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Inspection carried out on 11 April 2018

During a routine inspection

Thornlea delivers care and support for a maximum of 17 older people. At the time of our inspection, 17 people lived at the home. Thornlea is a bungalow, situated on a main road in the South Shore area of Blackpool. There are two lounges, a dining room and a rear garden with a decking area offering a range of seating. There are multiple aids and adaptations to meet the needs of people who live there.

At the last inspection on 04 November 2015, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

During this inspection visit, people we spoke with said they felt safe and comfortable living at the home. Thornlea was clean and well-maintained and care records we reviewed included risk assessments intended to enhance everyone’s safety and welfare. Staff had training to protect people against the risk of harm, poor care and abuse.

We observed staff ensured people received their medicines on time and concentrated on one person at a time. Evidence in staff files confirmed employees who administered medicines completed relevant training to protect individuals from unsafe management of medication.

The provider followed their recruitment policy to protect people from unsuitable staff. Records we reviewed evidenced there were sufficient numbers and skill mixes of staff to meet each person’s requirements. Staff undertook a variety of training courses to underpin their duties. A relative said, “There are lots of staff on duty and they all seem well trained.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. When we discussed choice, consent and freedom with people and relatives, they told us they felt in control of their lives.

Staff frequently provided fluids to maintain people’s hydration levels. We observed they offered a choice of food at meal times and checked each person had sufficient to eat. A relative commented, “The food is very nice.”

We observed staff engaged with those who lived at Thornlea and their relatives with a cheerful and friendly approach. People were smiling and relaxed throughout our inspection, which demonstrated strong bonds with those who supported them. A relative commented, “The staff are A1, top notch. They’re so lovely.”

Care records we looked at showed the management team engaged people and their relatives in the development of their care plans. People and relatives told us staff involved them in all aspects of their care, including the review and update of treatment.

The provider had worked with the local hospice to ensure staff received accredited training in end of life care provision. Staff monitored each person’s general health, through a coding system, to ensure the provision of additional support if the person started to deteriorate.

Staff discussed and agreed what support people required and established a care plan to meet their needs. We found records were person-centred because assessments and documentation were geared towards the individual’s abilities and preferences.

The management team conducted and completed a variety of processes to check quality assurance and people’s experiences of living at Thornlea. These included multiple audits to retain oversight of everyone’s safety and welfare. People and relatives told us Thornlea’s management team were supportive, approachable and led the home well.

Further information is in the detailed findings below.

Inspection carried out on 04 November 2015

During a routine inspection

The inspection visit at Thornlea was undertaken on 04 November 2015 and was unannounced.

Thornlea provides care and support for a maximum of 15 older people. At the time of our inspection there were 15 people living at the home. Thornlea is situated in a residential area of Blackpool close to local amenities. All bedrooms offer single room accommodation and there is a lounge and dining area. There are gardens available so people can choose where to relax.

A registered manager was 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 06 May 2014, we found the provider was meeting all the requirements of the regulations inspected.

During this inspection, we found staff were knowledgeable about protecting people from potential harm or abuse. People told us they felt safe and comfortable whilst living at Thornlea. One person said, “I come here for day care because I am safe in here when the family are out at work.” The management team had completed risk assessments designed to protect people from unsafe care.

Staff used a kind and respectful approach when they engaged with people. The provider had guided staff to support individuals in ways that protected their human rights and maintained their dignity and privacy. One person told us, “The staff are very kind and caring and treat me with dignity and respect when carrying out personal tasks for me.”

We found there were enough staff to meet people’s requirements in a timely manner. A relative stated, “There are sufficient staff on duty and they respond quickly to the bell when it is used.” The management team provided training and regular supervision to ensure staff were effective in their roles. The provider had followed safe recruitment procedures to protect people from unsuitable personnel.

We observed people’s medicines were managed in a safe and discrete manner and they received their medicines on time. One person confirmed, “My medication is given on time.” Staff had received related training to underpin their knowledge and skill. The registered manager and local pharmacy had carried out checks to ensure processes were completed safely.

People were supported to eat their meals where they chose and were offered a variety of meal options. One person said, “The food is good and I get plenty to eat and drink.” Risk assessments and other documentation, such as weight charts, were in place and updated to protect individuals from the risk of malnutrition.

The provider had guided staff in the principles of the Mental Capacity Act (MCA) and associated Deprivation of Liberty Safeguards (DoLS). We observed staff consistently checked people’s consent prior to explaining and offering support.

Care records were personalised to each person’s requirements. We noted staff regularly completed assessments of people’s needs. These were reviewed and updated to ensure care planning remained responsive to the individual’s ongoing requirements. We found people and their representatives were involved in their care.

People and their representatives commented the management team was ‘hands on’ in their approach to the organisation of the home. Staff said the provider was supportive and led the home well. One staff member told us, “[The provider] is a fantastic employer and he supports us well.” People were supported to feed back about the quality of their care. There were a number of audits in place to check and maintain their health, safety and well-being. The provider worked in partnership with other services to share and obtain good practice.

Inspection carried out on 29 April 2014

During a routine inspection

During this inspection we looked at how well people were cared for, how the service worked in cooperation with other agencies to ensure appropriate planning took place. How the home was staffed to meet the needs of people living there. What quality monitoring systems were in place. We also looked at what systems were in place to enable people to raise comments and concerns about their care and treatment and whether this was effective in keeping people safe.

Information we gathered during the inspection helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, staff supporting them, and from looking at records. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Thornlea.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Systems were in place to make sure management and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The manager had been trained to understand when an application should be made and how to submit one. This meant people would be safeguarded as required. The manager said, �We have all just recently attended training.� Staff we spoke with confirmed this.

Staff we spoke with had knowledge and understanding of individual personal care plans and risk management plans for people they were supporting. One staff member told us, �All the plans are being updated. The information is good as it is clear and easy to follow�.

Maintenance service certificates were in place and up to date to ensure systems in the home were safe.

Is the Service Effective?

People�s health and care needs were assessed with them, and they were involved in developing their plans of care where possible. Relative�s views were also sought to ensure people received the right care to meet their needs. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

In order to deliver effective care the manager and staff demonstrated an understanding of the individual needs of people living at the home. Staff we spoke with told us they worked well as a team to ensure people�s needs were being met. One said, �We work well as a team. It�s a small home and information is being passed down all the time�.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting residents. Comments from people we spoke with included, �I have been here a long time. It�s a peaceful place to live�. Also, �The staff are always around. They can�t do enough for you�.

Throughout the day we spent time in all areas of the home to observe staff interaction with residents. People were supported by kind and attentive staff. We saw staff showed patience and gave encouragement when supporting people. One resident we spoke with said, �I would not want to be anywhere else.� Staff told us they felt there were enough staff on all shifts to provide care and support to people living at the home. This was confirmed when we looked at staffing ratios on weekly rotas.

People�s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes. Residents personal histories had been developed by staff. Staff we spoke with told us this had helped them to identify with things personal to the resident. One staff member told us, �This has helped us get to know people better�.

Is the Service Responsive?

People had access to a range of literature relating to the complaints procedure. Relatives and residents we spoke with said they knew how to make a complaint if they were not satisfied. One person told us, �If I am not happy with something I would tell A�., she always listens and sorts things out�. Staff and managers we spoke with told us a system was in place to investigate record and reach outcomes for any complaints they received. People could therefore be assured complaints would be investigated and action taken as necessary.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. The service had reviewed and was developing a more robust quality assurance system. Records we looked at showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had an understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure people received a good quality service at all times.

There were a range of audits and systems put in place in by the manager and provider to monitor the quality of the service being provided.