Thorndene

We found the following examples of good practice.

There was a COVID-19 champion at the service. They ensured staff, people and relatives had access to testing, personal protective equipment (PPE) and information. They also monitored areas such as staff training and testing.

There was accessible information for people who needed this support to understand COVID-19 and how to stay safe. People were supported to use PPE if they wanted to do so.

There were sufficient supplies of appropriate PPE. Staff wore PPE as required.

Thorndene is a residential care home that was providing personal care for seventeen people living with severe healthcare needs, learning disabilities, autism spectrum disorder and behaviour that challenges. The home has been developed and designed in line with best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. These values were seen in practice at the home. For example, the building was like any other on the road with no signs to show

it was a care home. Staff did not wear uniforms and people lived their lives in the ways they wanted.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found improvements had been made since our last inspection and the service has met the characteristics of Good and Outstanding in responsive. The overall rating is Good.

What life is like for people using this service:

• The home has shown continuous improvement following our previous inspection in August 2016. For a home which supports people with multiple and complex needs and with behaviours that challenge, there have been remarkably positive and consistent outcomes for people.

• Staff had an excellent awareness of individuals' needs and treated people in a warm, loving and respectful manner. They were knowledgeable about people's lives before they started using the service. Every effort was made to enhance this knowledge so that their life experiences remained meaningful.

• The registered manager and staff went above and beyond what was expected of them to ensure people received personalised and responsive care and support. Everyone including those with limited verbal communication could express an opinion about the care provided and contributed to their care plans.

• The provider promoted a good quality of life for people. People were happy living at the home, were able to express themselves and engage with staff, participate in activities they enjoyed within the home and in their community and develop their skills and independence.

• People were supported to maintain relationships with those important to them and to develop new relationships.

• The registered manager had inspired and supported the staff team to improve people's lives, had achieved good outcomes for people, ensured people were kept safe and received high quality, person centred care and support in line with all their individual needs.

• The registered manager and their team provided excellent support to staff; and were open and transparent in their management. The management team put people at the heart of what they did, and were well supported by the provider in their quest to deliver a good service.

More information is in Detailed Findings below.

Rating at last inspection:

Good (Report published August 2016)

Follow up:

Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Good.

Thorndene is a residential service for 22 people living with a learning disability. People also had communication and mobility needs. There were 21 people living at the service at the time of inspection. The service offers spacious accommodation. It is a large country house, arranged in small homely groups, with a separate, smaller bungalow in the grounds providing accommodation and support for five people. The bungalow is designed to promote increased independence.

The care and support needs of the people varied greatly. There was a wide age range of people living at the service with diverse needs and abilities. The youngest person was in their 30’s and the oldest in their 80’s.

There was a new registered manager working at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run. On the day of the inspection the registered manager was not available. The previous registered manager who recently retired from the post supported us throughout the day. The previous registered manager continued to support the new registered manager and was also a director of the company. There were also two duty managers who oversaw the day to day management of the main house and a manager who oversaw the management of the bungalow. There was duty manager on site seven days a week.

Staff had received safeguarding training to protect people. They said that they would report any concerns to the registered manager and felt confident that the correct action would be taken to keep people safe and protect them from abuse. Some staff were unsure where to report any concerns of abuse to outside the company, like the local authority safe guarding team. This is an area for improvement. Systems were in place to ensure that people’s finances were protected.

Risks to people were identified and there were measures in place to reduce risks to keep people as safe as possible. There was guidance in place for staff on how to care for people effectively and safely and keep risks to a minimum without restricting their activities or their lifestyles. People received the interventions and support they needed to keep them as safe as possible. Accidents and incidents were recorded and the majority were reviewed to identify if there were any patterns or if lessons could be learned to support people more effectively to ensure their safety. Some of the accident and incident reports lacked detail. When people had unexplained bruising these were recorded but no analysis or cross referencing had taken place to investigate how the bruising might have occurred and how to reduce it in the future. This was an area for improvement.

Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do. There were regular fire drills so people knew how to leave the building safely. Safety checks were carried out regularly throughout the building and the equipment to make sure they were safe to use.

Staff told us how they always asked people for their consent as they provided the care. They described how they supported people to make their own decisions and choices. Some people chose to be supported by their relatives when making more complex decisions. Staff had received training on the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made, involving people who know the person well and other professionals, when relevant. The management understood this process.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLs applications had been made to the relevant supervisory body in line with guidance. Care staff would benefit from further clarity of why and how they were supporting people in line with their deprivation of liberty recommendations. This was an area for improvement.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. When prospective staff had gaps in their employment history this had not always been recorded. This was an area for improvement.

People had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team. People had key workers that they got on well with. Staff were caring, kind and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff. When people could not communicate verbally, staff anticipated or interpreted what they wanted and responded quickly. Staff respected decisions that people made when they did not want to do something and supported them to do the things they wanted to. People had choices about how they wanted to live their lives. Throughout the inspection people were treated with kindness and care.

There was a strong and visible person centred culture in the service. (Person centred means that care is tailored to meet the needs and aspirations of each individual.) The registered manager/provider, the duty managers and all the staff were passionate about providing a service that placed people and their families at the very heart of the service. They provided support that was based on mutual respect and equality. As a result, people felt really cared for and that they mattered. People received care that was personal to them. Staff understood their specific needs well and had good relationships with them. People were settled, happy and contented. People chose to spend time with staff. Staff treated people as individuals with dignity and respect. Staff were familiar with people’s life stories and were very knowledgeable about people’s likes, dislikes, preferences and care needs. They approached people using a calm, friendly manner which people responded to positively. This continuity of support had resulted in the building of people’s confidence to enable them to make more choices and decisions themselves and become more independent.

Before people decided to move into the service their support needs were assessed by the registered manager. People's care and support was planned and reviewed to keep people safe and support them to be as independent as possible.

People were supported to participate in a variety of activities that they enjoyed and that were tailored to their needs and choices. Activities took place throughout the week. A system to receive, record, investigate complaints was in place, which showed complaints had been responded to appropriately.

There was an effective system of monitoring people’s health needs and seeking professional advice when it was needed. Assessments were made to identify people at risk of poor nutrition, skin breakdown and for other medical conditions that affected their health.

People were supported to have a nutritious diet. Care and consideration was taken by staff to make sure that enjoy their meals. People chose the food and drinks that they wanted.

People received their medicines safely and when they needed them. They were monitored for any side effects. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable.

There were enough staff, who knew people well, to meet their needs at all times. The needs of the people had been considered when deciding how many staff were required on each shift and to support people in different activities. Staff were clear about their roles and responsibilities and worked as a team to meet people's needs. People received care and support from a dedicated, stable team of staff that put people first and were able to spend time with people in a meaningful way.

Staff had support from the registered manager to make sure they could care safely and effectively for people. Staff completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. Staff completed essential training provided by the company. There was also training for staff in areas that were specific to the needs of people, like epilepsy and dementia. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.

The registered manager led the staff team and had oversight of the service. Staff were motivated and felt supported by the registered manager. The registered manager and staff shared a clear vision of the aims of the service. Staff had received regular one to one meetings with a senior member of staff. They had an annual appraisal, so had the opportunity to discuss their developmental needs for the following year.

The provider had systems in place to monitor the quality of the service. Audits and health and safety checks were regularly carried out. The registered manager had sought formal feedback from people, relatives

We spoke with several of the people who used the service. Those spoken with were happy with the care and support given and had no concerns with regard to the quality of care. One said "I enjoy living here. Staff treat me well and help me. If I am unhappy I talk to the manager". Another person said "Staff help me and talk to me if I am worried". Through observation during the inspection, we were able to observe staff supporting people who used the service in a respectful way and observed staff taking time to explain, where possible, the options available whilst involving people in making choices.

Through direct observation, discussions with staff and records we viewed, we saw that the service actively encouraged people to be members of the wider community. The service provided imaginative and varied opportunities for people to develop and maintain social, emotional, communication and independent living skills.