Thornwood Care Limited

Updated 12 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 16 November 2018 and was unannounced. The inspection team consisted of an inspector and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we reviewed the information we already held about this service. This included details of its registration, previous inspection reports, action plans and any notifications they had sent us. Notifications are information about significant events the provider is legally obliged to send to the Care Quality Commission. We also reviewed the Provider Information Return (PIR). This is a form in which we ask the provider to give some key information about the service, what the service does well and improvements they plan to make. We contacted the local authority with responsibility for commissioning care from the service to seek their views. We spoke with and received correspondence from three visiting health and social care professionals, which included, speech and language therapists, dietician and a social worker.

We looked at areas of the building, including people’s bedrooms, the kitchen, bathrooms, and communal areas. Some people were unable to speak with us. Therefore, we used other methods to help us understand their experiences. We used the Short Observational Framework for Inspection (SOFI) during lunchtime. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

During the inspection we spoke with 13 people that used the service and seven members of staff: registered manager, deputy manager, cook/activity co-ordinator and five care staff. We reviewed four sets of records relating to people including care plans, medical appointments and risk assessments. We also 'pathway tracked' four people living at the home. This is when we followed the care and support a person has received and obtained their views. It was an important part of our inspection, as it allowed us to capture information about a sample of people receiving care. We looked at the staff recruitment and supervision records of four staff and the training records for all staff. We looked at medicines records for all the people and minutes of various meetings. We checked some of the policies and procedures and examined the quality assurance systems at the service.

Updated 12 December 2018

This inspection took place on the 16 November 2018 and was unannounced.

Thornwood 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.

Thornwood is a care home providing accommodation for up to 16 people with a dementia type illness. There were 15 people living there at the time 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.

The service 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.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. Care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, nutritional risks including swallowing problems and risk of choking, and moving and handling. Pressure relieving mattresses and cushions were in place for those who were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes. Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns. Staff had a clear understanding of making referrals to the local authority and CQC. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. People said they felt comfortable and at ease with staff and relatives felt people were safe.

Staff had received training to ensure they provided safe and effective care and there were opportunities for additional training specific to the needs of the service. This included the care of people with specific health needs such as diabetes and dementia. Staff had formal personal development plans, including two monthly supervisions and annual appraisals. The provider assessed people's capacity to make their own decisions if there was a reason to question their capacity. Staff and the registered manager had a good understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people's care plans contained restrictions on their liberty, applications for legal authorisation had been sent to the relevant authorities as required by the legislation.

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People were very complimentary about the caring nature of staff. People told us care staff were kind and compassionate.

A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff. Activities were provided throughout the day and were developed in line with people's preferences and interests. Staff had received training in end of life care supported by the Local Hospice team. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. The service worked well with allied health professionals. People and their families knew how to raise any concerns they had and were confident these would be responded to

Staff spoke positively about the provider and registered manager and felt supported. There were systems to seek people's views about their care, and the management of the home. The provider had systems to monitor the quality and safety of the service provided. Staff said they were encouraged to suggest improvements to the service. Relatives told us they could visit at any time and, they were always made to feel welcome and involved in the care provided.

Further information is in the detailed findings below.