About the service:

22 and 24 Thornhill Road is a care home owned and managed by St Anne’s Community Services in a residential area of Brighouse. The home is registered to provide accommodation, nursing and personal care for up to seven adults. At the time of this inspection there were seven people using the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice and independence. People using the service received planned and co-ordinated person centred support that is appropriate and inclusive for them.

People’s experience of using this service:

• People who lived at 22 and 24 Thornhill Road had limited communication so we observed staff interaction and spoke to a visiting relative.

• A visiting relative told us their relative was consistently treated with kindness, dignity and respect. They told us they felt people were safe and well supported. They told us, “[Name of person] could not really walk and had no quality of life until coming here. I know they are happy.”

• People received personalised support from staff who knew them well. Staff had built positive relationships with people living in the service. Staff supported people to retain their independence and to remain involved in planning and reviewing their care to ensure it was provided in accordance with their own preferences.

• Staff worked closely with a range of community health professionals to promote good outcomes for people.

• The service was consistently well-led. People felt able to raise any concerns with the registered manager and were confident they would be addressed. Staff felt well supported by the registered manager.

• The registered manager and staff completed a range of quality checks and audits of the service to make sure the care and support provided was of high quality. This supported the continuous improvement of the service,

Rating at last inspection: Good (report published August 2016).

Why we inspected: This was a planned comprehensive inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor this service. We plan to compete a further inspection in line with our re-inspection schedule for those services rated good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection was unannounced and took place on 16 August 2016.

Thornhill Road is a care home with nursing owned and managed by St Anne’s Community Services in a residential area of Brighouse. The home provides care to a maximum of seven people with learning disabilities and behaviours that challenge. The property is purpose built, comprising of two large adjoining bungalows and is fully accessible for the people living there.

The last inspection was in May 2014 and at that time the provider was meeting all the standards and regulations inspected.

There was 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 safe. Staff knew how to recognise abuse and report any concerns about people’s safety and welfare. People’s medicines were managed safely.

There were enough staff to meet people’s assessed needs. The required checks were done before new staff started work and this helped to reduce the risk of people receiving care and/or support from staff who were unsuitable to work in a care setting.

We found staff were well supported; they had regular one to one supervision, annual appraisals and staff meetings. All new staff received induction training and following induction they received training on safe working practices and subjects related to the specific needs of people living at the home.

We found the home was clean, well maintained and suitably equipped to meet people’s needs and support their independence. Risks to people’s safety and welfare were identified and managed. There were clear procedures in place for staff to follow in the event of an emergency.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and this helped to make sure people’s rights were protected and promoted.

People’s dietary needs and preferences were recorded and catered for. When people needed support to eat and drink this was provided with sensitivity and discretion.

People were supported to maintain their health and had access to the full range of NHS services. Staff supported people to be as independent as possible.

People’s care records included detailed information about their needs and preferences. We found staff knew people well and were attentive in providing appropriate individualised support. We saw people who used the service actively seeking out the company of staff, which showed us they had formed good relationships with the care workers. We saw staff was kind, caring and compassionate.

People’s bedrooms were neat, tidy and personalised and their belongings were looked after properly which demonstrated staff respected people’s private space and possessions. There were nominated Dignity Champions and a dignity group held regular events for staff and people who used the service.

The home was committed to providing people with the best possible end of life care and had achieved Gold Standards Framework accreditation.

People were supported to participate in activities in the community and at home. For example, people were supported to walk in the local park, to visit family and friends and to go on holidays.

There was complaints procedure in place and we saw any concerns or complaints were dealt with effectively. The home also kept a record of compliments which included positive feedback from visiting health care professionals.

The home had a relaxed and organised atmosphere. The registered manager led by example interacting in a positive way with people who lived in the home and staff.

People who lived at the home and those acting on their behalf were consulted individually about their care and

This inspection was carried out by two inspectors who arrived at the home at 2pm. During the inspection, they spoke with the registered manager, deputy manager, area manager, three support workers and one nurse. After the visit they spoke with two relatives and the St Anne’s compliance and maintenance manager by telephone. The inspectors also looked around the premises, observed staff interactions with people who lived at the home and looked at records. There were seven people living at the home on the day of the visit, one of whom was in hospital.

When we visited Thornhill Road in January 2014 we found people were not protected against the risk of receiving care and treatment that was inappropriate or unsafe and accurate and appropriate records were not being maintained. We asked the provider to make improvements. We went back on this visit to check whether improvements had been made.

Before this visit we had received information of concern about the high use of agency staff at the home, people being neglected and documents not being kept updated. We looked at these issues during our visit and found no evidence to support this information.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key 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. The summary describes what we observed, the records we looked at and what people living at the home, their relatives and the staff told us.

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

Is the service safe?

People were cared for in an environment that was safe and secure. We saw the premises were clean and generally well maintained. One relative told us, “There’s no smell there. It’s always really clean and I’m not easily pleased, believe you me.”

We found there were sufficient numbers of suitably qualified staff to meet peoples’ needs. This was confirmed by the staff and relatives we spoke with. When we asked about staffing levels at the home one relative said, “My relative certainly hasn’t suffered any neglect due to a lack of staff.”

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

This showed us people were protected from abuse and avoidable harm.

Is the service effective?

Relatives told us they were happy with the care provided at the home and people’s care and treatment needs were being met.

From our observations and from speaking with staff and relatives we found staff knew people well. Care staff were familiar with peoples care and support needs.

Staff working at the home received appropriate training to meet the needs of the people who lived there.

This showed us that peoples’ care, treatment and support at the home achieved good outcomes and promoted a good quality of life for the people that lived there.

Is the service caring?

Care workers were patient and encouraging when they were supporting people. We saw people who lived at the home looked clean, well dressed and well-cared for.

We sat in one of the lounges during the afternoon of the inspection and also observed people having their evening meal in the two kitchens. We observed how staff interacted with people. We saw and heard staff being kind, attentive and patient when they spoke with people. When staff were helping people to eat their meal they were encouraging and allowed people to go at their own pace.

We saw a thank you card from a relative which said, “Thank you for the work you put in to helping X (person’s name) settle into her new surroundings. X is very contented and relaxed. It’s a pleasure to be out and about again. She always looks smart whenever we turn up.”

When we spoke with this relative after the visit they said, “She’s getting superb care, she’s showered every day. X even said to me, I like it there.”

The other relative, who told us they visited their daughter every week, said, “Their care on there, it’s really very good. She’s improved a lot since she’s been there. They’ve got her walking about and she never did that at the place she was at before. She’s always clean and tidy and well-fed.”

This confirmed the observations we made on the day of the visit and showed us staff treated people with compassion, kindness and respect.

Is the service responsive?

We looked at two peoples’ care files and saw their needs had been assessed before moving into the home. Care, treatment and support provided to people who lived at the home met their individual requirements. Care plans and risk assessments were regularly reviewed and updated, taking account of peoples’ changing care needs.

From what we saw and heard during our visit we found care and support was provided in accordance with peoples’ wishes. People’s preferences, interests and diverse needs were also taken into consideration.

Staff said they would go to the deputy manager if they wanted to raise a concern. One support worker told us, “Y (the deputy manager)’s a doer. One of the clients wanted a more adaptable chair. We got Y (the deputy manager) on the case and a new chair was obtained.” Another support worker told us “When Z (person’s name) went into hospital recently the registered manager met him at the hospital.” This showed us the managers at the home responded appropriately when peoples’ care needs changed.

People had regular access to activities and were supported to maintain relationships with their friends and relatives. One relative said, “They’ve arranged for her to have her own wheelchair as her mobility is declining.” The other relative said, “They’re well taken care of and they take them out regular. They even asked me to go with them.”

This showed us care provided at the home was organised so that it met peoples’ needs.

Is the service well-led?

People were protected against the risks of inappropriate or unsafe care because the provider had effective systems in place to assess and monitor the quality of service people received.

The home had a registered manager and deputy manager in post. The registered manager had been in post for two years and told us they also managed a similar-sized St Anne’s home in Halifax. The registered manager told us they split their time between the two homes. They explained the other home did not currently have a deputy so they were spending more time there than at Thornhill Road. Staff we spoke with confirmed this and said the registered manager was not on site that often, they said they usually dealt with the deputy manager. We discussed the management of the home with the area manager during our visit. The area manager told us St Anne’s was currently looking into introducing a ‘one manager –one home’ policy. This would ensure the registered manager at a service was on site on a daily basis.

We asked the registered manager how they obtained feedback from people and their relatives about the service. They told us the home sent out an annual survey. We looked at the 2013 responses to this survey and saw feedback about the home was all positive. For example, “My view is that they give first class support.” When we spoke with two relatives they confirmed they were very happy with the care at the home.

Staff told us they were clear about their responsibilities and felt well supported by the managers. They said their opinions were taken into consideration.

This showed us the leadership and governance of the home assured the delivery of high quality, person centred care and promoted an open and fair culture for its staff.

People who used the service could not communicate clearly so we observed staff providing support and we spoke with staff and two relatives about the people who used the service at Thornhill Road. This gave us assurances that staff knew the needs of people.

Our observations of the service showed that most care staff spoke with and interacted with people who used the service in a patient and pleasant manner.

There were systems and processes, policies and procedures in place to support care delivery. Report writing in care records was mostly up to date but we found inconsistencies and a lack of documentation which could affect the care and treatment that people received. One care record we saw was not up to date and we were told by staff that they were unsure what support this person required to mobilise around the home.

We found that staff were supported and monitored in their working practice. Training and appraisal programmes were in place.

Our observations of the service showed that people who used the service were involved in activities tailored to meet their individual needs. We saw activities were not always delivered in a way they were documented in the care plan.

People who used the service appeared comfortable with the surroundings. They appeared relaxed with the staff in their interactions with them. Relatives we spoke with after our visit told us they were made welcome by staff. One relative told us their relative ‘had lots of attention.’

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences.

Following our visit to the service in June 2012 we asked the provider to make a number of improvements. They sent us a detailed action plan and they sent us weekly updates about the action that had taken place. They responded promptly and from their own audits have decorated parts of the home to improve the surroundings for the people who live there.

We sat in the lounge with people and saw that staff talked to them to explain what they were doing.

The staff we spoke with were positive about the changes that had been made and said they thought the service had improved since our last visit.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences.

Prior to our visit we were contacted by a visiting health care professional who was concerned that people living in the home were being left unsupervised and that care plans were poor.

We spent time sitting in the one of the lounges with three of the people who live at the home. During this time we observed minimal time being spent by staff trying to engage with people living in the home and any engagement that we did observe was limited to those times when staff were delivering personal care.

We did see in that in a review meeting in March 2012 the family of one person had said they felt their relative was happy and really, really well looked after.