Thornhill

Thornhill is a care home providing personal care to people with a learning disability and autistic people. The service accommodates 7 people. At the time of the inspection 6 people were using the service.

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.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right support: The service maximised people’s choice, control and independence. Staff were safely recruited and received an induction followed by training from the provider. Training was monitored and staff were supported with regular meetings and supervisions. Staffing capacity was enough to meet people’s needs. The provider followed current best practice guidelines to effectively manage people's medicines and risks associated with infection prevention and control (IPC). People and their relatives were very positive about the care provided. People told us they felt safe, and staff had the skills to support them.

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 supported this practice. If people lacked capacity to make certain decisions appropriate support was sought to support them.

Right care: Care is person-centred and promoted people's dignity, privacy, and human rights. People were encouraged to communicate freely and accessed community for activities when they wanted to. Staff supported people to learn new skills and maintain important contacts. People's care records were person-centred and up to date. Staff knew people well and understood their support needs which empowered people to make decisions about their care.

Right culture: People who use services live confident, inclusive, and empowered lives thanks to the leaders' and care staff's values and behaviours. The staff team coordinated efficiently to ensure that people's rights and preferences were respected. The management team set a good example, and people were encouraged to take positive risks and were supported to complete more tasks independently.

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

Rating at last inspection and update

The last rating for this service was good (published 22 April 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. 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.

We undertook a focused inspection. This report only covers our findings in relation to the Key Questions Safe and Well-led. 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 not changed. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Thornhill on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

21 Thornhill provides personal care and accommodation for up to seven people. There were six people living at the home at the time of our inspection.

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

The provider had various infection control procedures in place. The majority of these procedures were robust and followed government guidelines. However, we did highlight some minor issues on the day of inspection. The registered manager and nominated individual took action to address these issues.

People received safe care and were protected from abuse. Staffing levels were at an appropriate level to care for people safely.

People had ongoing access to various healthcare professionals. Staff supported people to engage in a number of activities. The provider did however, acknowledge activities had not been at their usual level due to the current pandemic restrictions in place.

Positive comments were received from relatives, staff and one professional including how well the service was run and the level of care people received. Various quality checks were completed to ensure the quality of care provided was of a good standard.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right support:

• Staff supported people to live the best lives they could. Each person's care had been tailored to meet their unique needs.

Right care:

• The service provided an environment which allowed people to live their lives in a way which supported their dignity, privacy and human rights. Relatives told us they care people received was very good and they had seen improvements in people's well-being whilst living at the service.

Right culture:

• The registered manager and staff team worked together to create an inclusive culture within the service. All feedback received was positive regarding the aims, ethos and cultural environment in the service. The service ensured people maintained contact with their relatives during the current pandemic. This had included staff driving one person to their family home to allow them to see their family whilst remaining in the provider's vehicle (to support with social distancing).

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 8 February 2018).

Why we inspected

We undertook this targeted inspection to check specific concerns we had received about people’s access to healthcare professionals to support their well-being; people engaging in activities, people having access to their own finances and the culture within the service. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Thornhill is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service could accommodate up to seven people. At the time of the inspection six people were using the service.

The service had a registered manager. 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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

We inspected the service in November 2015 and rated the service as ‘Good’. At this inspection we found the service remained ‘Good’.

Relatives felt the service was safe. Policies and procedures were in place to keep people safe such as safeguarding, accident and incident policies. Staff had received training in safeguarding and knew how to report concerns.

Staff recruitment procedures were robust and included Disclosure and Barring Service checks and references. Staffing levels were appropriate to the needs of the people using the service.

Risk assessments were detailed, person-centred, and gave staff clear guidance about how to help keep people safe. People had personal emergency evacuation plans in place in case of an emergency.

Staff were trained in a range of subjects such as infection control, health and safety and fire safety. Staff had also received training to support them to meet the needs of people who used the service, such as autism.

Staff received regular supervisions and an annual appraisal which covered their personal development. Staff felt they were well supported by the registered manager and assistant manager.

People had access to a range of healthcare, such as GPs, opticians and dentistry. Nutritional needs were acknowledged and people enjoyed a healthy varied diet.

The premises were well suited to people’s needs, with ample individual living space. Communal areas were available for people to spend time together. Bathrooms were designed to meet the needs of the 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.

People were encouraged to make choices in everyday decisions wherever possible. Staff provided support and care in a dignified manner, ensuring privacy when necessary.

Person-centred care plans were in place and contained good levels of detailed information. Care plans contained people’s likes, dislikes and preferences. Regular reviews took place to ensure staff had up to date information.

People enjoyed a range of activities both inside and outside the home. The service had positive links with the community with people accessing local community centres, discos and shops.

The provider had a complaints process in place which was accessible to people in a pictorial format.

The provider had a quality assurance process to monitor the quality of the service. Staff were extremely positive about the registered manager and assistant manager. We found people who used the service, family members and staff attended regular meetings where the quality of the service was discussed.

Staff and relatives felt the service was well managed. The registered manager was reported to be open, honest and effective.

We also undertook a short observational framework for inspection (SOFI) exercise to observe the interactions between them and the staff. SOFI is designed to be used when inspecting services for people who had some difficulty in communicating their opinions on the services they receive.

During the SOFI, we observed people being supported to express their preferences; for example, one of the people who used the service was observed using pictorial cards to communicate with the care staff. Staff were seen to be attentive and gave people the information about their activity options in a way that was appropriate to their needs. One person had been supported to make their own drink and was sitting beside the care staff drinking it. We observed another person being supported by care staff in their own living room getting ready to go out for a meal.

We found that people who were using the service were receiving the care and support they needed. For example, the staff we spoke with could describe how they met the assessed needs of the people they were providing with care.

We found that the people who were using the service were protected from abuse as the provider had procedures in place for the staff to follow if they suspected anyone was at risk of abuse.

We found that the provider has taken steps to provide care in an environment that was suitably designed and adequately maintained.

The complaints procedures had been made available to the people who used the service and their relatives. This was provided in a format that met their needs.

We found that some records, which the provider is required to keep, to protect the peoples' safety and wellbeing, were being stored securely and could be located promptly when needed. For example, the care records were kept in secure cabinets.

During the inspection, the care staff on duty were observed speaking to people in a kind and respectful way. The methods staff used to communicate with people were personalised and meaningful. We also observed that people were clean and well groomed.