Thornbury Community Services

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the provider met people’s needs. This is the first assessment of the service. The key question has been rated good. This meant people’s needs were met through good organisation and delivery.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider placed people at the centre of care delivery and demonstrated a strong commitment to providing highly personalised support. Care was tailored to people's individual needs, preferences, life histories and aspirations, ensuring support reflected what was important to them.

Staff had a detailed understanding of the people they supported and used this knowledge to provide compassionate, person-centred care that promoted people's emotional, social and physical wellbeing. Care plans were comprehensive and person-led, providing clear guidance on how people wished to be supported.

People were actively involved in decisions about their care and were encouraged to make choices about their daily lives. Support was regularly reviewed and adapted to reflect changing needs and preferences, ensuring care remained responsive and individualised.

Staff developed positive and trusting relationships with people and responded sensitively to their needs. This enabled people to feel valued, understood and supported. One relative told us, “I am so grateful for the service this agency provides.”

The provider went beyond people's expected care needs by adopting creative and personalised approaches to support. As a result, people experienced positive outcomes, improved wellbeing, and greater independence, choice and control over their lives. The provider demonstrated an exceptional commitment to supporting people to live full and meaningful lives. For example, a person with complex healthcare needs was enabled to participate in a Make-A-Wish family holiday to Disneyland Paris, an experience that had significant personal value to them and their family. Through detailed clinical planning, multidisciplinary collaboration and robust risk management, staff overcame considerable barriers to participation while ensuring safe and effective care throughout the trip.

This person-centred approach enabled the person to achieve a life-enhancing experience that may otherwise not have been possible. Feedback from the family highlighted the positive impact the holiday had on their wellbeing and ability to create lasting memories together. This demonstrated how the provider consistently went beyond routine care delivery to achieve exceptional outcomes, placing people's aspirations, relationships and quality of life at the centre of care and support.

The provider worked effectively with partners to coordinate care and ensure people experienced joined-up support that met their needs.Care delivery was responsive to changing needs and the service worked collaboratively with health and social care professionals involved in people's care. Staff coordinated admissions and discharges to support continuity of care and to ensure people could be supported safely.

Continuity of care was a clear strength, with a small, consistent team of staff supporting each person. This enabled staff to build strong relationships and quickly recognise any changes in people’s needs or wellbeing. One relative said, “It’s great we have a core team of staff that support (person).” All the people and relatives we spoke with were highly complimentary about this approach. This consistency helped ensure safe, coordinated and person-centred care was delivered.

The provider gave people information in a way they could understand and supported them to access information relevant to their care and support. The service was highly accessible and delivered information in a variety of formats to meet people’s individual needs. All reviews were conducted face-to-face, which enhanced accessibility, particularly for people with communication needs, including those living with complex health conditions.

Relatives spoke positively about the service’s responsiveness. One relative commented, “I can get hold of them at a moment’s notice.” People's communication needs were considered within care planning, and information was adapted to support effective communication. Detailed instructions were available for staff supporting people with complex healthcare needs, helping to promote safe and consistent care.

Care plans clearly outlined people’s communication needs, ensuring staff had a good understanding of how best to support each individual. The use of small staff teams enabled continuity of care and allowed staff to develop meaningful relationships with people, helping them to understand both verbal and non-verbal communication cues. The service user guide was detailed, accessible and clearly explained the provider’s expectations, support arrangements and escalation processes. Information within care plans was comprehensive and helped ensure staff understood people’s needs and how to respond appropriately.

Staff demonstrated a strong awareness of individual needs. One staff member shared, “There was a client who was not able to communicate verbally. They understand and can hear, staff used pictures to work out what they’re asking for. I get to know individual people and their needs.” This approach ensured people were supported in a personalised and inclusive way, promoting effective communication and positive outcomes.

The provider listened to people and involved them, and those important to them, in decisions about their care and support.People and their relatives told us they were actively involved in reviewing their care and that this was done regularly. Several people confirmed they had recently taken part in an annual review, providing them with an opportunity to discuss their care and any changes needed. In addition to formal reviews, the service completed in-person quality monitoring visits between care plan reviews. This approach gave people further opportunities to raise concerns, share feedback, and remain actively involved in shaping their care packages.

Feedback gathered during the assessment indicated most people felt supported and knew how to raise concerns with the provider. The service also used surveys, reviews and engagement opportunities to gather feedback and drive improvements.

The provider worked to ensure people could access care and support based on their assessed needs. Staff recognised when people required additional support to access care, treatment, or external services. They worked proactively with a range of professionals and agencies to remove barriers and ensure people received the support they needed in a timely way.

Admissions and referrals were considered against the provider’s ability to meet people’s needs safely. Staffing arrangements, training and competency checks were designed around individual care packages to ensure people had access to suitably skilled staff.

Communication methods were adapted to meet individual needs and assessments considered health, wellbeing and communication requirements. This helped support equitable access to care for people with a range of complex needs.

The provider took account of people’s individual circumstances and supported people to achieve positive outcomes.People’s health, care, wellbeing and communication needs were regularly assessed and reviewed. Care plans reflected assessed needs and risks, and health changes were identified and escalated appropriately. People’s individual characteristics, including cultural, religious, communication, and accessibility needs, were assessed and clearly documented within care plans. This enabled staff to provide personalised care that respected people’s preferences and promoted inclusion.

The provider ensured information was shared in accessible ways such as easy formats to enhance their understanding, to make informed decisions. Where appropriate, families, and representatives were involved to ensure people’s voices were heard, particularly for those who may have difficulty expressing their views independently.

The provider supported people to plan ahead and considered future needs and changing circumstances.Care plans were regularly reviewed and updated to reflect changes in people’s health and wellbeing. Systems were in place to monitor review dates and ensure care documentation remained current and relevant.

Planning considered a range of potential future scenarios, including emergency situations, changing health needs and transitions in care. Care plans included clear escalation guidance and contingency arrangements to help ensure continuity of support.