Archived: Thornley Leazes Care

Thornley Leazes Care is a residential care home providing personal care for up to 12 older people, some of whom had learning disabilities and others who lived with dementia. There were 12 people living at the service during the inspection. The service also operated a domiciliary care service out of the same building and they supported 19 people in the local community.

Thornley Leazes Care accommodates 12 people in a two-storey building. The service continued to work towards the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Staff followed infection control procedures. Overall medicines were managed well and the provider was reviewing paperwork in connection with this.

People continued to receive good care and were supported with kindness and compassion. Staff knew people well and provided support which met people’s needs and enabled them to take part in activities within the home and community in line with their preferences.

People felt safe and staff knew how to protect them from harm. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Various paperwork, particularly in the home care element of the service required some improvements to ensure it was always robust and up to date. Quality checks were in place and were in the process of being reviewed. We have made a recommendation in connection with these.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good overall (published 22 February 2017). Improvements were required in the well- led key question and this continued to be the case.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on 10 and 11 November 2016 and it was unannounced. The last inspection we carried out at this service was in January 2015 when the provider was not meeting all of the regulations that we inspected which included the need for consent, safe care and treatment and good governance. The provider submitted action plans linked to each of these breached regulations, stating how and by when they would meet the requirements of these regulations. At this inspection we found improvements had been made in all three of the regulations that had been breached at our last visit.

Thornley Leazes Care does not require a registered manager to be in post under their registration with the Commission, as the registered provider is an individual in day to day charge of the service and the carrying on of the regulated activity. A registered manager is a person who has registered with the Care Quality Commission to manage the service. In this service, the provider is a ‘registered person’ who is actively involved in the service who has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Concerns identified at our last visit to this service in January 2015 related to the management of medicines and people's finances had been addressed and we were satisfied that measures had been put in place to support people to remain safe. Medicines were now managed safely and some small areas for further improvement were discussed with the assistant manager and registered provider.

Staff were aware of their personal responsibility to report matters of a safeguarding nature and they were knowledgeable about the different types of abuse. People told us they felt safe living at Thornley Leazes Care residential home or in receipt of care from the service on a domiciliary basis, and we found no evidence during our inspection that contradicted this.

Risks within the environment of the care home setting and in people's own homes had been assessed and measures put in place to mitigate these risks. Equipment used in care delivery had been appropriately serviced and checked to make sure that it remained safe for use. A business continuity plan had been drafted for staff to refer to in an emergency, for example if there was a loss of power to the building. Health and safety checks around the building were carried out regularly, including fire safety checks.

Staffing levels within the service were appropriate to meet people's needs and were adjusted depending on people's activities and their desire to access the community. Staff files revealed that recruitment processes were thorough and that staff were trained in areas relevant to the needs of the people they supported. They received appropriate supervision and appraisal and told us they felt supported to fulfil their roles by the registered provider, and the assistant and home care managers.

People received an effective service from staff who were knowledgeable about their needs, likes and dislikes. They enjoyed good relationships with each other. Staff provided person-centred care and understood people's behaviours and personality traits. People told us they were supported to live their lives in the way that they wanted to and that their general healthcare needs were met. Records supported this.

Staff supported people to remain as independent as possible and they maintained people's dignity when delivering care. Some conversations were not held in private when they should have been. The registered provider took our feedback about this on board and said this would be addressed. Advocacy services were available to those people who wished to assess them.

CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. The Mental Capacity Act (MCA) was appropriately applied and applications to deprive people of their liberty lawfully had been made to prevent them from coming to any harm where they lacked capacity. The service understood their legal responsibility under this act and that they assessed people’s capacity when their care commenced and on an on-going basis when necessary. Decisions that needed to be made in people’s best interests had been undertaken. Records about such decision making needed to be improved.

People told us they received care that was responsive to their needs. They enjoyed a range of activities which they were supported to pursue by staff. People made day to day choices and they spent their time as they wanted to. They reported that the food was of a good standard and they could choose alternatives if they did not like the meal prepared at any one time. The care people received was appropriately monitored and feedback from people, staff and visitors about the service was gathered formally in annual surveys and throughout the year at any time in person. An appropriate complaints policy and procedure was in place and it was brought to the attention of people and visitors to the service.

Improvements to quality assurance systems and processes since our last inspection were evident and formal documented audits related to infection control, health and safety matters and medicines had been introduced. However, some of this auditing needed further development. In addition, some records and recording across the service (residential and domiciliary) needed to be improved. Some people's care records needed to be more detailed and records related to the MCA and recruitment needed to be better maintained and organised. We have made a recommendation about reviewing quality assurance processes, governance and recording within the service.

We found a small number of incidents had not been notified to the Commission in line with legal requirements. In addition, the provider had failed to display the rating they were awarded following our last comprehensive inspection of the service in January 2015. We have made a recommendation about these two matters.

We received positive feedback from people and staff about the registered manager and her approach.

The registered provider accepted all of the feedback we gave at this visit and said she was committed to making the necessary improvements to the service.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

Is the service caring?

We saw that people were supported by kind and attentive staff who displayed patience and gave encouragement when supporting people. Our observations confirmed that staff promoted independence whilst ensuring that they offered assistance to people when required. People told us that they were happy with the care and support they received from the service. One person said, "I like it here" and "The staff are fine." One person's relative said, "I trust the staff. I know that they are going to take care of 'X'."

People (and their relatives and staff) told us they pursued many activities and this was evident during our inspection. Some people were supported with community based activities such as shopping, and to attend social events such as going to the theatre. This showed that the provider promoted people's community involvement and well-being.

Is the service responsive?

People's care needs and any potential risks that they may be exposed to were assessed before they received care and support from the provider. In the care home setting, the provider had arrangements in place to review people's care records regularly and they assured us that amendments would be made to people's documentation as their needs changed to ensure they remained accurate and any issues were promptly addressed.

Staff told us, and records showed that where people required input into their care from external healthcare professionals, such as occupational therapists or doctors, or where, for example, their weight or behaviours needed to be monitored, they received this care.

There was an effective complaints system in place although records showed that no complaints had been received whilst the service has been under the provider's ownership.

Is the service safe?

There were enough staff on duty to meet people's needs. Records showed that staff were appropriately trained to ensure that they were equipped with the correct skills and attributes to carry out their jobs effectively and safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLs) which applies to care homes. The provider confirmed that no applications for a deprivation of a person's liberty under the Mental Capacity Act 2005 have been submitted to the local authority safeguarding team. We discussed the recent supreme court judgement handed down on March 2014 in the case of 'P v Cheshire West and Chester Council and another' and 'P and Q v Surrey County Council', about what constitutes a deprivation of liberty. The provider confirmed they would contact their local safeguarding team in light of this judgement, for further advice on their responsibilities and the arrangements they now need to put in place, for people in their care.

We looked at how the provider managed medicines and found that this was appropriate. Medication administration was safe and records were complete. In addition, the obtaining, storage, safe keeping and disposal of medicines was safe.

The home was generally clean although some equipment and furnishings that people came into contact with were not clean. Infection control procedures that were in place were not always followed by staff and some of these procedures did not follow national best practice guidelines. This was putting people at risk of infection. We have set a compliance action and asked the provider to tell us what they are going to do to meet the requirements of the law in relation to maintaining a clean and hygienic environment and following infection control national best practice guidelines.

We found the building was not well maintained because damp and mould was present in communal areas and within people's bedrooms. In addition, entry into the building was not secure and therefore any person(s) may have been able to enter the building undetected. People were not accommodated in a safe environment. We have set a compliance action and asked the provider to tell us what they are going to do to meet the requirements of the law in relation to maintaining a safe and appropriate environment.

People's care needs had been assessed but their care records were not always well maintained. For example, we saw that people who lived at Thornley Leazes had care plans and risk assessments in place, and those people in receipt of care in their own homes did not. There was a risk that people may not receive safe care, as staff did not always have individualised care plans and risk assessments to refer to. We have set a compliance action and asked the provider to tell us what they are going to do to meet the requirements of the law in relation to maintaining appropriate care records.

Is the service effective?

People told us they were happy with the staff who cared for them and they met their needs. One person said, "The staff are alright." Another person told us, "I like staff." It was evident from speaking with staff and through our own observations that staff had a good knowledge of the people they cared for and their needs.

Certificates were available that showed staff had received appropriate and up to date training to meet people's needs effectively.

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. A care manager and a district nurse that we spoke with told us they were confident that the provider delivered a good care service and kept them updated and fully informed of any changes in people's care needs.

A quality assurance system was in place and the provider gathered the views of people and staff about the service they delivered. One relative had commented in a questionnaire, "I have always thought the residents are well looked after."

Staff told us they were clear about their roles and responsibilities. The provider had a range of policies and procedures in place which gave direction and instruction to staff. Staff and management meetings were held as and when required. Health and safety checks were carried out regularly and where applicable in line with national or best practice guidelines.