Archived: Thorncliffe Residential Care Home

Thorncliffe Residential Care Home is a residential care home for 28 older people with a range of needs. Bedrooms were located on both the ground floor and first floor; a lift was available. There were 28 people accommodated at the service on the day of our inspection.

At our last inspection we rated the service 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.

At this inspection we found the service remained Good.

All the people who used the service told us they felt safe in the service. We saw safeguarding training had been completed by all the staff and those staff we spoke with knew their responsibilities in relation to this.

Risk assessments were in place to keep people safe, without restricting them. Risk assessments were reviewed regularly to ensure they remained current.

Medicines were managed safely. Staff had received training in administering medicines and their competencies were checked regularly. We found medicines were stored safely and the medicine administration records were completed without any gaps.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

When commencing employment, all staff had to undertake and induction. Training courses were available to staff which were relevant to their roles. Staff members told us and records confirmed that staff members received supervisions and appraisals on a regular basis.

People who used the service told us staff were kind and caring. We observed interactions from staff that were kind, caring and respectful.

Staff members knew people very well, including their preferences, background and history. People’s care records contained information relating to their sexuality, cultural/spiritual needs and relationships.

Records evidenced that GP’s, district nurses, podiatrists and other health care professionals were contacted to meet people’s health care needs.

All the staff we spoke with told us they would be happy for a family member to be cared for by the service.

We saw detailed, person centred care plans were in place. These clearly reflected people’s choices and preferences. People told us they had been involved in the development and review of their care plans.

One person told us they had needed to raise an issue with management. However, they were satisfied with how management had dealt with this and that it was resolved to their satisfaction. We saw the complaints policy and procedure was available in communal areas.

All the people we spoke with knew who the registered manager was and told us they were approachable.

The registered manager sought feedback from people who used the service, relatives, external professionals and staff to improve the service.

The service’s management and leadership processes achieved good outcomes for people.

The service was meeting all relevant fundamental standards.

Further information is in the detailed findings below

The service were last inspected in June 2014 when the service met all the regulations we inspected.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, including the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

We found the administration of medicines was safe and people thought they received their medicines on time.

People who used the service said food was good. People were given a nutritious diet and had choices in the food they were offered. We saw meals were unhurried and people chatted to each other socially.

Some staff had been trained in the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there was a good interaction between staff and people who used the service. People told us staff were kind, knowledgeable and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

There was a record of people's end of life wishes to ensure their needs could be met at this time.

There was a record kept of any complaints (none since the last inspection) and we saw the manager took action to investigate and reach satisfactory outcomes for the concerns, incidents or accidents to reach satisfactory outcomes.

Staff, people who used the service and visitors all told us managers were approachable and supportive.

Staff meetings gave staff the opportunity to be involved in the running of the home and discuss their training needs.

The manager conducted sufficient audits to ensure the quality of the service provided was maintained or improved.

The environment was maintained at a good level and homely in character. The outside space was undergoing further improvements which in the good weather would prove beneficial to people who used the service.

Was the service safe?

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. The registered manager audited any incidents and used the information to improve the service. People who used the service said, "I don't have any complaints but you can talk to the staff if you want something", "I feel sure I could talk to a member of staff if I had any concerns or my family. I have no complaints" and "I have nothing to grumble about but I would say something if I did". This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one.

The service was safe, clean and hygienic. There were policies and procedures for the control of infection. There were dedicated domestic staff to clean the home. Three people who used the service told us, "The laundry is the only thing I am not so keen on. My niece is going to bring my sewing basket to fix buttons and things which seem to come off. The home is clean and tidy", "It is kept very clean and tidy. The laundry is a good service" and "The laundry service has been very good and they have done it all for me. They clean the home every day". We looked at the systems for handling the laundry, clinical waste and how staff managed infection control and found them to be safe.

Was the service effective?

People's health and care needs were assessed with them if possible, and they were involved in writing their plans of care. We saw that all three plans of care we looked at had been agreed to and signed by people who used the service or a family member. Three people who used the service told us, "They have looked after me very well. Nothing is too much trouble. If you need anything they are there straight away", "The staff talk to both of us and keep us informed of my care. I get the care I need. My daughter signs the forms but tells me what is going on" and "I am satisfied with the care I get".

Specialist dietary, mobility, skin care and community support needs had been identified in care plans where required. Specialist equipment was provided such as pressure relieving devices or mobility aids.

The manager and other key staff audited the effectiveness of the systems they used. This included medication, the environment, infection control and mental capacity. The information was used to improve the service.

Staff were well trained in all the mandatory topics such as health and safety, infection control, fire awareness, food hygiene, medication administration, first aid, mental capacity, deprivation of liberties and moving and handling. There were other training opportunities in dementia care, care of people who had a stroke or diabetes, good customer relationship and end of life care. Staff were encouraged to take a nationally recognised qualification in health and social care. Senior staff were supported to take a management course. Staff were appraised and supervised but told us this was a two way process and they could raise topics of their own. Staff were given the training and support they needed to be an effective team.

Was the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. There was a friendly atmosphere within the home and we observed that staff interacted and chatted to people who used the service throughout the day. Three people who used the service told us, "The staff are very kind and nice to me. I am satisfied with everything really and I do understand that sometimes I get a little fed up, but the staff help me to cheer up. A firm is only as good as it's staff and they are all good here", "The staff are nice. They are polite and caring and we have a bit of a laugh" and "The staff are all lovely. I could not ask for care staff who are any better".

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People who used the service were encouraged to provide as much information about their past lives and what they liked or did not. This information gave staff the knowledge to treat people as individuals.

People lived in a comfortable environment and were able to personalise their rooms to make them feel more at home. Three people told us, "The room is a bit small but it has been very well decorated. I am only here for a short while but I can say the home is comfortable", "I have a nice room. It is kept very clean and tidy" and "I have a nice bedroom. It overlooks the drive and lawn. I have some of my own things such as pictures on my wall and a big television".

Was the service responsive?

People completed a range of activities in and outside the service regularly. Each person had their known hobbies and interests recorded. The care home had entered a local gardening competition and on the day of the inspection we observed people taking part in an arts and crafts activity. Other activities included outings, baking, games, exercise and special event days. Activities were suitable for the people accommodated at the home.

The registered manager held regular meetings with people who used the service and staff. Each day staff attended a 'handover' meeting to ensure they were up to date with people's needs. Staff were able to voice their opinions at meetings and supervision sessions. We saw that results from questionnaires had been very positive but the manager took steps to improve areas where the results were not as good.

Was the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. There was a system for providing information to other providers in an emergency.

Records we looked at were up to date and policies and procedures had been reviewed by the registered manager. The records were stored securely and easily available for inspection.

The service had good quality assurance systems. The registered manager undertook regular audits of the service. Records seen by us showed that identified shortfalls were addressed promptly and as a result the quality of the service was continually improving.

Two staff members we spoke with told us of their involvement with care plans which was suitable for their roles. They said they had been well trained and the home was clean and tidy. They told us, "We get regular supervision and appraisal. It is a two way process and we can bring up topics we want to. I think I am well supported in my job. There is a good staff team. I love helping people and looking after people. I am happy working here" and "We get very well trained and the manager is available for any advice. We get regular supervision and appraisal. We have our say during supervision and appraisal. I feel well supported by management. I like working here although it is sometimes hectic and stressful but it is good. I like the team and looking after people".

People told us they enjoyed the food. Comments included, "The food is very good here", "We get plenty to eat and drink during the day " and "I like the food; I can choose what I want".

We found that people's medicines were managed safely. However, regular accuracy checks of unused medicines would minimise the risk of medicines misuse.

All of the care staff had achieved a recognised qualification in care, which would help them to look after people properly. Staff were observed interacting with people in a pleasant and friendly manner and being respectful of people's choices and opinions. People told us there were sufficient staff to look after them. People made positive comments about the staff team. One person said, 'Staff are lovely they look after us well'.

We found records that were required to be kept to protect the safety and wellbeing of people who used the service were accurate and up to date to ensure people's needs were fully met.