Thornhill House Church Lane

Thornhill House is a care home providing personal and nursing care to 19 people aged 65 and over at the time of the inspection. It is a purpose built, single story home in a countryside setting next to a village.

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

People and their relatives told us the service provided excellent care. They told us how they felt that Thornhill House was their home and that they were supported by caring staff who showed genuine compassion and respect to those living in the home. We saw lots of positive interactions with staff and people, and we could see people enjoyed the company of staff. Staff respected each person's rights and treated them as individuals. Care plans and risk assessments were person centred and they detailed how people wished and needed to be cared for. They were regularly reviewed and updated as required. We observed a strong, community orientated service.

People and their relatives had trust and confidence in the staff and management and everyone, without exception, said they would recommend the service to others.

People, their relatives and other health and social care professionals gave consistent, positive feedback about the service. This included the approach of staff, registered manager and partnership working. One GP told us, “The care there is superb and frankly sets them far apart from the neighbouring care homes.” The registered manager and staff regularly worked with other professionals to ensure the best outcomes for people living in the home.

The provider ensured people had access to a wide range of meaningful activities. This included trips out to places that people said they wanted to visit and events. We saw many examples of where the involvement of the local community had enabled people to feel included and part of their community once again.

The management team had maintained an open and supportive culture in the home. Staff and people using the service told us they felt the registered manager was approachable and accommodating.

Medication was managed safely for the majority. During inspection we identified that the recording of ‘as and when’ medications was not sufficient however the registered manager immediately acted on this feedback. Additionally the premises were very safe, and checks were carried out regularly however the documentation did not reflect this. Again, the registered manager was responsive, open and transparent and immediately actioned this.

Risks which compromised people’s health and well-being were appropriately assessed, reviewed when needed and contained detailed information. People told us they felt safe with the service.

Accidents, incidents, safeguarding and complaints were managed appropriately and monitored by the management.

The registered manager had a range of audits in place and accessed other sources of information to review and improve practice. People were able to give their opinions on their care service and a range of communication methods were in place to ensure people continued to have this opportunity.

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.

Policies and procedures were in place and updated, such as safeguarding, complaints, medication and other health and safety topics. infection control standards were monitored and managed appropriately.

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 Outstanding (report published 31 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Thornhill House on our website at www.cqc.org.uk.

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.

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.

Thornhill House Church Lane was last inspected on 9 September 2014 and they were meeting all of the standards that we reviewed at that time.

There was a strong commitment to developing caring, respectful relationships with people and they were supported by staff who demonstrated compassion and empathy. People and their relatives told us that staff were extremely kind, caring, and thoughtful and people were afforded privacy and treated with dignity and respect. They received a personalised service which encouraged meaningful, imaginative activities and opportunities for people to pursue and develop hobbies. Links with the community were pursued to ensure that people were not socially isolated and they were able to continue important relationships.

People were involved in planning their care and were consulted about any changes that were considered. People received care which was based on best practise and continually reviewed. Care was planned around people’s individual preferences and this included their spiritual and cultural wishes. People’s diverse needs were considered and their human rights were respected. They had also developed a recognised approach to support people at the end of their lives to ensure that it was dignified and comfortable.

People’s relatives could visit at any time and reported that they were always welcomed. Complaints were encouraged and any concerns were thoroughly investigated and lessons were learnt from them.

People were protected by staff who understood their responsibilities to detect and report abuse. Risk to people’s wellbeing were assessed and actions put in place to reduce them. People received their medicines as prescribed and safe systems ensure that they were protected from harm.

People told us that there were always enough staff to meet their needs promptly and that they felt safe. Staff received training and support to enable them to fulfil their role effectively and were encouraged to develop their skills. .

Staff supported people to make choices and sought consent to their care. When people were unable to make their own decisions they were made in their best interest, with people who mattered to them. Restrictions on people’s liberty were considered and applications made to ensure that they were legally approved.

The manager and staff team worked closely with external healthcare professionals to ensure people's health and wellbeing was promoted and maintained. Mealtimes were planned to ensure that people had good quality food and a choice, as well as regular access throughout the day.

The home was managed by an experienced and motivated registered manager who developed their staff team to ensure that they were up to date with new and best practice. There was a strong commitment to deliver a high standard of personalised care and continued improvement was based on the views of people who used the service. There were systems in place to drive quality improvement which included regular audits and responsibilities were shared within the staff team.

We spent time speaking with people who lived at Thornhill House as well as speaking with staff, a medical professional and a volunteer advocate. We reviewed records and spent time observing people in the home. If you want to see the evidence that supports our summary please read the full report. We used the evidence to answer five questions.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people who lived there. We spoke with people who said that they felt safe and secure. One person said, "This is an excellent place to live. Everything about it is superb, especially the staff." Every member of staff we spoke with said that they were happy with staffing levels and said that these helped to provide safe and appropriate care.

Staff records demonstrated that mandatory training was up to date and that staff were trained to meet the complex needs of people. Staff were trained in caring for people with Alzheimer's disease, complex communication needs and dementia.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

During our visit people asked to spend time talking to us. We were told how comfortable they were living there and how much like home it felt. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well. For example, we noted that staff were able to tailor the way they spoke to each person, particularly their sense of humour and speech, to be able to make each person feel listened to and important.

A person told us that they felt looked after and enjoyed everything about living there, especially the quality of the food. People were cared for by staff who were supported to deliver care safely and to an appropriate standard. Staff had received training to meet the needs of the people living at the home and told us that they were able to put their training into practice.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people, especially when they needed help moving around or just wanted a chat. Staff took into account the complex needs of people when planning activities so that they could take part in these safely. We spoke with a person who said, "I go out for a walk every day, even in the winter. It keeps me healthy and sometimes I get to see a game of cricket, which I really enjoy."

Staff said that they were very happy with the level of professional and emotional support they received from the registered manager. One member of staff said, "This is the best working atmosphere I've ever had, it is absolutely spot on."

Is the service responsive?

People's needs had been assessed before they moved into the home and these were checked by regular reviews, in which they were involved. People's needs assessments included an assessment of their capacity to make decisions as well as consideration of their dietary and nutrition requirements.

People's preferences and interests were acted on by staff who used monthly meetings to support people to meet their needs and goals. People had access to activities that were designed to stimulate them and they were able to influence the running of the home. We spent time speaking with a specialist activities coordinator who told us that people felt involved and listened to in the planning of activities because of the process of involving them by using meetings.

Is the service well led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Staff told us that they were clear about their roles and responsibilities and that management support helped them to do their job effectively. One person spent time talking with us and the registered manager and wanted us to know how well supported they had felt. A medical professional said, "This place is phenomenal, the staff are really superb."

People told us that the food provided was very good and we found that people's nutritional needs were being met.

People thought that staff were well trained to meet their needs and records confirmed that most staff were up to date with relevant training.

People living at the home told us that they were happy and well cared for. One person told us that they were ''well looked after'' and ''the staff are wonderful''. Another person explained that they attended meetings which were held to discuss any issues or complaints and to agree things like food choices and activities.

The relative we spoke to said that she ''couldn't ask for anywhere nicer'' and that '' it is like a family here and I am very happy with the standard of care''. The visitors we spoke to told us that they had been waiting eleven months for a place to become available and that this was the only home they would consider placing their relative in as it ''is fantastic''.

We observed staff carrying out their duties in a kind and considerate manner, and that the wishes of individual people were respected