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Inspection carried out on 14 March 2018

During a routine inspection

Thornbank is a residential care home that provides care for up to 33 older people. Some people using the service were living with dementia. At the time of this unannounced inspection of 14 March 2018 there were 30 people who used the service.

At our last inspection on 12 February 2016, we rated the service overall Good, The key questions Safe, Caring, Responsive and Well Led were rated good. The key question Effective was rated Requires Improvement with a breach of Regulation 11 of the HSCA Regulated Activities 2014, Need for consent. Shortfalls included people had not been assessed properly in relation to their mental capacity and where required best interests meetings had not been completed.

We asked the provider to complete an action plan to show what they would do and by when to improve the key question of effective. The provider submitted an action plan to us about the measures they were taking to address the concerns found at the previous inspection. This included training in the Mental Capacity Act and Deprivation of Liberty safeguards, competency assessments for all staff, weekly observations by the registered manager and improvements to people’s care records regarding their capacity.

During this inspection 14 March 2018 we found that the improvements had been fully embedded into practice and Effective is now rated as Good. We found the evidence continued to support the overall 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.

The service continued to provide a safe service to people. This included systems in place intended to minimise the risks to people, including from abuse, falls and with their medicines.

Staff understood their roles and responsibilities in keeping people safe. They were trained and supported to meet people’s needs. Staff were available when people needed assistance and had been recruited safely.

People were complimentary about the care they received and the approach of the registered manager and staff. They told us that they felt safe and well cared for. Staff had developed good relationships with people. Staff consistently protected people’s privacy and dignity and promoted their independence.

Systems were in place to receive, record, store and administer medicines safely. Where people required assistance to take their medicines there were arrangements in place to provide this support safely.

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.

People enjoyed a positive meal time experience and were enabled to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and access healthcare services.

People received care that was personalised and responsive to their needs. They participated in meaningful activities and were supported to pursue their interests. The service listened to people’s experiences, concerns and complaints and took action where needed.

The environment met the needs of the people who lived there. All areas of the home were clean and in good state of repair with equipment maintained.

The registered manager was accessible, supportive and had good leadership skills. Staff were aware of the values of the provider and understood their roles and responsibilities. Morale was good within the workforce.

The service had a quality assurance system and shortfalls were identified and addressed. There was a culture of listening to people and positively learning from events so similar incidents were not repeated. As a result the quality of the service continued to improve.

Inspection carried out on 12 February 2016

During a routine inspection

Thornbank Residential Care Limited provides accommodation and personal care for up to 33 older people, some living with dementia.

There were 30 people living in the service when we inspected on 15 February 2016. This was an unannounced inspection.

There was a registered manager in post. 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.

Staff were trained and supported to meet the needs of the people who used the service. However, people’s capacity to make decisions was not always properly assessed. This meant consent was not routinely obtained for all aspects of care and treatment provided.

There were procedures and processes in place to ensure the safety of the people who used the service. There were sufficient numbers of staff to meet people’s needs. Recruitment processes checked the suitability of staff to work in the service. There were arrangements in place to ensure people were provided with the medicines in a safe way.

People’s nutritional needs were assessed and met. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

Staff had good relationships with people who used the service and were attentive to their needs. Staff respected people’s privacy and dignity and interacted with people in a caring, respectful and professional manner.

People were provided with personalised care and support which was planned to meet their individual needs. People, or their representatives, were involved in making decisions about their care and support.

A complaints procedure was in place. People’s comments, concerns and complaints were listened to, and addressed in a timely manner.

Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system and shortfalls were identified and addressed promptly. As a result the quality of the service continued to improve.

Inspection carried out on 24 April 2013

During a routine inspection

During our inspection we spoke with four people who used the service and a visiting friend of a person who used the service. We asked them to tell us how they felt they were being cared for. They told us, �Good quality� and, �Very good." We asked people how they felt the staff treated them. One person said, "Staff look after me beautifully." A friend of a person who used the service said, "Staff are great."

Our observations indicated that staff asked the people who used the service if they wished to participate in activities and receive support to meet their personal needs. We observed that staff gave people choices.

The service had good infection control procedures in place and complaints were being managed appropriately.

We found that staff were well trained and well supported by the service's management team.

Inspection carried out on 10 May 2012

During a routine inspection

We spoke with five people who used the service. They told us that they were treated with respect and that their views and choices were listened to and acted upon. People also said that they felt that their needs were met. They were all positive about the food available and the choices they had. One person commented that they thought the food was �Very good� and the cook �Considered everything�.

A relative told us they thought that staff were �Kind and considerate� and that they �Couldn�t go anywhere better.� Two people told us that their family visited �Anytime.� We asked all five people if there were enough staff to help them if they needed anything. They all replied �Yes.� One person told us �All carers are so kind.� Another told us that call bells were answered quickly and night staff check that they are well during the night. They said that made them �Feel more comfortable about being here.�

During our visit we observed that staff encouraged people living in the service to be independent. One person told us how staff had helped them learn the layout of the building so they could get around better. Another told us how they had been encouraged to start playing a musical instrument.

Reports under our old system of regulation (including those from before CQC was created)