The inspection took place on 9 October 2018 and was unannounced. The previous inspection took place on 16 March 2016 when the service was rated good in all domains and good overall.

Thicketford Place is a small care home, providing support for up to six adults with learning and physical disabilities. The provider is a charity organisation, The Cornerstone Trust who set up the home in 1993. A group of trustees oversee its running, with the day to day management carried out by the registered manager. The home is on a main road, in a busy residential area in Bolton. There is good access to local buses and there are nearby shops and other local amenities.

Thicketford Place is a ‘care home’. People in care homes receive accommodation and nursing 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.

The care home can accommodate six people in one adapted building. At the time of the inspection there were four people living at the home. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Registering the Right Support CQC policy

There was a registered manager at the service. 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.

Safeguarding and whistle blowing policies were in place and staff demonstrated a good understanding of safeguarding issues. They were confident to report any concerns or poor practice they may witness.

Staffing levels were sufficient to meet the needs of the people who used the service and staff recruitment was robust. There were general and individual risk assessments, which were reviewed and updated as required.

Health and safety measures were in place within the home. Accidents and incidents were recorded and addressed appropriately. Robust medicines systems were in place to help ensure safety in this area.

The assessment process for new people to the service was thorough and detailed to help ensure needs could be met. All care files were comprehensive and included relevant, up to date information.

There was a thorough induction for new staff and an on-going training programme. Staff had regular quarterly supervision meetings and appraisals were undertaken annually.

The kitchen was clean, tidy and well-ordered and food safety guidelines were followed. People’s dietary requirements were adhered to. The premises were clean and tidy and the building was accessible for people with restricted mobility.

The service was working within the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Communication between staff and people who used the service was friendly, respectful and compassionate. People’s dignity and privacy were respected. Various methods were used to communicate effectively with people.

People were supported to express their preference for particular care staff and were supported to access advocates if required. Staff were aware of confidentiality and data protection issues.

Care plans were person-centred, and people were encouraged to make choices and pursue their preferred interests and pastimes. The service provided support for a number of activities and interests that the people who used the service wished to engage in.

Reviews of care were undertaken, and people were supported to be as involved as possible. The complaints policy was prominently display

The inspection took place on 16 March 2016 and was unannounced. The last inspection was carried out on 21October 2013 when the service was found to be meeting all requirements reviewed.

Thicketford Place is a small care home, which can provide support for up to six adults with learning and physical disabilities. The provider is a charity organisation, The Cornerstone Trust who set up the home in 1993. A group of trustees oversee its running, with the day to day management carried out by the registered manager. The home is on a main road, in a busy residential area in Bolton. There is good access to local buses and there are nearby shops and other local amenities. At the time of the inspection there were three adults in long term support at the service.

There was a registered manager in place at the service. 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.

The service had a robust recruitment procedure and staff were recruited safely. There were sufficient numbers of staff to meet the needs of the people who used the service.

Appropriate risk assessments were held in care files for areas such as moving and handling, nutrition, falls. Accidents and incidents were dealt with and recorded appropriately.

Staff had undertaken training in safeguarding adults and were aware of the procedures to follow if they had any concerns. They were confident of the reporting procedure for safeguarding concerns.

Staff had undertaken appropriate medication training and safe systems were in place for the ordering, dispensing, storage and disposal of medicines.

People’s nutritional needs were catered for and food and fluid intake was monitored to help ensure people’s health and well-being was supervised.

Care plans included a range of health and personal information and were person centred. The files were regularly reviewed and updated.

Staff had undertaken a robust induction programme and training was on-going throughout their employment.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

People told us staff were kind and caring. We observed interactions between staff and people who used the service and saw that they were respectful and friendly. People’s privacy and dignity was respected.

Information was given to people who used the service and their relatives and communication was good. Efforts were made to ensure staff and people who used the service had effective methods of communication.

Care plans were person-centred and information about people’s individual preferences and interests was recorded.

There was a range of activities for people to access and people were supported to go on holiday if they wished to.

There was a complaints procedure, which was displayed prominently in the home.

Relatives and staff told us the manager was approachable and accessible.

Staff meetings, supervisions and appraisals were undertaken regularly, ensuring staff had a forum to discuss any issues and their continual professional development was overseen.

A number of quality audits and checks were carried out on a regular basis to help ensure continual improvement to care delivery.

Thicketford Place provided care in a homely and safe environment for adults with varying levels of learning and physical disabilities. We were not able to speak with the adults who were at home during the inspection but were able to speak with family members, advocates and care staff.

Comments included: "I have always found the staff to be well engaged with the adults who live there", "The adults always are well dressed and looked cared for" and "I never have had any concerns".

We found placement agreements and care and support plans were in place, which had been agreed both by next of kin or advocates and the local authority learning disability team.

We reviewed all four care files and found they were well maintained and in a chronological order. Each contained detailed life plans and care support plans.

Thicketford Place had appropriate systems in place for the safe management of medication. Staff were supported by current medication policies and procedures.

We sampled five staff personal files and found they demonstrated staff were safely and effectively recruited.

There were appropriate systems in place to monitor the quality of the service. Current policies and procedures were in place to support staff.

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. We spoke to the relatives of three people, who told us:

“I have always found the staff ensure the privacy and dignity of X: They are great “.

“I have no concerns about how my X is looked after at Thicketford Place, the staff are marvellous”.

“All the staff are wonderful; they are so patient and caring”.

“The care is fantastic: My X has a brilliant key worker, but all the staff are great”.

“I have total confidence that X is safe, both in the home and with the staff”.