Thingwall Hall nursing home provides care and support for up to 44 people with learning disabilities and complex support needs. The accommodation is spread over four bungalows with a smaller number of people occupying them, and a larger home with twenty bedrooms and communal areas.

At the time of our inspection there was 23 people in total living at Thingwall Hall nursing home.

At the last comprehensive inspection the service was rated good. At this inspection we saw that the service remained good.

There were systems and processes in place to ensure that people who lived at the home were safeguarded from abuse. This included training for staff which highlighted the different types of abuse and how to raise concerns. Staff we spoke with confirmed they knew how to raise concerns. Risk assessments were detailed and specific, and contained a good descriptive account for staff to follow to enable them to minimise the risk of harm occurring to people who lived at the home. Our observations showed there was plenty of staff around the home to help people with their day to day needs. Medication was well managed and only administered by either registered nurses or staff who had the correct training to enable them to do this. There was a process for analysing incidents, accidents and general near misses to determine what could be improved within the service provision. There was personal protective equipment (PPE) available within the home, and staff wore appropriate protective clothing when competing personal care tasks or serving meals.

Staff were suitably trained, supervised and appraised to enable them to provide good care to people who lived at the home. Training was a mixture of e learning and face to face courses. The service was operating in accordance with the principles of the Mental Capacity Act 2005, and best interest processes were documented for people who required support with decision making. Consent was also sought and clearly documented in line with legislation and guidance. Menus were varied, people told us they had input into the menus. There was access to other medical professionals who often visited the home and were involved with people from a clinical point of view. The service was able to demonstrate good relationships with external healthcare professionals. The building had been recently refurbished to a high standard. All bedrooms were spacious and had en suite facilities. There was new floorings and directional signage around the home.

Staff treated people with kindness and respect. People were treated as individuals, and their choices and preferences were respected by staff. This was evident throughout our observations around the home, and the information recorded in people’s care plans. Staff also described how they ensured they protected people’s dignity when providing personal care. People were included in their care and support as much as possible, and there was evidence to suggest that person centred plans had been discussed with people and their relatives.

People’s support plans were person centred and contained a high level of detail about the person, their likes, dislikes, how they want to be supported and what successful support looks like for them. There was a process to listen to and respond to complaints which was clearly displayed for people in the home and any visitors if they wished to raise a formal complaint. Staff were trained to support people who were on an end of life pathway, and we saw that training was taking place for this.

The vision of the organisation was person centred and the staff we spoke with told us they liked working for the company. Quality assurance systems were robust and sampled a wide range of service provision. We saw that were issues had been identified they had been subject to an action plan which was reviewed regularly.

A number of people who used the service were not able to tell us about their experiences of using it or comment about the care and support they received, due to a variety of complex needs. We therefore spent time observing how they were cared for by the staff. We spoke with three people who were able to confirm they were happy with all aspects of their care and support.

People were appropriately supported to make decisions which were in their best interests and information was available about others who had been appointed to act on people's behalf. Staff were knowledgable about the actions they needed to take if a person no longer had the capacity to consent.

People's care and support needs were reguarly reviewed so that staff had up to date information about people's needs and how they were to be met. Staff were confident about dealing with emergencies.

All parts of the service were clean and hygienic and staff followed appropriate guidance for ensuring the prevention and control of infection.

People who used the service received care and support from the right amount of staff that were qualified and skilled to do their Jobs. Comments made to us about the staff included; "Staff are excellent" and “I am really happy with the staff.”

People's records were stored safely and only made available to authorised staff. Records were well maintained and kept up to date and they were available in a format appropriate to people's needs.

A number of people at the home were not able to tell us about their experiences of using it or comment about the care and support they received, due to a variety of complex needs. We therefore spent time observing how they were cared for by the staff. We spoke with three people who were able to confirm they were happy living in the home.

We spoke with relatives about how the staff involved people and how they respected people’s individual choices around daily living. Their comments included, "The staff give loving care", "I feel the care is good", "I am impressed by care the staff give" and "I am always told if a doctor needs to be called."

Relatives we spoke with informed us they attended care reviews with the staff and other health professionals, so they were kept informed of the their family member's plan of care and any changes that may be needed.

A relative told us they felt the care was good and people at the home were therefore "In safe hands."

We spoke with relatives who confirmed they attended meetings and completed satisfaction surveys, so they could share theirr views about the home. A relative told us "You could not have better." Relatives also told us they would speak up if unhappy and were confident their concerns would be listened to.

A relative told us the staff were very good and "Put themselves out to help people at the home and their relatives." Likewise another family member told us, "I can't praise the staff enough, I have full confidence in them."

This was an unannounced inspection, carried out over two days on 14 and 17 November 2014.

Thingwall Hall provides accommodation, personal and nursing care for up to 44 adults. The service is made up of four, six bedroomed bungalows and a small nursing home.

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.

The last inspection of Thingwall Hall was carried out in September 2013 and we found that the service was meeting all the essential standards that we assessed.

People told us that they were happy and felt safe living at the service and they told us that staff knew them well. People told us they were not afraid to tell someone if they had any concerns about the way they were treated. One person commented, “I would tell someone right away if I was worried about anything”. Staff had received up to date training about safeguarding adults from abuse and they had access to policies and procedures which they could refer for guidance if needed. Staff were able to describe indicators of abuse and the different types of abuse. Staff and the registered manager were aware of their responsibilities to report abuse to relevant agencies and records showed they had done so in the past when required. Prior to our inspection visit we contacted the relevant local authorities for information and they reported to us that they had no concerns about safeguarding people who used the service from abuse.

Strict procedures were followed for recruiting new staff, this ensured people were cared for and supported by suitably qualified and experienced staff. We found that where possible people who used the service were involved in the selection of new staff.

We found that people were generally consulted about their care and support and that they were involved in making day to day decisions and choices about how they were supported and how they spent their time. However on the day of our visit we found people living in one of the bungalows were not offered a choice at lunchtime.

Staff responded appropriately were they recognised changes to people’s health and wellbeing by referring any concerns they had onto other health and social care professionals. We saw that the staff team understood people’s care and support needs and we observed staff treated people in a kind and respectful way.

We found the home was clean, hygienic and well maintained in all areas seen.

We looked at the care records of seven people who lived at the home. We found there was sufficient information about the support people required and that it was written in a way that recognised people’s needs. This meant that the person was put at the centre of what was being described. We saw that all records were completed and up to date.

We saw the provider had policies and procedures in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), safeguarding and staff recruitment. This meant that staff had documents available to them to help them understand the risk of potential harm or abuse of people who lived at Thingwall Hall Nursing Home.