Thornage Hall Independent Living

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm .This was an aged, rated inspection for Thornage Hall.At our last inspection we rated this key question good. At this inspection,the rating for this key question has remained good.

This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. The manager listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The registered manager and senior team including trustees worked in co-production with relatives and people using the service to develop and review policies and agree service improvements based on feedback.

Regular audits helped the service to focus on service improvements and take on board feedback from other agencies and services. All incidents and near misses were recorded and reviewed to consider actions taken by staff and any further actions required to reduce the likelihood of future incidents. There was a robust framework for managing risk and making adaptations where required which included a review of staffing.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Individualised care was provided and there was a holistic approach. People were carefully assessed for the service and their needs kept under review. A family member told us that their relative had first attended the day services before coming to live at the site and this had been beneficial. Another person had recently swapped houses based on their assessed needs and wishes. Some people lived in a house off site and were afforded more independence and had been assessed as having the appropriate skills such as road safety.

Hospital passports and health records showed an integrated approach with other services and sharing information on a need-to-know basis should a person require secondary care. Staffing was flexible to enable them to support the person in the way they needed and take into account any changes to their needs.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm,and neglect. The provider shared concerns quickly and appropriately.

Most people had support from regular staff, family members and health and social care representatives so we were confident their needs were known and they could voice concerns. There were clear processes to raise concerns which were reproduced in clear easy read formats.

People said they felt safe and said staff were there if they needed them. People said they knew the managers and would speak to the team leaders in their houses if they had any worries or concerns. One person said, "There is an anti-bullying policy in place and bullying doesn't happen here. ”A staff member told us an open culture was promoted where staff felt safe and protected to speak up.

Staff received initial training and updates on safeguarding and supporting people with a learning disability and, or autism in a person-centred way which upheld their right and dignity. Safeguarding concerns were reported to the relevant agencies so they could be formally investigated.Themes and trends were collated. Any patterns of behaviour were analysed to consider any actions necessary which might be to rule out underlying infection or pain or to consider if people received consistent responses from staff to reduce ambiguity.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive, and enabled people to do the things that mattered to them.

Risk assessments were an integral part of a person’s care and whilst risk taking was encouraged this was completed in a systematic way considering what the risks might be and how they could be reduced to acceptable safe levels.

A review of incidents helped to ensure staff practices were monitored and risks were reflected upon to see if lessons could be learnt.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Health and safety leads and robustly planned maintenance helped ensure equipment and the building were maintained and functioning correctly. Some audits such as the fire safety audit, and the legionnaires risk assessments had clear recommendations which had been actioned very quickly. The risks associated with the farm and external building were subject to further compliance regulations and estates management were knowledgeable about the biodiversity of this site and the rules governing listed buildings.

Emergency procedures were clear with staff trained to deal with fire and evacuate safely.

We also recognised that although the premises were designed to be least restrictive there were some people who were becoming more independent and learning new skills whilst others were becoming more reliant on staff support and potentially finding their environment more difficult to navigate. This was being addressed through assessment and review, but we considered there were some risks posed by the environment where adaptations and technology could be considered to support people for example with early onset dementia. We also raised issues around unsecured wardrobes and unrestricted ground floor windows which should be considered in any review of the person's needs as people were getting older and there were changes to people's cognition and sensory needs.

The provider made sure there were enough qualified, skilled, and experienced staff, who received effective support, supervision, and development. They worked together well to provide safe care that met people’s individual needs.

Staffing rotas were organised in advance, so staff knew their shift patterns and although there were core staff, staff were expected to rotate to meet the needs of the service. Staff commented that the rota could be a bit chaotic, and we found some staff did not appear as familiar with each house. We asked the registered manager to review rotas to ensure they were appropriately documented.

Agency staff were used but the service ensured consistency of agency staff. Permanent staff said it was difficult when using agency staff but there were staff who were supernumerary to the rota and could assist staff when necessary.An example of this was if a person going to the day centre/ farm was unwell, administrative and management staff could provide them with support. Regular reviews helped to ensure support hours remained appropriate to needs and could be adjusted in line with changes.

Staff records were satisfactory and there was a robust recruitment process which took into account the views of people who would be supported by the new staff.

Staff were supported through training, induction, and supervision to ensure they were fully competent to meet people’s needs.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People were responsible for their own cleaning with the support of staff. Each house had their own arrangement, and some people had decided to get cleaning support. Regular audits helped ensure cleanliness was maintained and daily checklists ensured some things were done on a regular basis such as clearing the fluff from the tumble dryer which could be a fire hazard.

We found each house suitably organised and clean with no unpleasant odours or equipment and no soft furnishing needed replacement.

Staff had training around infection control, and we observed good hygiene practices particularly around food preparation and medicines. Gloves were worn and changed with each medication administered and staff were observed regularly washing their hands.

The provider made sure that medicines and treatments were safe and met people’s needs,capacities, and preferences. Staff involved people in planning, including when changes happened.

Overall medicines were well managed, but we found minor accounting errors, and staff not always checking people’s medicines who self-administered in line with the policy. They were checking weekly rather than daily. Medication errors had been reducing at the service and there were clear processes to support staff to improve their practice where necessary. Medicines were usually held securely in people’s room unless there was a reason not to. Staff were observed administering medicines and this was done in a sensitive way and they were mindful of time sensitive medicines and observing the right interval between medicines. Information about people’s medicines included any allergies or specific instructions.

Staff told us their medicines training was thorough and included being supported and observed at least 5 times

Any mistakes made were appropriately addressed and staff supported to refresh their training. Medicine errors were noted and we discussed with the registered manager how things could be tightened up and ensuring all staff were familiar and following processes.