Archived: Thornfield

People’s experience of using this service: At our last inspection we rated the home as Outstanding in three of the five key questions and overall. At this inspection, there had been many further improvements in pursuit of an ever more safe, effective, caring, responsive and well-led service. As a result, the home is now rated as Outstanding in four key questions and overall.

People were at the very heart of the service. A person commented on the “…high quality care, you would have to go quite a way to find a better one, everyone’s nice.” People’s feedback and our observations provided us with many examples of how good this person-centred approach made them feel. For example, a relative said, “My mum was resisting care, however as soon as she entered Thornfield she is so happy - a changed woman in fact. I couldn't fault the care provided. Mum has a new lease of life and all problematic behaviour has disappeared as has her stress. The home is full of love and laughter and activities abound with an emphasis on music, which all enjoy.”

Staff promoted people's right to make choices in every aspect of their lives and actively supported them to maintain their independence for as long as possible. There was a commitment to provide a socially stimulating environment seven days a week, one person said, “The entertainment here is very good, never boring.” People were treated with the utmost dignity and respect. End of life care was provided in an individualised and compassionate way. People were treated with dignity and respect in a way that truly valued them as individuals. The registered manager and all staff, whatever their role, were always prepared to go the extra mile to ensure people received

the care they needed and lived full and meaningful lives.

There was a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (the 'provider') 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 registered manager was deeply involved in all aspects of the running of the home and provided their team with skilled leadership. This ensured all staff had the same aim to enable people living with dementia to lead fulfilled lives. The culture of Thornfield was exceptionally open and positive. The atmosphere was relaxed and friendly; a fact repeatedly commented on by visitors. One said, “(X) has settled in beautifully at the home because of the staff's professional attitude and kindness, everything printed in their brochure is exactly as stated and all the family are very happy with these arrangements.”

Learning and development was a high priority for both the registered manager and their team. This meant the staff team were exceptionally skilled and motivated. Under the registered manager's research-led leadership a number of innovative changes had taken place, to promote people's physical and mental health. A person told us, “High quality care, you would have to go quite a way to find a better one, everyone’s nice.” A visitor said, “Thornfield is a lovely home, well run, with caring dedicated and professional staff who are always happy to go that extra mile.”

The service placed people’s wellbeing at the heart of their work. People received personalised support which met their needs and preferences wherever possible. People told us the service listened to their wishes and suggestions to improve their care and support.

Effective quality assurance systems were in place to monitor the quality of service being delivered and the running of the home. Regular audits were completed by the registered manager and the

management team to check on the quality of the service, such as medicines and the premises.

Regular staff meetings took place to supplement supervisions.

Staff members commented on how much staff morale had improved by the registered manager's approachable style. However, they also appreciated the registered manager’s quick and firm response when practice needed to improve.

People received their medicines as prescribed. Systems were in place to safeguard people from abuse, and the service responded to any concerns or complaints. We saw good practice in relation to equality and diversity. There was a thorough recruitment process in place that checked potential staff were safe to work with people who may be vulnerable. Enough staff were in place to meet people’s needs.

More information is in the full report.

Rating at last inspection: This service was last inspected in 2016, when it was rated as outstanding in three areas with outstanding as an overall rating.

Why we inspected: This inspection was scheduled for follow up based on the last report rating.

Follow up: We will continue to monitor the intelligence we receive about the service. If any concerning information is received, we may inspect sooner.

We last inspected Thornfield on 6 September 2013 when we judged they were compliant with all the areas we inspected.

There was a registered manager at service who had registered with CQC. 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.

Thornfield was well run by an approachable registered manager who worked alongside a committed provider. The service was well-led and the registered manager and her management team provided a strong role model for good practice. Staff said they were well supported and had access to a range of training and supervision. There was good staff morale with staff clearly enjoying their work and understanding their roles and responsibilities.

The environment was designed to stimulate people and provide them with space to move around, both internally and externally. Vintage film posters and life-size images of famous celebrities were used by staff as reference points to help people find their way around. They also created points of discussion between staff and people living with dementia.

Staff were clear about the ethos and values of the home which they demonstrated in their actions and interactions with the people living in the home and their teamwork. There were sufficient numbers of staff on duty in order to meet the needs of people using the service. Throughout our inspection, staff were busy but not rushing to complete their work.

Staff had been trained to consider how to support people at their end of life with the aim to feel calm, pain free and safe. The registered manager recognised the importance of the use of touch, massage and music to help the person not to feel alone. They understood how important it was for relatives to feel able to contribute to the person’s care and shared skills with them to support them.

Staff were attentive and the atmosphere was unrushed. Staff had the specialist knowledge and skills required to meet people’s individual needs and promote their health and wellbeing, including end of life care. Staff knowledge of good dementia care practice meant they tried a different approach if they were unsuccessful when they first tried to offer assistance. They worked as a team to ensure people received the support they needed but in a manner which acceptable to them.

People were supported to retain an active presence in the local community and to maintain their personal interests and hobbies, such as swimming or charity work. There was a diverse range of activities, both on a one to one basis but also as a group. Care and activities staff were supported by an aromatherapist, physiotherapist and music therapist who visited weekly. The atmosphere was lively but staff also recognised when some people needed peace and a slower pace.

People living at the home told us staff were kind and caring. Other people were not able to comment directly but their actions showed us they felt safe and loved. There were positive relationships between staff and people living at the home, and their visitors. The service was exemplary in recognising people as individuals and responding to their preferences. Staff explained how some people needed regular reassurance while other people were more gregarious and were more able to express their emotions, whether negative and positive.

Food and drink were provided to a high standard and the importance of the social occasion of meals was recognised and celebrated; the commitment to good quality meals was high. Staff took time to ensure people understood the options that were available to them, for example they named the choices then described what they looked like or the main ingredients. Written information was available in the form of menus on the table and there were also photographs of the meals to provide a visual prompt. The kitchen was based at the heart of the home and people could see into it, watch meals being prepared and chat with catering staff.

Staff worked closely with local healthcare services and people had prompt access to any specialist support they needed. A health professional described how staff always asked for advice appropriately and were keen to learn techniques to help people to eat and drink safely. They described staff members’ good practice, such as seating at the same level as the person and connecting with the person they were supporting. They said staff were “great.” Another health professional said people looked well cared for and staff treated them as individuals. Medicines were well managed and staff practice was reviewed regularly to ensure their practice was safe.

People were confident concerns or complaints would be listened to and acted upon. Recruitment practices were well managed. Staff knew their responsibilities to safeguard vulnerable people and to report abuse. There were systems to monitor the quality of the service, including responding to suggestions for improvements.

The registered manager was aware of their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and demonstrated through their practice an understanding of how this impacted in the way they worked.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. We discussed DoLS with the registered manager and looked at records. We found the provider was following legal requirements in the DoLS. At the time of the inspection, an application had been made to the local authority in relation to people living at the service. This meant people’s legal rights were protected.

People were supported to make their own decisions wherever possible. Staff understood the principles of the Mental Capacity Act which was shown in their approach and practice. They acknowledged people’s emotions, by not undermining people’s feelings but at the same time helping them to feel safe rather than challenged. This enabled people to feel in control and able to make choices.

There were 35 people living at the home. We spoke with people living at Thornfield. We also spent time with people in communal areas of the home so we could make a judgement about how well people were cared for as most people were not able to comment directly on their care. We also spoke with six staff members and the manager. We looked at a selection of care records, and focussed on medication, staffing levels and staff training.

We saw people looking relaxed and at ease with staff and each other. People’s friendships were valued by staff, and we saw people sitting chatting with one another about the activities around them or remembered events from their past. Throughout the day, we saw people laughing, singing and dancing; the atmosphere was positive and inclusive because of the skills of the staff team. When people felt unwell or anxious, staff were quick to recognise the need to change their approach; either supporting people to move to a quieter area or sitting with them to reassure them.

People’s health and well-being was assessed, and care was provided in a way that suited people's individual needs. Medication systems were well organised and medication practice was safe. Staffing levels had been variable on some shifts but action was being taken to address this issue. There was a training programme in place and staff had been provided with training specific to the needs of the people they cared for, as well as mandatory training.

People looked relaxed in their home and at ease with staff. People were offered choices and encouraged to make decisions. Staff practice ensured people's dignity and privacy was respected. We saw that care records were up to date, and reflected what staff told us and what we observed regarding people's care needs.

The provider showed a strong commitment to provide an environment that enabled people and encouraged conversation and a stimulating atmosphere. Staff numbers met the care and social needs of people, and there was a commitment to quality assurance to ensure that standards were maintained.