This inspection took place on the 4 April 2017 and was unannounced.

Thorndale provides accommodation for older people requiring support with their personal care. The service can accommodate up to 60 people. At the time of our inspection there were 50 people living at the home. The home is divided into three distinct areas which are situated on three floors of the home. The Laburnum and Holly, Willow and Magnolia areas provide care to older people with varying levels of care needs. The Cherry and Lilac areas provide support to people living with dementia. People live in the area that is best suited to their assessed needs.

The service had 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.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals. Relatives spoke positively about the care their relative received and felt that they could approach management and staff to discuss any issues or concerns they had.

People received care from staff that knew them well and were kind, compassionate and respectful. Their needs were assessed prior to coming to the home and individual care plans were in place and reviewed regularly to ensure people’s needs could be safely met.

Staff were supported through regular supervisions and undertook training which helped them to understand the needs of the people they were supporting. People were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and / or their day to day routines. People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

There were appropriate recruitment processes in place and people felt safe in the home. Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns.

There were sufficient staff to meet the needs of the people; staffing levels were kept under review to ensure that people’s needs were met in timely way.

There were systems in place to monitor the quality and standard of the service; action was taken to address any shortfalls. The registered manager was visible and open to feedback, actively looking at ways to improve the service.

This inspection took place on the 17 and 19 May 2016 and was unannounced.

Thorndale provides accommodation for older people requiring support with their personal care. The service can accommodate up to 60 people. At the time of our inspection there were 58 people using the service. The home is divided into three distinct areas which are situated on three floors of the home. The Laburnum and Holly, Willow and Magnolia areas provide care to older people with high care needs. The Cherry and Lilac areas provide support to people living with dementia. People live in the area that is best suited to their assessed needs.

The service had 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.

There were not always sufficient staff to meet the needs of people in a timely way and staff did not always have the time to interact with people outside of meeting people’s basic care needs.

People’s nutritional needs were being met but people did not always feel the standard of the food was consistent.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals. Relatives spoke positively about the care their relative received and felt that they could approach management and staff to discuss any issues or concerns they had.

Staff were supported through regular supervisions and undertook training which helped them to understand the needs of the people they were supporting. People were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and / or their day to day routines.

People received care from staff that were friendly, kind and compassionate. Their needs were assessed prior to coming to the home; care plans detailed people’s needs and were reviewed regularly. People’s health care was carefully considered and relevant health care professionals were appropriately involved in people’s care.

There were opportunities for people and their families to share their experience of the home and to be involved with planning activities and entertainment.

There were a variety of audits in place that monitored the quality and safety of the service and action was taken to address any shortfalls. Management was visible and open to feedback, actively looking at ways to improve the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This unannounced inspection took place on 11 November 2014.

Thorndale provides accommodation for people requiring personal care. The service can accommodate up to 60 people. At the time of our inspection there were 58 people using the service. The home is divided into three distinct areas which are situated on three floors of the home. The Laburnum and Holly, Willow and Magnolia areas provide care to older people with high care needs. The Cherry and Lilac areas provide people with dementia care. People live in the area that is best suited to their needs.

There was a registered manager in post. However, they were absent from their post at the time of the inspection. The provider had appointed an interim manager to run the home in the registered manager’s absence. 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.

There were not enough staff to support people during meal times.

Systems in place for the management of medicines were not always safe.

People received an assessment of risks relating to their care. Although some risk assessments did not identify risks to people’s health and safety.

People were safeguarded from the risk of abuse. There were clear lines of reporting safeguarding concerns to appropriate agencies and staff were knowledgeable about safeguarding adults.

People received food that met their dietary needs and food choices were available.

The registered manager and staff were aware of their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). There were procedures in place to assess people’s ability to make decisions about their care. Staff understood how to make best interest decisions when people were unable to make decisions about their care.

People received support to maintain their health and wellbeing and people’s care was regularly reviewed to ensure it was effective.

People experienced care that maintained their need for privacy and dignity. Staff supported people to make decisions and choices about their care.

The service supported people to undertake a range of social activities and pastimes.

The provider had a complaints system in place which ensured people’s complaints were dealt with appropriately.

People were asked for their feedback about the service and improvements were made.

There was a system of quality assurance which was designed to identify any shortfalls in providing a good service. The provider made improvements to the service and had clear expectations that people should receive a good standard of care.

We considered all the evidence we had gathered under the outcomes we had inspected to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well lead?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff demonstrated an understanding of the support required to enable people with dementia to make choices about their daily lives and their care. The manager had recently been informed that the pharmacy which supplied people with their medicines and staff with an electronic medicine recording system had ceased trading. The manager had taken swift action to ensure people living at the home continued to receive a supply of medicine in a safe way. The provider completed a range of monthly safety checks to ensure fire detection equipment and systems had been regularly tested and maintained. There was a system of incident management in place to make sure the provider was aware of any accidents or incidents that had happened at the home.

However, people’s care records did not always contain accurate information to ensure staff understood how to deliver care. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Is the service effective?

People’s health and care needs were assessed with them, and they and their family members were involved in writing their plans of care. Relatives of people who used services told us that they had been involved in providing information about how to care for their family member. People and their relatives told us that overall they were happy with the level of care provided.

During the inspection we observed care being delivered to people with a diagnosis of dementia. We saw people were being supported by staff to sing their favourite songs in a group setting. We also observed that staff played tambourines in order to accompany the singing and to create an enjoyable and upbeat environment. Staff had considered how to create a homely and stimulating environment for people living with dementia. This included designated “themed” areas, such as a “home” area with an iron, ironing board and old fashioned pram and a “jungle” area complete with plants, books and soft animals on display. Staff also told us and we observed how they were successfully implementing “doll therapy” at the home. Staff no longer wore uniforms on the unit, and instead wore casual and comfortable clothes in order to create a more homely environment. Staff told us that this had been successful in providing good dementia care and we observed people were happy and relaxed in their environment.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us that they were happy living at Thorndale. One person said “It is overall excellent care”. Relatives of people who used the service also told us that they were happy with the care at Thorndale. One relative said “There is a good continuity of staff and they understand what my family member needs”. Another relative said “The care at the home is good and the staff are upbeat and helpful”. They also said “The staff are very professional and positive and are always polite to visitors; there is an atmosphere of genuine concern and care”.

Is the service responsive?

Staff had responded appropriately to a range of medical needs and we saw that medical professionals such as the G.P, district nurse and dietician were regularly involved in people’s care. People told us that they had a call bell system in place that they could use to call the assistance of a member of staff. Most people said that staff responded to their needs promptly; however a few people said that sometimes there was a delay in receiving assistance. Overall, people told us they were happy with the care delivered at Thorndale. We observed people sitting in the living room and saw that they were enjoying the company of one another. We also observed that staff were responsive to people’s needs and assisted them in a dignified and respectful manner.

Is the service well-led?

At the time of the inspection visit, the registered manager was not in post. The provider had appointed an interim manager to manage the home in the registered manager’s absence. The interim manager of the home was also supported by a deputy manager. The service had a quality assurance system, and this included gaining the regular feedback of people who used services. The manager told us that the provider monitored the home and that a system of “clinical governance” was in place to make sure people received good care. This included monthly meetings for each of the managers from the provider’s homes in order to discuss any concerns or any incidents that had happened. The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff stated that the manager expected high standards of care at the home and would act on any concerns raised immediately. We observed that the manager had received a bouquet of flowers and a card expressing thanks from the staff for being a supportive manager.

We spoke with six people who all told us they were happy with their care. One person told us “staff are wonderful” another said “it’s all right here.”

We looked at the assessments and care plans for one person who could be resistive to assistance. We saw that they had an authorisation in place for staff to be able to physically intervene to assist the person with personal care. We looked at the person’s care plans and found that they did not detail how or when staff should do this.

One person told us that the activities were very good and that there was an activities committee made up of people who lived in the home that helped plan the activity programme.

We found that medication records did not account for all medication in stock. We looked at three medicines that were not dispensed in the blister packs and saw that the total number of each was not accounted for on the medication records.

We saw that people living in the home and their relatives had been able to give feedback on the service through regular satisfaction surveys as well as residents meetings.

We spoke with six people who live at Thorndale. They were happy with their support and told us that staff were polite and respectful. One person told us that they “couldn’t fault the place” explaining that there “are always staff around when you need them.” Another person told us that the staff were “extremely caring. Couldn’t be more caring”. We saw that staff talked with people in a caring and sensitive manner and gave explanations when assisting people. We spoke with five members of staff who all had a good knowledge of people's care needs.

Because people with dementia are not always able to tell us about their experience of using the service, time was spent observing the quality of interactions between staff and people using the service.

We observed the care of people were within the communal areas of the service and visited people within their private rooms. People were observed to be engaged in group activities, people were observed to enjoy listening to music, singing along to well known tunes.

We observed staff conversing with people, enabling people with limited verbal communication to fully participate in discussions, allowing time to respond. People were served beverages of tea, coffee and soft drinks from the open plan kitchen within the lounge/diner.

People using the service were observed to be treated with dignity and respect from the staff and visitors were made welcome. We observed staff provide care for people using the service who were frail and bed bound. People appeared well cared for, warm, clean and comfortable.