Thornfield

Updated 5 July 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

The inspection team consisted of one adult social care inspector, an assistant inspector, and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type: Thornfield is a care home without nursing. People in care homes receive accommodation and personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a registered manager. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

The first day of this inspection was unannounced and the second day was announced as we had no concerns following the first day.

What we did:

Prior to the inspection we reviewed the information we held about the service and the notifications we had received. A notification is information about notable events, which the service is required by law to send us. The registered manager had completed a PIR or provider information return. This form asked the registered manager to give us some key information about the service, what the service did well and improvements they planned to make.

During the inspection we spoke with five people living at the service, four visitors, the registered manager and seven staff. Most people using the service were living with dementia or illnesses that limited their ability to communicate and tell us about their experience of living there. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not speak with us and share their experience fully.

We looked at the care records for four people in detail and sampled other records, such as those for medicines administration, audits and the management of risks. We looked at two staff recruitment files, sampled policies and procedures in use, and reviewed complaints, concerns and notifications sent to us about the service. We contacted four health and social care professionals; three responded and shared their views with us.

Updated 5 July 2019

About the service: Thornfield is a care home without nursing and is registered to provide accommodation and support for a maximum of 38 people. At the time of the inspection there were 32 people living with dementia staying at the service.

People’s experience of using this service: At our last inspection we rated the home as Outstanding in three of the five key questions and overall. At this inspection, there had been many further improvements in pursuit of an ever more safe, effective, caring, responsive and well-led service. As a result, the home is now rated as Outstanding in four key questions and overall.

People were at the very heart of the service. A person commented on the “…high quality care, you would have to go quite a way to find a better one, everyone’s nice.” People’s feedback and our observations provided us with many examples of how good this person-centred approach made them feel. For example, a relative said, “My mum was resisting care, however as soon as she entered Thornfield she is so happy - a changed woman in fact. I couldn't fault the care provided. Mum has a new lease of life and all problematic behaviour has disappeared as has her stress. The home is full of love and laughter and activities abound with an emphasis on music, which all enjoy.”

Staff promoted people's right to make choices in every aspect of their lives and actively supported them to maintain their independence for as long as possible. There was a commitment to provide a socially stimulating environment seven days a week, one person said, “The entertainment here is very good, never boring.” People were treated with the utmost dignity and respect. End of life care was provided in an individualised and compassionate way. People were treated with dignity and respect in a way that truly valued them as individuals. The registered manager and all staff, whatever their role, were always prepared to go the extra mile to ensure people received

the care they needed and lived full and meaningful lives.

There was a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (the 'provider') 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.

The registered manager was deeply involved in all aspects of the running of the home and provided their team with skilled leadership. This ensured all staff had the same aim to enable people living with dementia to lead fulfilled lives. The culture of Thornfield was exceptionally open and positive. The atmosphere was relaxed and friendly; a fact repeatedly commented on by visitors. One said, “(X) has settled in beautifully at the home because of the staff's professional attitude and kindness, everything printed in their brochure is exactly as stated and all the family are very happy with these arrangements.”

Learning and development was a high priority for both the registered manager and their team. This meant the staff team were exceptionally skilled and motivated. Under the registered manager's research-led leadership a number of innovative changes had taken place, to promote people's physical and mental health. A person told us, “High quality care, you would have to go quite a way to find a better one, everyone’s nice.” A visitor said, “Thornfield is a lovely home, well run, with caring dedicated and professional staff who are always happy to go that extra mile.”

The service placed people’s wellbeing at the heart of their work. People received personalised support which met their needs and preferences wherever possible. People told us the service listened to their wishes and suggestions to improve their care and support.

Effective quality assurance systems were in place to monitor the quality of service being delivered and the running of the home. Regular audits were completed by the registered manager and the

management team to check on the quality of the service, such as medicines and the premises.

Regular staff meetings took place to supplement supervisions.

Staff members commented on how much staff morale had improved by the registered manager's approachable style. However, they also appreciated the registered manager’s quick and firm response when practice needed to improve.

People received their medicines as prescribed. Systems were in place to safeguard people from abuse, and the service responded to any concerns or complaints. We saw good practice in relation to equality and diversity. There was a thorough recruitment process in place that checked potential staff were safe to work with people who may be vulnerable. Enough staff were in place to meet people’s needs.

More information is in the full report.

Rating at last inspection: This service was last inspected in 2016, when it was rated as outstanding in three areas with outstanding as an overall rating.

Why we inspected: This inspection was scheduled for follow up based on the last report rating.

Follow up: We will continue to monitor the intelligence we receive about the service. If any concerning information is received, we may inspect sooner.