This inspection took place on 31 October 2018.

Thorncliffe Grange Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. We regulate both the premises and the care provided, and both were looked at during this inspection.

Thorncliffe Grange is located in Denton, Manchester. The home provides nursing care and accommodation for up to 50 older people. Bedrooms are situated on the ground floor and first floor of the home. Access between floors is via a passenger lift and staircase. The building is situated in it’s own grounds with gardens and off-road parking. At the time of our inspection 41 people were living at Thorncliffe Grange.

There was 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.

At our last inspection in November 2014 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.

Staff were aware of their responsibilities to safeguard people from abuse. Safe recruitment practices were in place and the service followed national and local safeguarding guidance.

We found records were written in a positive and respectful way and provided appropriate guidance on how to support people safely.

Staffing levels were high which meant people received prompt support. Risks to people's safety were assessed and medicines were administered safely.

Staff knew people's care needs, preferences, personal histories and backgrounds. People said staff protected their privacy and their dignity was respected. People were supported to be independent.

People said staff treated them with kindness and compassion. Comments included, “This a good place, staff are brilliant" and "[Registered manager] is very caring and know people really well.”

We observed meaningful interactions between staff and people who used the service. People told us staff were kind and caring.

People received care from staff who were appropriately trained to effectively carry out their job roles. People were supported to have maximum choice and control of their lives. The service acted in accordance with the Mental Capacity Act (2005).

People's nutritional needs were met and they were supported to maintain good health and receive ongoing healthcare support.

Thorncliffe Grange had arrangements in place to receive feedback from people that used the service, their relatives, external stakeholders and staff members about the services provided. This information was used to support continuous improvement.

Effective quality assurance audits were in place to monitor the service. The service regularly sought feedback from the people who lived there and their relatives. Staff had regular supervisions and were invited to team meetings.

People and staff thought the registered manager and management team were approachable and supportive.

Many of the people who used the service were unable to fully express their views due to their varying levels of dementia and limited abilities to communicate verbally. People who were able to talk with us told us: “Everything is very good here”, “There is always staff around to help you and they come quick if you need them” and “The care and food in this home are excellent, I wouldn’t want to live anywhere else”.

Relatives told us: “My [relative] is looked after very well” and “I’m very pleased with everything about the home and the support [relative] gets”.

Care plans and risk assessments had been reviewed and updated on a regular basis. We also saw evidence to indicate that other healthcare professionals such as Speech and Language Therapist (SALT), General Practitioners (GPs), social workers and nursing assessors were involved in identifying, reviewing and supporting people’s needs.

On the day of our unannounced visit we found the home to be clean and fresh with no unpleasant smells detectable.

We found that there were sufficient numbers of staff on duty at the time of our visit.

Staff were receiving training that supported them to do the jobs the were employed to carry out. The provider may wish to review the training matrix in order to take appropriate action where any gaps in training may be evident or where training requires updating.

We were provided with information to demonstrate that the quality of service was being monitored by the provider.

People told us they were involved in planning and consenting to their care and support and they were supported to make choices and decisions about matters which affected them. People told us that they were very happy with the care and support they received at the service. Comments included:

“The girls (staff) are always very helpful and ask me what I want to wear or where I want to sit. They always tell you what they are going to do, they don’t just do it.”

We also spoke with a visiting relative who told us, “I am fully involved in ….care and any changes that are needed to their care are always discussed with me.”

During our visit we saw examples of good practice being carried out by care staff. People who required support with their personal care needs were treated with respect and dignity. Where people’s communication abilities were limited, we saw that nurses and care staff had a good understanding of people’s body language and responded appropriately.

Staff told us that they received supervision from their line manager but, when asked, were unsure of how often this took place. Records seen indicated that supervision was being carried out but was inconsistent in approach and not in line with the required minimum six times per year for all care staff. We have asked the provider to take action to address this matter.

People we spoke with told us that they were happy with the arrangments at meal times and that they were happy with the recent improvements being made to the environment.

People told us what it was like to live in Thorncliffe Grange and how the care worker's supported them. One person told us, "The staff are really very, very good, they look after me very well".

During our visit we spoke to a number of visiting relatives who spoke highly of the service and comments included, "I am very happy with the home and the way staff support my mum" and "I have no worries about mum living in this home and I am aware of her care plan and what it contains".

Overall, people appeared comfortable in their surroundings and told us that they were happy with their daily lifestyles including the choice of food available, the environment they lived in and the standard of service they received.

From information shared by people we spoke to during our visit and from our own observations, there are are number of areas where improvements are required and these were discussed with the person in charge at the time of our visit and are identified within the main body of the report.

Thorncliffe Grange provides accommodation for up to 50 people who need support with nursing or personal care. The home mainly provides support for older people and people who are living with dementia. The home is two converted Edwardian houses that are connected by a purpose built extension and link. Accommodation is arranged over two floors and there is a passenger lift to assist people to get to the upper floor. There were 39 people living in the home at the time of our inspection.

This was an unannounced inspection, carried out over two days on 11 and 12 November 2014.  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.

We last inspected Thorncliffe Grange in August 2013. At that inspection we found the service was meeting all the essential standards that we assessed.

The atmosphere in the home was calm and relaxed and staff were seen to respectful in their approach with people. People were being supported by staff that were knowledgeable in recognising the signs of abuse and the relevant reporting procedures they needed to follow.

During our time in the home we saw staff support people in a discreet and respectful manner. Staff quietly asked people if they needed any support to attend to their personal care.

People visiting their relatives living in Thorncliffe Grange told us they were happy with the care and support their relative received. They also told us that they thought the staff were very good and seemed to know what people needed.

The registered manager led by example and spent time working with staff, supporting them whilst carrying out their caring duties. The manager also had systems in place to monitor and review the service being provided at Thorncliffe Grange.

The registered manager had knowledge of the Deprivation of Liberty Safeguards (DoLS). They understood DoLS and were aware of how to make applications to apply it in practice. Deprivation of liberty safeguard is where a person can be deprived of their liberties where it is deemed to be in their best interests or their own safety.

Staff were appropriately trained and skilled and provided care in a safe environment. They all understood their roles and responsibilities. The staff had completed lots of training to make sure that the care provided to people was safe and effective to meet their needs. Nurses had the clinical skills they needed to make sure people's health needs were met.