We carried out a review of the data available to us about Thornfield Grange on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Thornfield Grange, you can give feedback on this service.
Thornfield Grange is a care home and provides accommodation and support for up to 9 people living with a learning disability and/or autistic spectrum disorder. There were 9 people living at the service when we visited.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Right Support
People were actively encouraged to access the community and develop life skills and independence.
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 in the service on the whole supported this practice.
Right Care
Staff promoted equality and diversity in their support for people and each other. The service worked proactively with other agencies to ensure people's wellbeing, and additions to the staff team of psychology and other therapy support meant best practice guidance was consistently followed. Where people had support, this was flexible, available when they needed it and to the level they needed. Staff understood and responded to people’s individual needs. Staff understood and supported people’s individual communication ways.
Right culture
The culture at the service had significantly improved, with a highly motivated, knowledgeable and empathetic staff team. Staff placed people’s aspirations, needs and rights at the heart of everything they did. They sought advice and feedback from everyone involved in people's care. The environment was bright and highly personalised. Staff were aware of and working to best practice guidance for supporting people with a learning disability and/or autistic people.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 11 July 2019). At the time we found the service needed to make improvements regarding the environment and culture.
Why we inspected
We carried out an unannounced inspection in May 2019 and found improvements were needed. We undertook this focused inspection to check the service had followed their action plan and to confirm improvements were made. This report only covers our findings in relation to the Key Questions effective, caring and well-led which contain those improvements.
We assessed whether the service is applying the principles of Right support right care right culture. We looked at infection prevention and control measures. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Thornfield Grange on our website at www.cqc.org.uk.
About the service: Thornfield Grange is a home for up to ten people who have a learning disability and who may be on the autistic spectrum. The service provides nursing and personal care. On the day of our visit there were eight people using the service.
People’s experience of using this service: We saw the environment did not meet the outcomes for people using the service reflected in the principles and values of Registering the Right Support. There were displays of medical information about long term conditions on display in the dining room and other equipment for attending to someone's personal care needs was not discretely located. The registered manager addressed this immediately following our visit.
People received a service that was not always caring by the use of institutionalised language in records and in the environment. Language and culture are closely linked and the use of terms such as "unit" and "patient" are not acceptable in a home setting.
Records relating to debriefing for staff members following an incident could be strengthened to show that staff had been supported effectively. We also asked that the feedback from advocacy services was clearly recorded and actioned
We have made a recommendation about the layout of care plans.
Staffing levels were appropriate and ensured people were supported to access community facilities. People received support to take their medicines safely and as prescribed. Risks to people's well-being and their home environment were recorded and updated when their circumstances changed.
People were supported to access healthcare services if needed. People were supported to have enough to eat and drink.
Interactions we saw between people and the staff team were positive and staff were proactive in anticipating when people were becoming distressed.
People were supported to engage in activities they enjoyed and we saw the service promoted people accessing local community facilities. People and their relatives and carers told us they knew how to make a complaint.
Some relatives said they felt communication could be improved and the registered manager accepted this feedback and said they would make this better. Systems to monitor the quality of the care provided were effective. The service was managed by a registered manager who had a clear vision about the quality of care they wanted to provide. The service worked well with other community partners.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection: Good (last report published May 2017).
Why we inspected: This was a responsive inspection based on concerns raised with CQC.
Thornfield Grange is a home for up to 10 people who have a learning disability and who may be on the autistic spectrum. On the day of our visit there were eight people using the service. It is situated in Bishop Auckland close to all facilities and transport links.
The service had a registered manager in place. 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.
We last inspected the service on 19 February 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.
Staffing was provided at safe levels and any staff absences were mainly covered by the registered provider’s own permanent and bank staff. The service were using agency staff as they were recruiting to permanent posts and were saw these staff were checked, supported and used consistently where possible. Staff told us they felt levels were generally safe but felt that night time should be kept under review.
Accidents and incidents had been appropriately recorded and risk assessments were in place for people who used the service and staff.
We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
Staff we spoke with were aware of procedures to follow if they observed any concerns in relation to safeguarding and we saw that staff were encouraged to raise concerns through supervisions and staff meetings that took place.
Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner.
Staff were suitably trained and training was arranged for any due refresher training. Staff received regular supervisions and appraisals and told us they felt supported.
We saw that people were supported to access a wide range of activities in the community and this included staff supporting people with educational and employment opportunities. Staff did feedback to us that another vehicle would reduce the pressure on planning community outings as presently this limited the access for people due to only having one vehicle.
The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA). People are 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.
People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. We experienced the lunchtime meal and saw people were given choices and support to eat a healthy and nutritious diet. Care records contained evidence of visits to and from external healthcare specialists.
Care records showed that people’s needs were assessed before they started using the service and they were supported to transition to the service at their own pace. We found that transition care plans could be more prominent and specific as the service did have people moving in and moving on from the service and there was not much written evidence of their support needs at that time.
Staff and relatives fed back that consistency of staff approach was the main challenge to the service and this could be improved.
Staff supported people who used the service with their social needs. We observed that all staff were caring in their interactions with people at the service. We saw people being treated with dignity and respect although we did raise that in records we viewed such as daily notes, meeting minutes and handover sheets that the term “unit” was used to describe the service. This was felt to be an institutionalised term and the registered manager agreed to support staff to refer to the ‘service or home’ rather than “unit”.
People who used the service and family members were aware of how to make a complaint. We saw complaints were recorded, investigated and monitored according to the registered provider’s policy.
Staff told us they felt supported by the registered manager and were comfortable raising any concerns. We saw that people and their relatives were involved in on-going reviews of care.
The service had a comprehensive range of audits in place to check the quality and safety of the service and equipment at Thornfield Grange and actions plans and lessons learnt were part of their on-going quality review of the service. We saw that the nursing files audit had not picked up outstanding documentation and we fed this back to the deputy manager for action.
We inspected this service on 19 and 21 January 2015. The inspection was unannounced. This meant the staff and provider did not know we would be visiting.
Thornfield Grange provides care and accommodation for up to ten people. The home specialises in the care of people who have autism. On the day of our inspection there were four people using the service.
The home 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.
On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a very friendly and respectful manner.
We spoke with four members of staff who told us they felt supported and that the registered manager was very approachable. Throughout the day we saw that people and staff appeared very comfortable and relaxed with the registered manager and staff on duty.
People had their physical and mental health needs monitored. There were regular reviews of people’s health and the home responded to people’s changing needs. People were assisted to attend appointments with various health and social care professionals to ensure they received care, treatment and support for their specific conditions.
We saw people’s care plans were very person centred and written in a way to describe their care, treatment and support needs. These were regularly evaluated, reviewed and updated. The care plan format was easy for service users to understand by using of lots of pictures and symbols. We saw lots of evidence to demonstrate that people were involved in all aspects of their care plans.
The staff we spoke with said they received appropriate training, good support and regular supervision. We saw records to support this.
The care staff understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.
Our observations during the inspection showed us that people were supported by sufficient numbers of staff. We saw staff were responsive to people’s needs and wishes and we viewed records that showed us staff were enabled to maintain and develop their skills through training and development activities. The staff we spoke with confirmed they attended training and development activities to maintain their skills. We also viewed records that showed us there were safe recruitment processes in place.
The registered manager understood her responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). DoLS applications had been made appropriately.
Throughout the day we saw staff interacting with people in a very caring and professional way. There were a range of individual activities that people took part in both in the home and in the local community.
The catering staff told us there was always plenty of food held in stock so people could choose what they wanted to eat each day. One person told us, “I like the food. I like the Pizza.”
We saw the provider had policies and procedures for dealing with medicines and these were followed by staff.
There was a range of information available to people in a picture format, for example, how to make a complaint, safeguarding adults and advocacy. We saw there was a keyworker system in place which helped to make sure people’s care and welfare needs were closely monitored. People said that they would talk to the registered manager or staff if they were unhappy or had any concerns. One service user told us, “Yes I made a complaint.”
We discussed the quality assurance systems in place with the registered manager. We saw there were a range of audits carried out both by staff, the registered manager and senior staff within the organisation. We saw where issues had been identified, action plans with agreed timescales were followed to address them promptly. We also saw the views of the people using the service were regularly sought and used to make changes.
When we visited we found the majority of people were unable to tell us directly about their experiences and views of their care. Therefore, we watched staff practices as they supported people. We found people were treated with dignity and respect. We also saw staff supported people to develop independent living skills.
The provider had made suitable arrangements to protect vulnerable people and respond appropriately to any allegation of abuse.
We found staff were recruited appropriately. This helped to make sure only people with the right skills and knowledge were employed to work for the care home.
We saw the provider had a system to regularly assess and monitor the quality of the service people received. People who used the service and their representatives were also asked for their views about the service.