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Inspection carried out on 1 May 2019

During a routine inspection

About the service: Thornfield House specialises in providing care and support to people with learning disabilities. The service was a large home, bigger than most domestic style properties. It was registered for the support of up to seven people and seven people were living there when we inspected. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when they were coming and going with people.

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways. There was a strong focus on promoting choice, control and independence. People’s support focused on taking positive risks to ensure they had as many opportunities as possible for them to gain new skills and become independent.

People received good care and support which met their individual needs.

People and relatives praised the home and the way in which care was provided.

People were supported in a safe environment. Risks to people's health and safety were assessed and managed. The service learnt lessons and improved the safety of the service following incidents.

There were enough staff deployed to ensure people received their required care and support. Staff were kind and caring and treated people well. Staff knew people well and had developed good, caring relationships with them.

Staff had received training to enable them to care for people living at the home.

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.

Medicines were managed safely, and people’s health needs were met.

The service was well managed. The provider had robust systems in place to assess, monitor and improve the service. People were given opportunities to have a say in how the service was provided.

Rating at last inspection: Good. (Report published November 2016).

Why we inspected: This was a planned inspection based on the last rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. It any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Inspection carried out on 20 September 2016

During a routine inspection

This was an unannounced inspection which took place on the 20 September, 7 and 10 October 2016. The service was last inspected in September 2013 and was meeting the regulations in force at that time.

Thornfield House provides accommodation and personal care for up to seven adults who have a learning disability. There were seven people living there at time of inspection. The people using the service had complex support needs around autism and behaviour support.

The service had a registered manager who had recently registered with us. 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 were safe living at the service and staff knew how to act to keep them safe from harm. The building and equipment were well maintained and there were regular health and safety checks undertaken by staff. The environment had been adapted to keep people safe.

There were enough staff to meet people sometimes complex needs and the staff were trained, supervised and supported to effectively meet people’s complex needs. The staff told us they felt well trained and inducted before they started working with people.

Medicines were managed well by the staff and people received the help they needed to take their medicines safely. Where people’s needs changed the staff sought medical advice and encouraged people to maintain their well-being. External healthcare professional’s advice was sought quickly and this included the provider’s specialist support staff.

People were supported by staff who knew their needs well and how best to support them. Staff were aware of people’s choices and how to support those people lacked the capacity to make decisions for themselves. Families felt the service was effective and offered them reassurance that their relatives were being well cared for. Where decisions had to be made about people’s care, families and external professionals were involved and consulted as part of the process.

People were supported to maintain a suitable food and fluid intake. Staff responded flexibly to ensure that people maintained their physical wellbeing and worked with people as individuals.

Staff were caring and valued the people they worked with. Staff showed kindness, empathy and humour in responding to people’s needs. Families felt their relatives were cared for by a staff team who valued them and would keep them safe. The provider sought to ensure that staff were supported in a caring way.

Privacy and dignity were carefully considered by the staff team, who ensured that people’s choices and wishes were respected wherever possible. Our observations confirmed there was genuine empathy and warmth between staff and people living at the home.

The service responded to people’s needs as they changed over time, sometimes responding promptly to sudden changes in people’s needs. The service supported people to access appropriate support so the staff could keep them safe and well.

The registered manager led by example, supporting staff to consider new ways to meet people’s needs. The provider and service regularly consulted families and staff to look for ways to improve the service and audits and reviews of care delivery were carried out.

Inspection carried out on 13 September 2013

During a routine inspection

During our visit we met with four of the people who lived at the home. Due to complex care needs, they were not all able to tell us about their experiences and opinions about living at the home. One person told us that they had �A good time� and that they liked the staff. They told us that they liked their room and they were proud to show it to us.

Comments from people who lived at the home from a recent quality audit included:

�Staff make me feel safe�.

�If I have a complaint team leaders write it down for me�.

�I have started to go out on my own because I wanted to�

We did not meet any relatives of people who lived at the home but saw the following comment one had given in the last quality audit:

�The service provided has been of the best to meet my relatives�s needs. I have only admiration for my relative�s presentation, well-being and their happiness in Thornfield�.

We saw that care planning and delivery was of a high standard. We observed a relaxed atmosphere with warm, supportive and friendly interactions between staff and the people who lived at the home.

The home was clean and tidy with good infection control measures in place. Medicines were managed safely and quality audits were in place to make sure that the home was safe and people received good quality support and care.

Inspection carried out on 29 January 2013

During a routine inspection

Some of the people who used the service had complex needs and were unable to tell us about their experiences. Therefore, we used a number of different methods to help us understand the experiences of people who used the service, such as reviewing care records and speaking with relatives.

We spoke with two relatives of people who used the service. They told us they felt involved in their relatives care and attended yearly reviews of their care plan. One person said �staff always keep me in the loop, so I feel involved and included�. Another relative said �I feel the door is always open and I can ring at any time�.

The two relatives we spoke with told us they were happy with the care and support their relative received. One person told us �the care is fantastic, they really get on top of things and take action when they need to�. Another person said their relative received �good quality care and the freedom to make choices for themselves�.

Both people we spoke with said they felt their relative was safe at Thornfield House. They said staff treated their relative with respect and listened to what they wanted. One relative said their relative was �well cared for and listened to�.

Both relatives told us if they had a concern they would raise this with staff and felt they would be listened to. They both said when they had raised concerns in the past these were acted upon and resolved immediately.

Inspection carried out on 9 February 2011

During a routine inspection

I like my bedroom and try and keep it tidy.

I like the staff and could talk to them if I was unhappy.

It is a good organisation to work for. There is lots of training on offer and you can work your way to more senior posts if you want to.

The service is well managed and the people living here get good opportunities to go out and follow their interests.

I really enjoy the work and ethos of the home it is very person centred.

I have been to enrol at College today and a member of staff came with me. I hope this course will help me get a job.

Reports under our old system of regulation (including those from before CQC was created)