerns. Comments included; "Mum is always clean and well cared for and well fed. That is enough for me", "I couldn't get any better. They have made a new woman out of me since I came here" and "I'm always bathed and showered. The food isn't bad either."

People who used the service told us they felt safe at the home. The relatives' we spoke with also told us that they considered Thornton House was a safe place to live.

The relatives and people who used the service told us they thought the service had enough staff. They told us that call bells were answered in a timely manner.

We saw the service carried out monthly audits of various aspects of the service’s operations such as medication management, care planning and the homes environment. When concerns were identified, an action plan was drawn up to enable progress to be made.

We found that records were kept securely and could be located promptly when needed.

At our last visit to the service on 17th December 2012 we found that improvements were needed to the records around the promotion of health and safety of the home environment. At this visit we found an improvement to these records had been made. This demonstrated that checks had taken place to ensure people were protected from the risks of unsafe or inappropriate care and treatment.

We spoke to three people who used the service. They said they were well looked after and happy with the service they received. They were positive about the staff who supported them. Some comments made were:-

“The staff are fantastic. I couldn’t fault any of them.”

“The staff are very good I get on smashing with them. It’s a very good service.”

We spoke to a relative and a friend of people who used the service. They said that a good service was provided and that the staff were caring and helpful.

We spoke to a health care professional. They said that the staff made appropriate referrals to them and followed any advice given.

Records showed that people had been assessed before they began to use the service and they had a care plan in place detailing the support they needed.

There were systems in place to obtain the views of the people who used the service and their relatives about how the service operated. Records showed that action was taken to address any shortfalls identified.

A tour of the home indicated that the service was clean and well presented.

There were practices in place to ensure that the recruitment of staff appropriately supported the people who used the service.

We found that improvements were needed to the records around the promotion of health and safety of the home environment.