This inspection took place on 9 and 10 February 7 and was unannounced. Thistle Hill Hall is run by Debdale Specialist Care Limited. The service is registered to provide accommodation for 23 people. There were 19 people living at the home on the day of our visit.

Thistle Hill Hall provides high quality accommodation, personal care and nursing to adults with support needs relating to their mental health. People who use the service have access to a rehabilitation programme to support their recovery and promote their independence. The service is based around each person’s individual needs and is therefore not time limited. The home provides five self-contained flats and 18 single bedrooms, over two floors. There are three communal lounges, a dining room, activities room, gym and a large garden.

The service had a registered manager in place at the time of our inspection. 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.

We found that Thistle Hill Hall was a truly innovative and inspiring home which put people at the heart of service.

People who used the service felt safe in the service and the community. People were, as far as possible, empowered and enabled to take responsibility for their own safety. There were systems and processes in place to minimise the risk of abuse and staff were very clear about their role in safeguarding people from harm. There was a culture of transparency and people were encouraged to whistle blow on poor practice.

Risk associated with people’s care and support were managed safely whilst promoting independence. The management team explored and invested in innovative solutions to ensure people’s safety. There were effective, organised systems in place for the safe handling of medicines. The staff team were committed to enabling people gain independence in managing their own medicines.

The team at Thistle Hill Hall were passionate about maximising people’s capacity to make decisions and choices in their lives. People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly and the team were committed to ensuring that people were supported in the least restrictive way possible.

People received effective healthcare support from a range of internal and external healthcare professionals and staff used innovative ways of promoting people’s mental and physical wellbeing.

People were supported to eat and drink enough, they were encouraged to make choices about food and drink and provide feedback. A creative approach was taken to building people’s independence and skill with cooking.

People were supported by a team of staff who were highly skilled in meeting people's needs and who received on-going training and development opportunities to enable them to deliver the most effective service.

The service had a person centred culture focussed on the promotion of people's rights to make choices and live a fulfilled life as independently as possible and this resulted in people being valued and treated as individuals. People received a personalised service which was responsive to their individual needs and there was an emphasis on people’s identity and diverse needs and their recovery and rehabilitation from the moment they moved into the service.

People were supported by exceptionally caring staff that knew them well and understood how to support them to maximise their potential and attain their goals. People's progress was monitored and celebrated. Staff were constantly looking for opportunities that would help people grow, gain confidence and live a fulfilled life. People were supported and enc

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with six people who used the service and asked them for their views. We also spoke with two rehab support workers, a senior rehab support worker, an activity coordinator and the registered manager. We looked at some of the records held in the service including the support files for four people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found people gave consent to their care and treatment and received care and support that met their needs. A person who used the service told us, “I am happy with the decisions I make, I can’t think of any I don’t make.” Another person told us, “My room is nice, the food is nice, everything is nice.”

We found people who used the service were kept safe and protected from harm. Staff knew how to respond to any allegation of abuse. A person who used the service told us, “I have always felt safe here, I am treated nicely.” Another person said, “It’s safe here. It is a routine. I have a roof over my head.”

We found the staff team were supported through training and the provider had an effective system for receiving and responding to any complaints. A person told us, “The staff are alright, they do their jobs. They help with any medical problems as well as social ones.” Another person told us, “I would tell one of the managers if I was not happy, they listen to me.”

During our visit we spoke with three people who use the service and with three staff working there.

All of the people we spoke with who use the service told us that they were happy with the care and support they received. One person told us “Staff are very caring.” Another said “Staff support me to do the things I want to do”. Another person told us “I was a bit apprehensive when I first moved in, but I’ve settled in well and liked living here”.

The people we spoke with who use the service told us that staff supported their health and personal care needs and took prompt action to get them medical attention when it was needed.

All of the people we spoke with said they felt safe in the service and knew how to raise any concerns they might have. One person told us, “Staff do a really good job.” All of the people we spoke with said staff treated them with respect.

All of the staff we spoke with said the provider was very good in terms of ensuring that all staff training was up-to-date and that a new e-learning training & development programme had recently been introduced which they enjoyed. Staff also told us the provider had given them a lot of support in their personal and professional development enabling them to undertake further, more advanced, professional training.

This inspection took place on 28 and 29 October 2014. Thistle Hill Hall provides a mental health rehabilitation service for up to 18 adults aged 18-65 years old. On the day of our inspection 18 people were using the service.

The service had a registered manager in place at the time of our inspection. 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 and associated Regulations about how the service is run.

We last inspected Thistle Hill Hall in November 2013. At that inspection we found the service was meeting all the essential standards that we assessed.

People were encouraged to talk about how they could keep themselves safe. Staff took appropriate action to minimise the risks to people’s safety. The provider had not assessed the number of staff that were needed on duty at any given time to ensure people were safe from harm anywhere in the building. We have made a recommendation about the staffing levels.

Medicines were managed safely and people received their medication in an individual manner that best suited their needs. People were supported to manage their own medicines as this would help with their rehabilitation programme.

Staff received training and support to ensure they had the knowledge and skills to provide safe and appropriate care and support.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS is part of the MCA, which is in place to protect people who lack capacity to make certain decisions because of illness or disability. DOLS protects the rights of people by ensuring that if there are restrictions on their freedom these are assessed by professionals who are trained to decide if the restriction is needed. We found this legislation was being used correctly to protect people who were not able to make their own decisions about the care they received. We also found staff were aware of the principles within the MCA and had not deprived people of liberty without applying for the required authorisation.

People were involved in planning the weekly menu and mealtimes were made into social occasions. People had sufficient food and drink to maintain their health and were informed of the importance of a healthy diet. People were supported with their healthcare needs and these were reviewed regularly.

We observed people being treated with dignity and respect and enjoy interacting with staff. Staff took the time to understand what support people required and listened to their views.

People were supported to develop skills that would enable them to live independently. People knew how to raise any complaint of concerns they had and these were considered and responded to.

People who used the service and staff were encouraged to express their views on how the service was run. There were systems in place to monitor the quality of the service but when shortfalls were identified these were not always acted upon.