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Inspection carried out on 15 August 2019

During a routine inspection

About the service

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.

Inspection carried out on 10 November 2016

During a routine inspection

Thornley Leazes Care operates both a care home and domiciliary care service under their registration with the Care Quality Commission. The care home provides accommodation and personal care and support for up to 12 people, primarily with learning disabilities. Some people supported by the provider in both the care home and the domiciliary care settings, were living with dementia. In addition, some people supported with domiciliary care had physical disabilities. There were 12 people living at the care home at the time of our inspection, and a further five people in receipt of domiciliary personal care, in the local Allendale and Catton community areas.

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

Inspection carried out on 15, 16 & 19 January 2015

During a routine inspection

Thornley Leazes Care operates both a care home and domiciliary care service under their registration with the Care Quality Commission. The care home provides accommodation and personal care and support for up to 12 people, primarily with learning disabilities. Some people supported by the provider in both the care home and the domiciliary care side of the business, are living with dementia. In addition, some people supported with domiciliary care have physical disabilities. There were 12 people living at the care home at the time of our inspection, and a further 12 people in receipt of domiciliary care in the community in and around the Allendale area.

This inspection took place on 15, 16 and 19 January 2015 and it was unannounced. The last inspection we carried out at this service was in May 2014 when the provider was not meeting all of the regulations that we inspected which included cleanliness and infection control, the safety and suitability of premises and records. The provider submitted action plans linked to each of the regulations they were in breach of, stating how and by when they would meet the requirements of these regulations. At this inspection we found that 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. 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. Therefore there is no requirement for them to register a separate registered person as a manager.

Systems were in place to protect people from abuse and to report any abuse to the local authority safeguarding team for investigation. Two safeguarding concerns had been raised against the provider in the last 12 months which had been investigated and not substantiated.

People’s needs and the risks they were exposed to in their daily lives had been assessed. Care records were regularly reviewed in the home, but in respect of domiciliary care we found that although some improvements in records was evident, further work was needed as there was a lack of information and instruction for staff.

Care planning and risk assessing around the administration of medicines was not sufficient in the domiciliary care service. Records related to the administration of medicines did not accurately reflect how staff supported people to take their medicines. No agreements were in place about the level of support staff provided to assist people to take their medicines. Where there were medicines care plans or risk assessments in place, these were not detailed enough.

Regular health and safety checks were carried out on the premises and on equipment. The provider rectified an issue regarding door security during our inspection. Recruitment processes included checks to ensure that staff employed were of good character. The staff team and staffing levels were consistent and people’s needs were met. Staff records showed they received training related to their role which was up to date. Staff told us they received supervisions and appraisals and they could feedback their views directly to the registered provider at any time.

CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards exist to make sure people are looked after in a way that does not inappropriately restrict their freedom. The registered provider was in the process of applying for DoLS to be put in place for those people who lived at the home who needed them. We found the MCA was not always applied appropriately in that the best interest decision making process had not always been followed. Records did not fully reflect people’s capacity levels and we found the management of some people’s finances required review.

People told us, and records confirmed that their general healthcare needs were met. People’s general practitioners were called where there were concerns about their welfare as were other healthcare professionals such as dentists and chiropodists. People told us they were happy with the food they were served and they could ask for anything they liked and it was accommodated. People’s nutritional needs were met and specialist advice was sought when needed.

Our observations confirmed people experienced care and treatment that protected and promoted their privacy and dignity. Staff displayed caring and compassionate attitudes towards people, and people spoke highly of the staff team. Staff were aware of people’s individual needs. People and staff told us that regular activities took place within the home and the local community.

There was a lack of suitable quality assurance systems in place to monitor the service. For example, audits were not done in areas such as infection control, medication and health and safety. This had resulted in some shortfalls which the provider and staff team were unaware of. The registered provider had recently appointed a deputy manager whose role was to develop the administrative side of the business and introduce quality assurance measures to drive improvements within the service.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and their corresponding regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were; Regulation 10, Assessing and monitoring the quality of service provision which corresponds to Regulation 17, Good governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Regulation 13, Management of medicines, which corresponds to Regulation 12(f) & (g), Safe care and treatment, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; and Regulation 18 Consent to care and treatment which corresponds to Regulation 11, Need for consent, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 7, 8 May 2014

During a routine inspection

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;

• 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.