Thistle Manor

Thistle Manor is a residential care home providing personal and nursing care for up to 33 people with mental ill heath aged 18 and over. The accommodation is provided in three separate units, including flats offering scope for greater independence. At the time of the inspection 28 people were using the service.

People’s experience of using this service and what we found

People told us they felt safe at the service. Staff had received training on positively responding to people and safeguarding. We observed people were relaxed and content in the company of staff and managers. Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns. Recruitment practices made sure appropriate checks were carried out before staff started work, some improvements were needed with records and these were put right. There were enough suitable staff available to provide care and support; staffing arrangements were kept under review.

Health and safety was promoted, this included maintenance of the premises, servicing and checking systems. We found some matters in need of attention, they were proactively rectified during the inspection. Risks to people's individual well-being were being assessed and managed. Staff followed some good processes to manage people's medicines safely. Some improvements were needed; however, the registered manager took timely action to progress these matters.

Arrangements were in place to gather information on people's backgrounds, their needs, abilities and preferences before they used the service. 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 at the service supported this practice.

People were encouraged to lead healthy lifestyles. They were supported with their healthcare needs, medical appointments and planning their recovery. People were offered a variety of meals and drinks; healthy eating was promoted and monitored. Individual needs and choices were known and catered for. There was a good standard of décor and furnishings to provide for people's individual needs, comfort and wellbeing. Adaptations had been made to meet people’s needs. The provider offered staff a programme of training, development and supervision.

People made positive comments about the staff and managers. We observed staff interacting with people in a kind, pleasant and friendly manner. Staff knew people well and were respectful of their choices and preferred routines. People's privacy and dignity was respected. People were supported to develop their skills and gain confidence.

People received personalised care and support. Innovative technology had been developed to plan, deliver, monitor and review people’s care. There were opportunities for people to engage in a wide range of community based and in-house activities. People were supported to have contact with families and friends. Processes were in place to support people with making complaints. Some complaints records were unclear. The registered manager confirmed to us, the action taken to make improvements.

Thistle Manor had a welcoming, friendly and inclusive atmosphere. People were treated as partners in managing their individual support. Management and leadership arrangements supported the effective day to day running of the service. The provider used a range of systems and technology, to regularly monitor and improve the service. There were processes to consult with people who used the service and others, to assess and monitor the quality of their experiences and make improvements.

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 30 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Thistle Manor provides accommodation and nursing care for up to 33 people with mental ill health. The home is located in its own grounds on the outskirts of Clitheroe. The home is spilt into three units known as Woodlands, Meadows and Oaklands. There are separate lounges and dining rooms and a shared activity room and gym. All bedrooms are single with en-suite facilities. Staff are available to provide assistance and support 24 hours a day. At the time of the inspection there were 31 people accommodated in the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 last inspection on 3 September 2014, the service was found to be meeting the regulations applicable at that time.

Safeguarding adults’ procedures were in place and staff understood how to protect people from abuse. Risks associated with people’s care were identified, assessed and recorded. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Safe staff recruitment procedures were in place which ensured only those staff suitable for the role were in post. People's medicines were managed appropriately and people received their medicines as prescribed by health care professionals.

Staff had completed an induction programme when they started work and they were up to date with the provider's mandatory training. The registered manager and staff understood the main principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation. There were appropriate arrangements in place to support people to have a varied and healthy diet. People had access to a GP and other health care professionals when they needed them.

Staff treated people in a respectful and dignified manner and people's privacy was respected. People living in the home had been consulted about their care needs and had been involved in the care planning process. We observed people were happy, comfortable and relaxed with staff. Care plans and risk assessments provided guidance for staff on how to meet people’s needs and were reviewed regularly. People were encouraged to remain as independent as possible and supported to participate in a variety of daily activities.

Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. The registered manager took into account people’s views about the quality of care provided through discussion, meetings and satisfaction surveys. The registered manager used the feedback to make on-going improvements to the service.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found:

Is the service safe?

Processes and practices were in place to safeguard people from abuse and neglect. People we spoke with did not express any concerns about the support and care they were receiving at Thistle Manor. Two people spoken with said, 'I feel safe here. Staff make me feel safe' and 'As soon as they know there is a problem, the staff come and sort it out'.

We found risk assessments were in place and reviewed on a regular basis in order to protect the people who used the service, staff and people within the community.

Arrangements were in place to train staff on medicines management. However, we found staff had not been properly assessed on their ability to manage people's medicines safely the manager told us matter would be resolved.

People said they were satisfied with the accommodation provided at Thistle Manor. We found the premises were safe and well maintained.

Is the service effective?

Records and discussion showed people's health and wellbeing was monitored and they were getting support as appropriate, for healthcare appointments.

We found people who used the service were involved in assessing their progress at Thistle Manor. Records showed people had made improvements. However, developing people's independent living skills was not always effectively supported.

Processes were in place for staff to attain nationally recognised qualifications. Staff spoken with, told us of the training they had received. Staff considered there was good teamwork and the management team were supportive and approachable.

Is the service caring?

The people we spoke with indicated they were satisfied with the care and support they experienced at Thistle Manor. Comments included, 'I feel I get the right level of support' and 'Everything is fine. I'm getting the help I need'.

People made positive comments about the staff team. They told us, 'Staff are nice' and 'Staff are very supportive, polite and communicative'. During the inspection we observed staff considerately supporting and involving people with their chosen activities and individual needs.

We found care plan records were personalised and addressed the individual health and social care needs of people who used the service. However, we found records of some interventions had not been kept this meant people may not have had the support they needed.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Policies, procedures and a code of practice were available to support appropriate practice around DoLS and the Mental Capacity Act 2005. However, we found the care planning process was lacking in screening people's capacity to make their own choices and decisions. After the inspection the manager told us this matter had been resolved.

We found some improvements could be made with the environment to help promote people's comfort and wellbeing.

Is the service responsive?

We found arrangements were in place to assess people's needs and abilities prior to admission. This meant individual needs and choices would be considered and planned for before they used the service.

Records and discussion showed people's' mental health, healthcare and general wellbeing was being monitored and responded to. People were getting appropriate attention from medical professionals.

We found people were supported to undertake chosen activities at Thistle Manor, in the local community and further afield.

Processes were in place to effectively support people with raising concerns and making complaints.

Is the service well-led?

There was a registered manager in post who had responsibility for day to day management of the service. There was also a team of RMN (Registered Mental Health) nursing staff providing direction and leadership. The service also had an on- site management support team for various functions including personnel, training and IT systems.

We found people using the service were involved with decisions which affected them on an informal daily basis, during reviews. They also had the opportunity to be involved and consulted about the service, through surveys and in residents meetings.

People who used the service indicated they were satisfied with the care and support they experienced at Thistle Manor. One person said, 'I think it's quite good'. Comments in questionnaires we looked at included, 'Happy to continue to live here' and 'I like living here.

Regular audit checks were being carried out on various processes and practices. This meant there were systems in place to assess and monitor how the home was operating and to evaluate the quality of the service. However, as some matters needed attention, we found these systems could be improved.

People were being involved as far as possible in planning and consenting to their support and were enabled to make decisions about matters which affected them.

People told us the support they received was good and that they had care plans describing how their support should be provided. We found some progress could be made with care plans, to make sure they have the right information and clearer details for staff to follow.

People were supported to access resources and activities within the community and keep in touch with others. They were supported to make choices and develop independent living skills.

People were getting support with healthcare needs and they had access to on-going support from health care professionals.

We found arrangements were in place to support people with their medicines, but better records needed to be kept to make sure people are supported properly.

We found the staffing arrangements were sufficient in ensuring people received effective care and support.

There were systems in place to help support people to make complaints and raise concerns, but procedures needed updating to make sure people had all the correct information.

People were treated with respect and valued as individuals, they were able to make choices and develop independence skills. People were being involved in planning their support and were enabled to make decisions about matters which affected them. We were told their involvement was to be developed to further promote people’s recovery and wellbeing.

People were supported to access resources and activities within the community and keep in touch with relatives.

People were getting support with healthcare needs and they had access to ongoing attention from health care professionals.

People had no concerns about their care and treatment; they said they felt safe with the staff. They told us they liked the staff. We found people using the service were supported by properly recruited, trained, capable staff.

People were being consulted about their experience of service. We found that checks on practices and systems were being carried out and action taken to improve and develop the service.