Archived: Thistledown Residential Care Home Hayling Island

Thistledown is registered to provide accommodation and support for a maximum of six adults who have learning disabilities. At the time of our inspection four people were using the service.

Thistledown is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other 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 observed throughout our inspection visit.

We last inspected the home on 16 November 2016 where we found two breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements and this action had been completed.

There is a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Safe arrangements were in place for the selection and recruitment of staff.

The provider had arrangements in place to safely support people with their medicines.

There were effective arrangements were in place to reduce the possibility of infection.

Staff received training appropriate to peoples’ needs and were regularly monitored by a senior member of staff to ensure they delivered effective care.

Staff were knowledgeable about the requirements of the Mental Capacity Act 2005 and worked with advocacy agencies, healthcare professionals and family members to ensure decisions made in people’s best interests were reached and documented appropriately

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 were protected from possible harm. Staff were able to identify the different signs of abuse and were knowledgeable about the home’s safeguarding processes and procedures. They consistently told us they would contact CQC and the local authority if they felt someone was at risk of abuse. Notifications sent to CQC and discussions with the local authority safeguarding team confirmed this.

Staff interacted with people and showed respect when they delivered care. Relatives and healthcare professionals consistently told us staff engaged with people effectively and encouraged people to participate in activities. People’s records documented their hobbies, interests and described what they enjoyed doing in their spare time.

Records showed staff supported people regularly to attend various health related appointments. Examples of these included visits to see the GP, hospital appointments and assessments with other organisations such as the community mental health team.

People received support that met their needs because staff regularly involved them in reviewing their care plans. Records showed reviews took place on a regular basis or when someone’s needs changed.

The service had an open culture where people told us they were encouraged to discuss what was important to them. We consistently observed positive interactions between staff and people. People were supported to participate in a wide range of activities they had chosen.

There were effective arrangements in place to investigate and respond to complaints.

The provider was open and honest about the improvements they wanted to make and provided examples where they had learnt lessons and implemented change.

Appropriate arrangements were in place to support people towards the end of their life.

Thistledown Residential Care Home is a small service which provides accommodation for a maximum of 6 people living with a learning disability. At the time of our inspection there were four people living at the service.

People we spoke with told us they felt safe with the care and support they received at Thistledown. Staff who supported them knew how to recognise different types of abuse and what actions to take if they suspected someone was at risk of harm.

The service kept personalised risk assessments which were up to date and people had been consulted in writing these. There were environmental risk assessments in place and a business continuity plan in the event of a fire.

Staff recruitment was robust and staff received appropriate training to undertake their role. New staff received an induction period and all staff received regular supervision and annual appraisals.

The service did not not always follow the Mental Capacity Act as required by legislation. They had considered people’s best interest in relation to making specific decisions. However they had not considered applying for a Deprivation of Liberty Safeguard in relation to a person whose movements they were now restricting.

Staff were seen to be kind and caring; they knew the people they were providing care and support for. People were able to attend and participate in as many activities as they wanted to. People chose what they wanted to eat, there was a good selection of meal choices and staff were aware of any restrictions with people’s dietary requirements.

The service had a registered manager who had been in post since 2014. 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.

Quality assurance checks were being completed but did not always identify areas of concern. The service had policies and procedures in place which staff were following. There was a formal complaints procedure but no complaints had been received. The registered manager was aware of what actions they would need to take should they receive a complaint.

The service should notify CQC of incidents, we saw that on one occasion this had not happened, however the service had followed appropriate procedures and informed the local authority as well as taking action to minimise the risk of the incident reoccurring.

During this inspection we found two breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014

The provider sent us an action plan telling us what they would do to ensure the safety of the premises was addressed.

We visited this home again on 12, 24 and 25 September 2013. We found that the provider had ensured the premises were adequately maintained and plans were in place for further work to be carried out in the home.

During our inspection we spoke with the registered manager, four of the five people who live at this home and two relatives. Our inspection was carried out over three days to accommodate the work and activity schedules of people.

We found that people had their care planned in accordance with their needs and risks were assessed to ensure people's safety. People were supported to remain independent in their lives, attending places of work and participating in activities of their choice.

We found the home had made progress to meet the warning notices, however, there were still some improvements to be made.

Each person had a care plan and these included details of the person's preferred way of living. We saw that people were involved in devising their care plan and had signed a record to agree to its contents. Care records showed people's health care needs were being monitored.

Since the last inspection the registered manager has attended a training course on the safeguarding of vulnerable adults. We saw the home had a safeguarding vulnerable adults procedure. The registered manager was aware of the procedures the home should follow if there were concerns of a safeguarding nature regarding any of the people living at the service.

The home has introduced a system for asking people what they think of the service and for checking if people have any requests. The home also facilitated residents' meetings and had links with a relatives' group.

A number of improvements have been made to the physical environment. Repairs have been made to the emergency lighting on the first floor landing. The home now has a fire risk assessment. Repairs have been made to the kitchen linoleum flooring. Mould has been cleaned from the ground floor showers but the shower room and adjacent toilet were in a poor state of repair.

We found that care plans had not been developed with individuals. Evidence was not seen to show that people had been consulted about their support needs, or asked about how they preferred their support to be given.

Records showed that people's care and welfare had not been reviewed for a number of years. We saw that the most recent review was dated for 2008. This meant that we could not be sure that people's current care and welfare needs were known or met. Therefore, people were at risk of receiving care and treatment that may not meet their needs and could put their safety and welfare at risk of harm.

We saw potential hazards to people's health and safety. This included no emergency lighting on the top floor, lino lifting on the floor in the kitchen, mould in the shower room on the windows, walls and in the cubicles.

The provider did not have systems in place to monitor the quality of the service. This meant that shortfalls or areas for improvement had not been identified.