Archived: RNID Action on Hearing Loss Thornton Gate

The provider had a registered manager in place. 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.

At our last inspection in February 2016 the service was rated ‘Good.’ At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Each person we spoke with had their own tenancy agreement with a private landlord. This meant the care they received from RNID Action on Hearing Loss Thornton Gate was separate from their tenancy agreement and should they choose to change their care provider they would have the option to remain in their own home. This showed the registered provider was working in accordance with registering the right support guidance. Registering the right support is a CQC policy for providers supporting people with a learning disability and/or autism.

We found the service was responsive to people's needs. People told us they were supported to live independent lives and were consistently involved in the service provided. People lived lives which focussed on the achievement of goals and targets set by them. Care records recorded the care and support people received and the progress made towards people’s goals.

The registered manager completed a series of checks to identify where improvements were required in the quality of the service provided. Staff told us they were informed of the outcomes of these.

People told us they were able to see health professionals if needed and care records reflected the health professional’s advice and instruction.

Staff were aware of the importance of promoting people’s individual rights and of the equality and diversity issues people they supported may experience.

People told us staff knew them well and respected them and their homes. People told us they felt valued by staff.

People were supported by staff who were caring and respectful. Staff understood the communication barriers people they supported experienced. Staff used British Sign Language (BSL) to communicate with people and information was produced in formats which met people’s individual needs. This included Easy Read, pictorial and BSL.

We found there were sufficient staff to meet people's needs. Recruitment checks were carried out to ensure suitable people were employed to work at the service and people who used the service were given the opportunity to be involved in the recruitment of staff. Staff received an induction on starting work at the service and training and supervision was available to help them develop and maintain their skills.

People were supported to have 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. Staff understood the principles of the Mental Capacity Act 2005 and appropriate arrangements were in place to help protect the rights of people who were unable to consent to their care.

Staff told us they were committed to protecting people at the home from abuse and would raise any concerns with the registered manager or the Lancashire Safeguarding Authorities so people were protected. People who received help and support told us they felt safe.

Staff supported people to receive their medicines safely and people told us they were happy with the help they received.

Individual risk assessments were carried out in relation to each individual's care and health needs as well as any environmental risks. This meant risks to people who received help and support were minimised. Staff we spoke with were knowledgeable of the assessments and the action they needed to take to maintain people’s safety.

People were supported to have a healthy diet. Documentation contained the likes and preferences of people who received support.

Technology was used to help ensure people’s safety and promote independence. For example, we saw flashing lights and doorbells were in use as well as vibrating alarm clocks and pillows. This meant people were able to maintain their independence and could be alerted to emergencies if required.

Relatives told us they were consulted and involved in their family members care. People we spoke with confirmed they were involved in their care planning and they were happy with the level of involvement they had.

Staff we spoke with were able to describe the help and support people required to maintain their safety and people who lived at the home told us they felt safe.

People told us they could raise their views on the service provided and they felt involved in this. We saw minutes of meetings where people were invited to share their views and were asked their opinion on the service provided.

There was a complaints procedure and people were aware of this. People we spoke with told us they had no complaints, but they if they did these would be raised to the registered manager or staff.

We found people were supported to maintain their homes cleanliness and pictorial prompts to support good practice handwashing was displayed in communal facilities at the service.

Further information is in the detailed findings below.

Thornton Gate is a domiciliary care agency where people are supported in self-contained flats within a large building. The agency supports people who are predominantly deaf with additional needs. The service is staffed on a 24 hour basis with sleep in facilities for staff.

Accommodation is provided on three floors with lift access. The premises are located near Cleveleys town centre and parking facilities are provided at the front of the building.

Six people were being supported by the registered provider at time of inspection.

There was a registered manager in place. 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.

At the inspection carried out in August 2013, the service was meeting the requirements of the regulations that were inspected at that time.

At this inspection we found people were supported with their communication using British Sign Language (BSL) and other communication systems dependent upon their individual need. The registered manager encouraged the use of IT to help people live as independently as possible. The service had developed a range of innovative ways to support people with their communication and understanding.

We found good communications systems in place to ensure people were involved and included within service provision. Information was provided in easy read formats. There was evidence of accessible information provided across the service. Photographs of staff and minutes of recent tenants meetings were on display in communal areas. This had a positive impact upon people, who had a good understanding of the routines and management of Thornton Gate. People were relaxed and well informed regarding events and the running of their home. Good communication systems helped to empower people.

People told us they felt safe and liked living at Thornton Gate. Staff were trained in BSL and were able to communicate with people they supported. We found the recent development of recruiting staff who were profoundly deaf had been initiated by people who lived at Thornton Gate. These suggestions were acted upon and staff who were profoundly deaf were recruited. The registered manager told us this had helped to provide positive role models for people. For example showing profoundly deaf people could be in paid employment. People we met consistently told us they liked being supported by deaf staff and hearing staff. We found staff had developed warm and caring relationships with people they supported.

There was a relaxed and friendly atmosphere within the service. We found staff were confident and knowledgeable with their roles and responsibilities. This helped to convey a sense of calm. The service was well managed and organised.

We received consistent positive feedback from a range of professionals. One health professional commented on how happy and content people were. They said the house was kept to a good standard and support provided was of a high standard.

Relatives shared very positive feedback as part of the inspection process. One relative told us, “We can’t praise them enough; they have given our family member a life and have given us a life.” Relatives told us they felt well supported by the registered manager and the staff team. Relatives were encouraged to visit and keep in touch with their family members.

Care plan records were personalised, well organised and maintained to a high standard. Information enabled staff to support people with their assessed needs. There was a strong culture of involving people and supporting people to make choices. There was a balance between positive risk taking and managing the risks posed to people. This helped people to flourish and lead active and interesting lives.

People were encouraged and supported to have meaningful lives. Skills and talents were identified and nurtured through the development of social activities. People were supported to build new skills to increase their independence. This increased people’s self-esteem and promoted good health. People were supported to participate in a wide range of community activities and maintain and develop friendships and relationships.

There was a range of audits in place to monitor the quality of the service provided. The registered manager was experienced and enthusiastic and supported her team with strong leadership. They worked closely together on a daily basis. We observed the quality of the service being monitored as part of the registered manager`s day to day duties

There was a culture of continuous improvement and a willingness to take on new ways of working. We found there was a strong values base within the service and wider organisation that empowered people to be involved, make informed choices and promoted their independence.

The registered manager was involved in developing service standards alongside people who used services. Supporting and involving people was key to all service improvements. The registered manager was closely supported by the senior management team. There was evidence of regular support provided by senior management and good involvement with people who lived at Thornton Gate.

People were aware of how to complain. One person was very clear in their understanding of the organisation and was able to tell us they would go to the top if they weren`t happy. This showed us how well the service supported people to know their rights and how to report any concerns they may have.

The registered manager was proactive in ensuring any safeguarding concerns were identified and acted upon in a timely manner. Staff were aware of their responsibilities to notify relevant agencies when they noted concerns.

When people required support with their medicines, the registered manager had suitable arrangements in place. People who could manage their own medicines and had capacity were encouraged to manage their own medicines. Medicines were safely stored and appropriate arrangements for administering them were in place.

The service promoted the recruitment of staff who were predominantly deaf. There was a good skill mix across the team. We found staff were highly motivated, and effectively supported. Staff records and our discussions with staff confirmed they were well trained and supported with their personal development. There was a low staff turnover and we found people benefitted from the stability and continuity the staff team provided.

People were supported to eat a healthy balanced diet. People who required help at mealtimes were supported by staff in a sensitive manner.

The service ensured that people were cared for in a supportive and dignified manner. One person told us, 'The staff are there when I need them. The staff are brilliant'. A relative said, 'The home is run very well, especially the manager ' she's very on the ball'.

Thornton Gate demonstrated good practice in maintaining infection control. Staffing levels appeared adequate with an appropriate skill mix to meet the needs of people using the service. However, the manager told us she was in discussion with the managing organisation to increase levels. This was in order to meet the increasingly complex needs of the people using the service.

Care plans and risk assessments were in-depth, signed and regularly reviewed. Thornton Gate had a range of appropriate processes in place to monitor the quality of service provision.

"We visit our son on a regular basis and the staff are very good at providing us with any information we need. They always involve us in decisions about our sons care."

"Excellent people I am very happy here".

"The staff are so well trained and able to spot if anything is wrong in relation to health or any other issues."

We also spoke with Lancashire county councils monitoring contracts team who had no issues with the service.

We spent time in two of the flats within the building talking to two clients through a staff member using sign language. We also spoke to their relatives. All comments and observations were positive, One relative said, "Its the best place for our son, he has come on so much since being there." Another relative said, "The staff and manager are all brilliant and help us out so much."