The inspection visit took place on 4, 7 and 11 December 2018. The first day of our inspection visit was unannounced. Thistley Lodge is a residential care home which provides care and nursing support to people with mental health conditions. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Thistley Lodge is registered to provide care for up to eight people. At the time of our inspection there were five people living at the home. The inspection was prompted by the notification of an incident following an investigation by the provider and safeguarding authorities. This incident is subject to a police investigation and as a result at this inspection we did not examine the circumstances of the incident. However, the information shared with CQC about the incident, indicated potential concerns about the management of risk and people’s safety.

Our inspection looked at whether people’s care was managed safely and that staff had the right level of competency and skill. When the investigation is concluded we will consider any further action we may take.

At our previous inspection in December 2017 we had rated the home as ‘Good’ overall, with ‘Requires Improvement’ in Well Led. This was because the provider’s audit system was not effective and there was a lack of audits and checks for us to review. In some cases, audits were not made available to us. In addition, there was no registered manager at the home. At this inspection we found there had been significant changes in how the home was run which had adversely affected the quality of care people received. We have rated the home ‘Inadequate’ in Safe, and Well Led, and ‘Requires Improvement’ in Effective, Caring and Responsive. This meant the service was rated ‘Inadequate’ overall.

There was a registered manager employed at the home at the time of our inspection visit who was registered with CQC to manage two care homes owned by the provider. However, the registered manager was also overseeing two additional homes for the provider, and so only spent up to two days per week at the home. 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.

Although people told us they enjoyed living at Thistley Lodge, senior staff were not always trained and supported in how to recognise and report safeguarding concerns. The provider did not always report and act on safeguarding concerns to ensure people were always cared for safely and risks to people were effectively managed.

Staff with the required skills and competencies were not always available to respond to people’s health needs and keep people and staff safe. Risks to people were not always properly assessed. Care plans did not provide sufficient information for staff to support people safely and minimise risks to their health and wellbeing.

Some care plans and risk assessments contained important health information and advice, which was not followed, to ensure staff provided consistent support that met people’s changing needs. People did not always receive support to maintain their health, where it was required.

Care plans were not effectively reviewed to ensure staff had the necessary and up to date information to support people as their needs changed. People’s care records did not always describe to staff how to support people with their communication needs.

People were not supported in line with the requirements of the Mental Capacity Act 2005 (MCA). Mental capacity assessments were not completed and best interest’s decisions were not recorded for scrutiny and oversight. Legal adv

The inspection visit took place on 19 December 2017 which was unannounced. This was a comprehensive inspection.

Thistley Lodge is a mental health nursing home, which provides care for up to eight people over two floors. At the time of our inspection there were five people living at Thistley Lodge. During our inspection visit, a person was spending the night at Thistley Lodge because they were planning to move there permanently from January 2018. This person wanted to make sure they enjoyed living there, before making a commitment. This increased the occupancy to six people during our visit.

People in care homes receive accommodation and nursing and/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.

A requirement of the service’s registration is that they have 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 and the associated Regulations about how the service is run. At the time of our inspection visit there was no registered manager in post. The registered manager had left the service in September 2017. Since then a manager has been in post, and in December 2017, they had applied to become the registered manager at the home.

At the last inspection in November 2016 the service was rated ‘Good’ overall. At this inspection we found the service remained ‘Good’ overall.

People and relatives were pleased and satisfied with the quality of care provided. People were encouraged to make their own decisions about how they lived their lives, such as receiving their care and support in line with their expressed wishes and goals.

People were supported to remain as independent as possible so they could live their lives as they wanted. People made choices about what they wanted to do for themselves, such as what to do, where to go and what to wear. People were encouraged to maintain important relationships with family and people built friendships with people at the provider’s other home close by.

Care plans contained supportive information for staff to help them to provide the individual care people required. For people assessed as being at risk, care records included information so staff knew how to minimise risks to those in their care. Staff knew how to support people to minimise identified risks and staff knew what action to take if people did not follow their risk management plans.

Staff knew how to keep people safe from the risk of abuse. Staff and the clinical lead nurse understood what actions they needed to take if they had any concerns for people's wellbeing or safety. The provider safeguarded some people’s finances to reduce potential for financial loss

Staff understood people’s individual needs and abilities which meant they provided care in a way that helped keep people safe. Staff received essential and regular training to meet people’s needs, and effectively used their skills, knowledge and experience to support people.

People’s care and support was provided by a caring and consistent staff team. People told us they felt safe living at Thistley Lodge because they got on well with each other and the staff team. People said it felt like a big family. Relatives were complimentary about the staff team and that they did what they could to help people promote their family members independence.

Staff worked within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge ensured people received consistent support so the right decisions and outcomes were made. Care records included the support people needed if they lacked capacity. Staff told us and we saw, they sough

This inspection took place on 19 November 2015 was unannounced.

Thistley Lodge is a mental health nursing home, which provides care for up to eight people over two floors. At the time of our inspection there were six people living at Thistley Lodge.

A requirement of the service’s registration is that they have 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. A registered manager was in post.

All of the people we spoke with told us they felt well cared for and felt safe living at Thistley Lodge. People told us staff were respectful and kind towards them and staff were caring to people throughout our visit. Staff protected people’s privacy and dignity when they provided care to people and asked people for their consent, before any care or support was provided.

Staff received training and support to ensure they could safely and effectively meet the individual needs of people living in the home. Staff told us the training they received gave them the skills to support people, especially those who could sometimes display behaviours that could cause concern to staff and others.

Care plans contained accurate and relevant information for staff to help them provide the individual care and treatment people required, however some risk assessments required further improvement to ensure staff continued to support people’s changing needs. Examples of care records reflected people’s wishes in how they wanted their care delivered and how people needed to be supported to maintain and promote their independence. We found people received care and support from staff who had the knowledge and expertise to care for them.

People told us they received their medicines when required. Staff were trained to administer medicines and had been assessed as competent which meant people received their medicines from suitably trained, qualified and experienced staff. Some people self-medicated and staff made sure these people had taken their medicines as prescribed and were stored securely.

Staff understood they needed to respect people’s choice and decisions. Assessments had been made and reviewed to determine people’s capacity to make certain decisions. Where people did not have capacity, decisions had been taken in ‘their best interest’ with the involvement of family and appropriate health care professionals.

The provider was meeting their requirements set out in the Deprivation of Liberty Safeguards (DoLS). At the time of this inspection, no applications had been authorised under DoLS for people’s freedoms and liberties to be restricted. However some people at the home had restrictions under the Mental Health Act and staff, with people’s co-operation, ensured these restrictions were adhered to.

Regular checks were completed by the registered manager and provider to identify and improve the quality of service people received. These checks and audits helped ensure actions had been taken that led to improvements. People told us they were pleased with the service they received and had regular opportunities to raise any concerns or ideas they had that improved the service.  

We spoke with three people who lived at Thistley Lodge about their experiences of the service. We observed the care that was given to people during our inspection. We also spoke with a range of staff including the registered manager.

We found people and advocates were involved with providing their consent regarding the planning of care of people using the service. On the day of our inspection we noted staff asked people for their consent before supporting them.

People we spoke with told us that the care that was discussed with them matched the care that was being provided to people using the service. They also told us they were regularly kept up to date about the changes made to their care.

We saw that the support plans were person centred and reflected people’s individual needs. We noted staff were compassionate and caring when supporting people. We found that staff had involved appropriate health professionals to review people’s support needs and to help support that person.

We noted the home was clean and there was a cleaning schedule which staff followed. We saw checks were made to review the cleanliness of the home.

We saw the provider ensured that the appropriate checks were undertaken before a new member of staff was employed. The manager showed us the induction plan which new staff had to complete during their employment at Thistley Lodge.

We found the service was well led and had systems in place to monitor the quality of service being provided.

We spoke with three people who lived at Thistley Lodge on the day of our inspection about their experiences of the service. We observed the care that was given to people during our inspection. We also spoke with two members of staff and the deputy manager who supported people.

People we spoke with told us that the care that was discussed with them matched the care that was being provided to them. We saw there were regular reviews on people's care and progress towards their support plan. We saw staff listened to the people's input about their care needs and their wishes. We saw people's independence was promoted within their support plans and on the day of our inspection.

We saw that the care plans were person centred and reflected the people’s individual needs. We saw the member of staff supported the person as detailed within their care plan. We saw care plans were easy to read and had pictures to help people understand their care plan.

People we spoke with told us that staff were friendly and supported their needs well. We saw staff knew what people's care needs were and how they needed to be supported.

We spoke with two staff members about what they thought abuse was and they showed they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

We found records were accurate and stored securely when not being used.

We visited this home on 6 March 2012. We carried out this review to check on the care and welfare of people using this service.

During our visit we spoke with four people using the service and two members of staff. The deputy manager was not available during our visit so we spoke with her by telephone at a later date.

The people that we spoke with that were using the service told us that they were happy with the care and support they received. They also told us that they felt involved in their recovery planning process.

Staff we spoke with were knowledgeable about people's care and support needs.

We saw that people had easy, positive relationships with the staff on duty. We observed that the staff were available to provide support or assistance as necessary, but were unobtrusive and encouraged people to do things for themselves before stepping in to provide assistance.

We looked at two people’s support records and saw that they were comprehensive, contained current information and were reviewed and updated regularly. We were told by people using the service that they had been involved in compiling their support plans. Evidence available within the files that we looked at confirmed what we were told. We also saw that regular audits of people's support records were undertaken to ensure that they were accurate and up to date.

People we spoke with told us that they felt safe in the service and that they liked the staff.

We spoke to the staff on duty about the safeguarding procedures for the service. They told us that they had completed training in safeguarding vulnerable adults and were able to talk through the processes they would follow should abuse be suspected. Training records we were provided with confirmed that the staff team had received training in this area.

We looked at the staff recruitment processes for the home. These confirmed that a robust recruitment procedure safeguarded the people using the service.

We looked at the systems in place for the management of medication. We saw that overall, on the day of our visit, the systems in place did not place people at unnecessary risk.

We looked at the staff rotas for a specific period of time. We saw that the numbers of staff on each shift were appropriate to the support needs of the people using the service. We asked the staff on duty if the felt there was adequate staff available and they told us that they felt that there was.

We looked at how the service measures the quality of care and support provided. In addition to regular one to one meetings with people and daily discussions we were told that the service carried out an annual survey to seek the views of the people using the service. We saw the results for the survey undertaken in 2011 which indicated an overall satisfaction with the service that was being received.

We saw that the health, safety and welfare of people living, working and visiting the home was monitored by appropriate checks and measures.