Thornfield is registered to provide accommodation for people who require personal care; most people are living with dementia. The inspection took place on 15 and 22 September 2016 and was unannounced. There were 34 people living at the home at the time of the inspection; this included one person who was in hospital.

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 recog

Our inspection was unannounced and lasted approximately eight hours. We had been contacted by someone raising concerns excessive hours worked by staff, staffing levels and medication concerns. During this visit, we inspected four outcome areas; all four were compliant.

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.

Our inspection lasted nine hours and we spent time in communal areas of the home observing the experience of people living at Thornfield. On the day we visited 32 people were living at the home. Some people were unable to comment directly on their experience of care so we used an observational tool called SOFI 2 (Short Observational Framework for Inspection), which enabled us to make a judgement on people’s well-being.

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.