Thornhill Nursing Home is a nursing home for 42 people, some of whom are living with dementia. There were 38 people who were living in the home when we inspected. At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Risks to individuals were managed well and people told us they felt safe. Staff had a good understanding of how to safeguard people from abuse or harm and accidents and incidents were documented well. There were safe procedures for managing medicines. Premises and equipment were being updated as part of a planned programme.

Staff were supported through effective training and supervision and there was good communication and teamwork. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s dietary needs were known by staff and there was plenty of choice in line with people’s preferences.

Staff demonstrated a kind and caring approach and there was evidence of respectful relationships fostered with the people who lived in the home. People were involved and informed about their care and support and their independence was encouraged.

Care documentation was clear on the whole and there was good evidence of people’s individual preferences, although it was not always clearly recorded when people, relatives or others had been involved in care planning. There was evidence of varied activities, although not all people were engaged on the day of the inspection.

There was very clear and detailed evidence of management oversight and quality assurance systems to enable care to be of a good standard. There was a very open, transparent culture of communication and the management team were very knowledgeable about the service.

Further information is in the detailed findings below

The inspection of Thornhill Nursing Home took place on 25 February 2016 and was unannounced. The previous inspection had taken place on 11 March 2014. The service was not in breach of the health and social care regulations at that time.

Thornhill Nursing Home is registered to provide accommodation for up to 42 people who require nursing or personal care. There were 40 people living at the home at the time of the inspection. There was a communal dining area on the ground floor and a communal lounge on the first floor. The home included a specific dementia wing designed to accommodate up to 11 people living with dementia. The butterfly wing had an open lounge/dining area.

The service had a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe living at Thornhill Nursing Home and relatives also felt their family members were safe. Staff and the registered manager had a thorough understanding of safeguarding procedures and knew what to do if they suspected anyone was at risk of harm or abuse.

Staff were recruited safely. Whilst there were enough staff to meet people’s needs, there were mixed views regarding whether deployment of staff was effective.

Premises were well maintained and regular safety checks took place.

Risks to people were assessed and measures were put into place to help reduce risks to individuals.

Medicines were stored and administered in a safe way.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards. We found staff had a thorough understanding of these safeguards. Authorisation had been appropriately sought when people’s liberty was being restricted.

Consent was not always sought in relation to care and treatment. For example, some people were given medicine without consenting. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, regulation 11.

People told us staff were caring and we observed this. People were treated in a kind and caring manner and dignity was respected.

People received care that was personalised to their needs. Activities were varied and appropriate to individuals. Information was shared appropriately which helped to ensure people received continuity of care.

People and staff felt the service was well led. The registered manager was visible throughout the service.

Staff and the registered manager felt supported in their roles.

Regular audits took place to improve quality of service.

You can see what action we told the provider to take at the back of the full version of the report.

When we visited the home in December 2013 we found people were not protected against the risks associated with medicines because the provider had not ensured, through robust governance arrangements, that its staff were correctly dispensing medicines. The provider had also not ensured that variation to a medicine dosage determined by a secondary health care provider had been translated into practice. We said we were concerned and improvements were needed.

We went back on this inspection to check whether improvements had been made.

We spoke with the manager who told us they had carried out a number of checks to ensure staff were competent to administer medicines safely. This included a medication competency check where the manager observed each staff member administering medicines to people.

The manager told us they carried out 'spot checks' of medicines two or three times per week. This involved looking at medication administration records (MAR), checking stock and observing medication administration by staff. This showed medicines were safely administered.

We looked at the care records for three people during our inspection. These showed us that an assessment of people's needs had been carried out and their care plans had been developed from the information gathered through the assessment process. We saw care plans relating to nutrition, personal care, hobbies and interests. Care plans were well organised and the information was clear.

During our inspection we found that all parts of the home were clean and free from unpleasant odours. We saw that staff wore disposable gloves and aprons where necessary and that these were freely available.

As part of our inspection we looked at how medication administration records and information in care notes for people living in the service supported the safe handling of their medicines. People were not protected against the risks associated with medicines because the provider had not ensured, through robust governance arrangements, that its staff were correctly dispensing medicines. The provider had also not ensured that variation to a medicine dosage determined by a secondary health care provider had been translated into practice.

The provider had appropriate security arrangements in place to protect people who lived at the service. Scrutiny of mandatory inspections regarding health and safety demonstrated that checks had been undertaken by competent contractors.

Staff spoken with said that they always had enough staff to support the people who lived at the home.

During the course of our visit, we spoke with twelve people who use the service, three relatives and two members of staff. We looked at six care records for people who use the service.

People who used the services told us they were satisfied with the care they received. They told us the staff were friendly, polite, treated them with courtesy, respect and promoted their independence by involving them in making decisions about their care and treatment. One person said, “If I had any worries about the care I would tell the staff because I live here all of the time”. Visitors told us that they were satisfied with the care; they were involved and were kept up to date about the safety and welfare of their relatives. One visitor told us since the appointment of an activities coordinator in the home they had seen a positive difference in their relative’s well being. They felt this was due to the fact their relative was encouraged to actively participate in a range of activities on a regular basis.