We carried out a review of the data available to us about Threshfield Court on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Threshfield Court, you can give feedback on this service.
We found the following examples of good practice.
The home offered a range of virtual activities to people when they were unable to leave the home due to an outbreak.
The home had well established testing regimes in place. There was a designated area to safely carry out testing. Visitors to the home were assisted with testing when needed.
The home was clean and well maintained.
There was a purpose-built visiting pod in place that was used when visits into the home were restricted.
We found the following examples of good practice.
The provider was following government guidance around visiting. A purpose-built visitor’s room had been installed to support safe visits during the COVID-19 pandemic. The home was also supporting people to use telephone and video calls to stay in touch with family and friends.
Systems and processes were in place to safely admit people to the home. There was no movement of people between the units and staff were working on specific units to minimise the risk of transmitting COVID-19.
Testing of people who used the service, all staff and essential visitors was well organised. A designated area with allocated staff was set up to facilitate testing.
Virtual activities had been organised for people to attend such as a ‘virtual museum visit’ and a ‘virtual live theatre performance’. Activities coordinators were allocated to specific floors to support people with activities and prevent social isolation.
Threshfield Court is a residential care home providing personal and nursing care to 49 people aged 65 and over at the time of the inspection. The care home can accommodate up to 61 people across three separate floors, each of which has separate adapted facilities. One of the floors specialises in providing care to people living with dementia.
People’s experience of using this service and what we found
The leadership of the service promoted high-quality, person-centred care. Everyone we spoke with told us the service was exceptionally well-led and spoke highly of staff at all levels. Staff were extremely well-skilled and applied best practice in a way that achieved the very best outcomes for people. Care and support was informed by the most current, evidence-based techniques. People had access to new technology which enhanced their quality of life.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People were kept safe from risk of abuse and avoidable harm. They were supported by enough, competent and skilled staff. Medicines were safely managed and administered as prescribed.
Staff were kind and cared for people as individuals. They supported people to maintain their independence and gave people the information they needed to make informed decisions about their care and support.
Staff knew people well and cared for them in a way they preferred. People were supported to maintain their interests and to pursue hobbies.
Staff were exceptionally well-skilled in supporting people to have a comfortable, dignified and pain-free death.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 3 November 2015). There was also an inspection on 5 December 2017 however, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.
Why we inspected
This is a planned re-inspection because of the issue highlighted above.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
This inspection took place on 3 November 2015 and was unannounced. The last inspection was carried out in December 2013 when the service was found to be meeting the Regulations assessed.
Threshfield Court offers accommodation with nursing and personal care for up to 61 older people, many of whom are living with dementia. The service is in the small village of Threshfield, close to Grassington in the Yorkshire Dales. Threshfield Court is a large detached building with accommodation on three floors and a passenger lift to all the floors. The service currently provides a service to 52 people.
There was a registered manager in post at the time of our inspection. 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.
People told us they felt safe at the service. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. There were good systems in place to make sure that people were supported to take medicines safely and as prescribed. Risks to people had been assessed and plans put in place to keep risks to a minimum.
There were enough staff on duty to make sure people’s needs were met. Recruitment procedures made sure staff had the required skills and were of suitable character and background.
Staff told us they enjoyed working at the service and that there was good team work. Staff were supported through training, regular supervisions and team meetings to help them carry out their roles effectively. Staff were supported by an open and accessible management team.
The manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted. The registered manager had taken appropriate action for those people for whom restricted movement was a concern. Best interest meetings were held where people had limited capacity to make decisions for themselves.
People told us that staff were caring and that their privacy and dignity were respected. Care plans were person centred and showed that individual preferences were taken into account. Care plans gave clear directions to staff about the support people required to have their needs met. People were supported to maintain their health and had access to health services if needed.
People’s needs were regularly reviewed and appropriate changes were made to the support people received. People had opportunities to make comments about the service and how it could be improved.
There were effective management arrangements in place. The registered manager had a good oversight of the service and was aware of areas of practice that needed to be improved. There were systems in place to look at the quality of the service provided and action was taken where shortfalls were identified.
We spoke with some people living at the service and staff about their experiences and noted that at previous visits people have told us they received good care and staff were available when people needed them.
We found that documentation was up to date and reflected the care needs of individuals. We also found that correct procedures were in place around moving and handling, personal care and prescribed medication. We looked at how the service monitors care delivery and what systems were in place to assess the quality of the service people received.
People who used the service, and their representatives, told us they were well looked after. One person said, 'The care here is first rate.' We found people were able to choose where and how to spend their time and there were quieter areas for people who preferred a more restful environment. We observed staff were kind and respectful and spoke with people using their preferred names.
We found people's care and welfare needs were identified and they were given the support they needed to meet these needs. People had access to a range of NHS services including community psychiatric nurses and district nurses.
We observed the meal service at lunchtime, in one communal area and saw people were offered a choice of food. People who needed help or encouragement to eat were given appropriate support.
We found people who used the service were safe and staff were aware of how to recognise and report any concerns about people's safety and well being.
People we spoke with described the staff as 'first class and lovely.' We saw staff were supported to maintain and develop their knowledge, abilities and skills.
There were systems in place to assess the quality of the service people received.
Several people who lived at the home were able to tell us about their experience. We also spoke with two relatives who were visiting the home. Everyone told us they were satisfied with the care they or their relative received. People told us that they were treated with respect and were able to make choices and decisions about their care. One relative told us 'This is the best home for my relative. He has put weight on. They look after him so well." Another relative said 'This home is informal and less regimented than my relatives previous home.'
The service had in place policies and procedures covering safeguarding and the protection of vulnerable adults. Staff were familiar with safeguarding and whistle blowing procedures and knew what to do in the event of abuse being suspected.
Records we looked at confirmed that staff received training in areas such as dementia awareness, infection control and safeguarding. Staff we spoke with told us that they received 'really good support from the manager' and that they received useful/appropriate training.
There were a range of effective quality management systems in place to assess and monitor the quality of service that people received.
We visited the Conistone and Hebden areas of the home. These two originally separated areas had been merged into one providing care for 13 people. We talked to staff and observed the care people were given; we also looked at records that showed us the level of care people received. We saw that staffing levels were currently safe in the home. However we did find that earlier in the year there had been a problem with staffing levels when dependency levels were higher. This meant that staff may not have always been able to give people the care they needed.
We concluded therefore that whilst staffing levels were safe, previously there had been higher dependency levels in the home which could have had an effect on the delivery of care. The provider may find it useful to note therefore that staffing levels should reflect the dependency levels of people receiving care and that these must be reviewed on a daily basis to make sure staffing levels are appropriate.
The inspection team was led by a CQC inspector, and joined by an 'expert by experience' and a healthcare professional. These are people who have experience of using services and can provide that perspective and professional advise.
People told us that they enjoyed living at the home and that the care they received was good. They said that staff were kind and helpful and skilled at looking after people.
One person said 'This is a very good home, I have everything I need the staff are tremendous, they are thoughtful and very caring towards us all.'