We carried out an inspection of Thistle Manor on 8 and 9 November 2016. The first day was unannounced.

Thistle Manor provides accommodation and nursing care for up to 33 people with mental ill health. The home is located in its own grounds on the outskirts of Clitheroe. The home is spilt into three units known as Woodlands, Meadows and Oaklands. There are separate lounges and dining rooms and a shared activity room and gym. All bedrooms are single with en-suite facilities. Staff are available to provide assistance and support 24 hours a day. At the time of the inspection there were 31 people accommodated in the home.

The service had a registered manager in post. 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.

At the last inspection on 3 September 2014, the service was found to be meeting the regulations applicable at that time.

Safeguarding adults’ procedures were in place and staff understood how to protect people from abuse. Risks associated with people’s care were identified, assessed and recorded. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Safe staff recruitment procedures were in place which ensured only those staff suitable for the role were in post. People's medicines were managed appropriately and people received their medicines as prescribed by health care professionals.

Staff had completed an induction programme when they started work and they were up to date with the provider's mandatory training. The registered manager and staff understood the main principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation. There were appropriate arrangements in place to support people to have a varied and healthy diet. People had access to a GP and other health care professionals when they needed them.

Staff treated people in a respectful and dignified manner and people's privacy was respected. People living in the home had been consulted about their care needs and had been involved in the care planning process. We observed people were happy, comfortable and relaxed with staff. Care plans and risk assessments provided guidance for staff on how to meet people’s needs and were reviewed regularly. People were encouraged to remain as independent as possible and supported to participate in a variety of daily activities.

Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. The registered manager took into account people’s views about the quality of care provided through discussion, meetings and satisfaction surveys. The registered manager used the feedback to make on-going improvements to the service.

During the inspection we spent time in the company of people using the service. We spoke with seven people who used the service, six members of staff, the manager and the owner. We considered all the evidence we had gathered under the outcomes we inspected. We have used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found:

Is the service safe?

Processes and practices were in place to safeguard people from abuse and neglect. People we spoke with did not express any concerns about the support and care they were receiving at Thistle Manor. Two people spoken with said, “I feel safe here. Staff make me feel safe” and “As soon as they know there is a problem, the staff come and sort it out”.

We found risk assessments were in place and reviewed on a regular basis in order to protect the people who used the service, staff and people within the community.

Arrangements were in place to train staff on medicines management. However, we found staff had not been properly assessed on their ability to manage people’s medicines safely the manager told us matter would be resolved.

People said they were satisfied with the accommodation provided at Thistle Manor. We found the premises were safe and well maintained.

Is the service effective?

Records and discussion showed people’s health and wellbeing was monitored and they were getting support as appropriate, for healthcare appointments.

We found people who used the service were involved in assessing their progress at Thistle Manor. Records showed people had made improvements. However, developing people's independent living skills was not always effectively supported.

Processes were in place for staff to attain nationally recognised qualifications. Staff spoken with, told us of the training they had received. Staff considered there was good teamwork and the management team were supportive and approachable.

Is the service caring?

The people we spoke with indicated they were satisfied with the care and support they experienced at Thistle Manor. Comments included, “I feel I get the right level of support” and “Everything is fine. I’m getting the help I need”.

People made positive comments about the staff team. They told us, “Staff are nice” and “Staff are very supportive, polite and communicative”. During the inspection we observed staff considerately supporting and involving people with their chosen activities and individual needs.

We found care plan records were personalised and addressed the individual health and social care needs of people who used the service. However, we found records of some interventions had not been kept this meant people may not have had the support they needed.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Policies, procedures and a code of practice were available to support appropriate practice around DoLS and the Mental Capacity Act 2005. However, we found the care planning process was lacking in screening people’s capacity to make their own choices and decisions. After the inspection the manager told us this matter had been resolved.

We found some improvements could be made with the environment to help promote people’s comfort and wellbeing.

Is the service responsive?

We found arrangements were in place to assess people's needs and abilities prior to admission. This meant individual needs and choices would be considered and planned for before they used the service.

Records and discussion showed people's’ mental health, healthcare and general wellbeing was being monitored and responded to. People were getting appropriate attention from medical professionals.

We found people were supported to undertake chosen activities at Thistle Manor, in the local community and further afield.

Processes were in place to effectively support people with raising concerns and making complaints.

Is the service well-led?

There was a registered manager in post who had responsibility for day to day management of the service. There was also a team of RMN (Registered Mental Health) nursing staff providing direction and leadership. The service also had an on- site management support team for various functions including personnel, training and IT systems.

We found people using the service were involved with decisions which affected them on an informal daily basis, during reviews. They also had the opportunity to be involved and consulted about the service, through surveys and in residents meetings.

People who used the service indicated they were satisfied with the care and support they experienced at Thistle Manor. One person said, “I think it’s quite good”. Comments in questionnaires we looked at included, ‘Happy to continue to live here’ and ‘I like living here.

Regular audit checks were being carried out on various processes and practices. This meant there were systems in place to assess and monitor how the home was operating and to evaluate the quality of the service. However, as some matters needed attention, we found these systems could be improved.

People who used the service told us they were satisfied with the care and support they experienced at Thistle Manor. We spoke with six people; two made the following comments, "The whole team is supportive" and "This is the most settled place I've been".

People were being involved as far as possible in planning and consenting to their support and were enabled to make decisions about matters which affected them.

People told us the support they received was good and that they had care plans describing how their support should be provided. We found some progress could be made with care plans, to make sure they have the right information and clearer details for staff to follow.

People were supported to access resources and activities within the community and keep in touch with others. They were supported to make choices and develop independent living skills.

People were getting support with healthcare needs and they had access to on-going support from health care professionals.

We found arrangements were in place to support people with their medicines, but better records needed to be kept to make sure people are supported properly.

We found the staffing arrangements were sufficient in ensuring people received effective care and support.

There were systems in place to help support people to make complaints and raise concerns, but procedures needed updating to make sure people had all the correct information.

People using the service told us they were satisfied with the support they received at Thistle Manor. They told us, “I like everything about it” and “It’s a perfect place”. However we found some care records were incomplete or lacking in detail, which meant there was a risk people might not receive the care and support they need.

People were treated with respect and valued as individuals, they were able to make choices and develop independence skills. People were being involved in planning their support and were enabled to make decisions about matters which affected them. We were told their involvement was to be developed to further promote people’s recovery and wellbeing.

People were supported to access resources and activities within the community and keep in touch with relatives.

People were getting support with healthcare needs and they had access to ongoing attention from health care professionals.

People had no concerns about their care and treatment; they said they felt safe with the staff. They told us they liked the staff. We found people using the service were supported by properly recruited, trained, capable staff.

People were being consulted about their experience of service. We found that checks on practices and systems were being carried out and action taken to improve and develop the service.

People using the service told us they were satisfied with the support they received at Thistle Manor, that they were being involved in planning their support and were enabled to make choices and decisions about matters which affected them, both individually and as a group.

They said staff treated them well, that were enabled to develop independence skills and were being supported to experience learning opportunities. Also, that they were supported to access resources and activities within the community.

People said they were getting support with healthcare needs, with regular check ups being arranged. They had ongoing attention from health care professionals along with complimentary therapies.

Everyone spoken with was okay with the catering arrangements and how they were supported with food choices, meal preparation and cooking.

Positive comments were made about the accommodation and facilities provided at Thistle Manor. People liked their private rooms, the lounges, the gym, IT and craft rooms. They also appreciated the grounds and gardens.

People said they would speak up if they were not happy with things, they considered the staff and managers to be approachable. They said the staff were very good at listening to them and making time for them.