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Inspection carried out on 24 August 2017

During a routine inspection

We carried out the inspection of Thornton Hill on 24 and 31 August 2017. At the time of our inspection there were 39 people using the service. This was an unannounced inspection.

Thornton Hill is registered to provide accommodation and personal care for people. It is owned and managed by Anchor Trust. The service is a large converted manor house with a purpose built extension known as the Manor Wing. Thornton Hill is set in its own grounds and overlooks the valley. It is in the village of Thornton-in-Craven, which is approximately eight miles from Skipton.

At the last inspection the service was rated Good overall. At this inspection we found the service remained Good overall.

Since our last inspection the service had appointed a new manager who was in the process of registering with the CQC. However as the manager's registration had not been validated and had been on-going since April, we found the condition of registration had not been met. 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 and staff spoke positively about the manager, overall leadership and management of the service. The provider was continuously seeking and implementing new ideas and ways for the service to improve. They stayed abreast of best practice and current research in the field of dementia care and brought new ideas into the service in order to enhance people's quality of life.

Staff told us they were well supported. We saw supervisions and team meetings regularly took place, however some staff appraisals were missing.

We saw that some of the communal internal and external areas in the home looked clean and were repaired when required. We noted the home manager was in the process of implementing improvements needed in the service.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been adhered to in the home. The manager told us of the people at the home who lacked capacity. We found appropriate Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority in relation to people's care.

Staff knew how to protect people from the risk of abuse or harm. They followed appropriate guidance to minimise identified risks to people's health, safety and wellbeing.

There were enough staff to keep people safe. The provider had appropriate arrangements in place to check their suitability and fitness to support people.

Staff ensured the environment was clear of slip and trip hazards to support people to move freely around. The premises and equipment were regularly maintained and serviced to ensure these were safe.

Medicines were stored, recorded and managed safely and people received their medicines as prescribed.

People continued to receive support that was personalised and met their specific needs. Senior managers reviewed people's needs regularly to ensure current support arrangements continued to meet these.

Staff received relevant training and were supported by senior staff to help them to meet people's needs effectively. Staff knew people well and had a good awareness and understanding of their needs, preferences and wishes.

People were supported to eat and drink enough to meet their needs. They enjoyed the meals they ate at the service. People were also supported to stay healthy and to access healthcare services when needed.

Staff encouraged people to participate in a wide range of activities and to maintain relationships with the people that mattered to them in order to promote social inclusion. Staff were warm and welcoming of visitors to the home and friends and families were free to visit when they wished.

Staff were caring, treated people with dignity and respect

Inspection carried out on 28 May 2015

During a routine inspection

This inspection took place on 28 May 2015 and was unannounced. We last inspected this service on 22 April 2014 where we found there were not always enough qualified, skilled and experienced staff to meet people's needs and sometimes staff did not have time to talk to people who used the service. We asked the provider to take action to improve the staffing arrangements. The provider sent us an action plan telling us about the actions to be taken and that the improvements to the staffing arrangements would be completed by 1 September 2014.

Thornton Hill is registered to provide accommodation and personal care for people. It is owned and managed by Anchor Trust. The home is a large converted manor house with a purpose built extension known as The Manor. The Manor is a specialist unit for people living with dementia. Thornton Hill is set in its own grounds and overlooks the valley. It is in the village of Thornton-in-Craven, which is approximately 8 miles from Skipton.

The home employs a registered manager. The registered manager had worked at the home for three years. 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 understood what it meant to keep people safe and although not all staff had received safeguarding adult training, they could describe to us what action they would take if they saw or suspected abuse had taken place. The home had employed a lot of new staff and they were in the process of receiving a programme of training. Staff worked within the principles of the Mental Capacity Act 2005. Staff had been recruited safely.

The risk of infection was minimised for people who used the service because staff were using appropriate measures to monitor and clean the service.

Staff administered medicines safely and arrangements around medication were well organised.

Since the last inspection the environment had been improved throughout the building but particularly in The Manor, this supported people living with dementia and enabled them to maintain their independence.

The service was caring. From our observations during the day we saw that overall staff knew people well and we saw that staff approached and spoke with people in a friendly and respectful way. We highlighted a couple of instances, observed during the lunchtime meal, where the interactions between staff and people dining could have been handled better. The care manager agreed to address these without delay.

Although some people were offered and enjoyed activities throughout the day, others told us they were ‘bored’ at times.

There was a quality assurance system in place, which used audits in each area of the service so that there was a consistent approach to improvement.

Inspection carried out on 22/04/2014

During a routine inspection

Thornton Hill is a care home which provides accommodation and personal care for up to 45 adults. The home is a converted manor house and is split into two units, the main unit which provides elderly residential care and a unit, designed to specifically accommodate people living with dementia. The home had a registered manager in post and we found all required notifications had been reported to the Care Quality Commission. On the day of our inspection there were 40 people living in the home, 21 people living in the main unit and 19 in unit for people living with dementia. The service had a registered manager in post.

The overall feedback about the quality of the home was positive from people who used the service and their relatives. For example, people told us they were happy at the home and they particularly liked the food on offer. People said they felt safe and that staff treated them well. People and their relatives commented that they would like more activities to be available.

Staff, people who used the service and their relatives all told us there were not enough staff at the home. The home struggled to meet its target staffing levels on 11 out of 21 days in April 2014 due to a lack of bank staff to cover regular staff absences. Even when target staffing levels were met, such as on the day of the inspection, the planned staffing levels combined with the layout of the building meant there were times when staff were unable to supervise communal areas accommodating people with behaviour that challenges, putting them at risk. We observed times when people were not provided with prompt assistance or regular interactions meaning that their needs were not always met. The problems we found breached Regulation 22, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

The home had systems in place to keep people safe with staff aware of the key risks identified and how to protect people from harm. Risks to people were assessed and where incidents did occur, they were investigated and action taken to reduce the risk of further harm.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes and hospitals. There were no Deprivation of Liberty Safeguards (DoLS) orders in place and staff had received training on DoLS. We did not observe any restrictions of people’s liberty during the inspection. Staff understood how to protect the rights of people without capacity who could not make decisions for themselves.

People were able to make choices in relation to their daily lives, for example choosing what they wanted to do and staff respected these wishes. Staff were familiar with people’s individual needs, wishes and preferences, demonstrating they understood the people they were caring for.

Care plan documentation showed people’s needs were assessed and was sufficiently detailed to allow staff to deliver effective care. The completion of end of life care documentation required improvement to ensure people’s end of life preferences were recorded.

Staff were caring and compassionate and treated people with dignity and respect. The interactions we saw between staff and people who used the service were positive and this reflected in the feedback people and their relatives gave to us. A health professional who regularly visited the home told us staff were caring and supportive and that they would have no problem recommending the home to a relative.

People and their relatives were involved in the planning and review of care through regular care plan reviews and resident meetings.

Communal areas were spacious and comfortable. Two baths in the unit for people living with dementia were currently out of order due to maintenance issues which meant people had to get a shower or make the trip over to the main unit in order to get a bath. The environment in the unit for people living with dementia was bland with a lack of features to aid people living with dementia such as clear signage.

People who used the service and staff spoke positively about the manager and said they would effectively address any concerns they had and provided feedback about any improvements made to care as a result.

Systems were in place to allow the home to learn from incidents and continuously improve through audits and working to a service improvement plan.

Inspection carried out on 30 August 2013

During an inspection to make sure that the improvements required had been made

Our inspection of 16 May 2013 found that people did not always experience care, treatment and support that met their needs. For example, some people needed their fluid and food intake monitoring due to an identified risk of dehydration or insufficient nutrition. These records were not being completed accurately. Another example of poor recording was in relation to repositioning charts and night time checks. We also found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to safely manage them and that staff were not being fully supported to deliver care and treatment safely and to an appropriate standard.

We found at this inspection improvements had been and that action had been taken to address the shortfalls identified.

One person who used the service told us, “I am quite happy here, staff are very good.” Another person told us, “I can’t fault them here, I am well looked after.” We observed staff supporting people and offering assistance as needed. This was done in a professional, engaging and organised way.

Staff were described as ‘friendly and approachable.’ Without exception, people gave us the impression that they had good experiences at Thornton Hill.

Prior to this follow up visit we had received information of concern that staff were assisting people to get up at 5 am in order that people were up and dressed prior to the day time staff coming on duty. We therefore arrived at the home at 6:45am.

Inspection carried out on 22 May 2013

During a routine inspection

Some people were not able to tell us about their experiences. We therefore used a number of different methods to help us to understand the experiences of people. We spoke with thirteen people who used the service and seven visitors. Everyone we spoke with told us the care and support at the home was of a good standard.

People’s care plans contained a level of information that ensured their needs were being met. We saw records that showed people were involved in developing their care plans and that relatives or their representatives had been involved, where necessary. However, not all information, in relation to night checks and monitoring records, for example food and fluid charts, were completed. This meant that peoples care needs could be overlooked and we could not be assured that proper care was being given.

We also looked at the way medication was being managed in the home. We found that some people were not protected against the risks associated with medicines because appropriate arrangements were not in place to manage the administration of medicines safely.

People were cared for by staff who were not always fully supported to deliver care and treatment safely and to an appropriate standard. Staff described moral as low and some training was not being updated or provided.

There was an effective complaints system in place.

Inspection carried out on 21 August 2012

During a routine inspection

We spoke with five people who used the service and three visitors. Two people told us that they had been involved in planning their care, along with their relative. One person told us, “This place is comfortable and I am happy here.”

People told us that they enjoyed their life at Thornton Hill and that they were enabled to have freedom in their daily routines. This included taking part in individual interests and keeping in contact with friends and relatives. One person told us that they had had their 'own routine’ prior to moving to Thornton Hill and that this had continued when they had moved into the home. People we spoke with gave the impression that there were no set rigid routines. People particularly liked the meals and the staff working in the home. They made comments such as, ‘I like the staff here, they make sure I have everything I need.’ One person said, "The staff keep me going, they are always cheerful." People said that the manager was good at listening to any concerns or complaints and that staff did their best to put things right.

Inspection carried out on 12 April 2012

During an inspection to make sure that the improvements required had been made

We did not speak to people directly about their care records. However, we did receive some comments from visitors and people living at Thornton Hill about their views generally. Two relatives told us they; 'liked the home and liked the views outside.' One person said, "I like it here, the food is good, I keep my room tidy." Another person talked about the way their privacy was respected whilst taking a shower despite the fact that staff needed to be in the vicinity incase they became unwell. Staff were described as, 'excellent, caring, kind and patient.'

Inspection carried out on 6 January 2012

During a routine inspection

People who lived at the home told us the home was comfortable and they had everything they needed in their own rooms. They also told us that they had been encouraged to furnish their rooms with their own memorabilia and personal possessions.

People also told us that they were involved in the planning of their care and that their care worker discussed their support options and treatments with them and their family. Matters of personal care and of overall wellbeing had been discussed with them.

People said that staff were kind and very responsive to their care needs. They told us staff upheld their dignity when delivering personal care and respected their rights to privacy. People confirmed that they felt that their privacy was respected; they could lock their door for complete privacy if they wished and they were also offered their own key.

People explained that they felt safe in the service and they knew whom to speak to if they felt uncomfortable with a situation. They told us they would speak with the staff or manager who would act on their behalf. They told us they had been provided with the service's service user's guide which contained information on keeping them safe, but they had never had to use it.