Thornton Lodge is a care home without nursing providing accommodation and personal care for up to 45 people with past or present mental health issues, older people and people with learning disabilities. On the day of our visit there were 39 people living in the home. The premises are in the form of a large residential home with ordinary domestic facilities.

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.

People told us they felt safe. Many of the people had been living at Thornton Lodge for more than five years and they said they were safe and secure in their home.

People received care and support from staff who knew their needs and preferences well. People were supported by staff who had also worked in the home in the long term and knew how to keep people safe. Risks to people's health and safety were assessed. There were good risk management plans in place.

People were supported by appropriate numbers of staff. Robust staff recruitment procedures helped to keep people safe.

People were supported with the safe administration of their medicines and there were regular audits undertaken by the provider to monitor the processes in place and to ensure people remained safe.

People were supported by staff who were well trained and supervised.

The provider ensured people's nutritional needs were met. People contributed to the planning of their meals and were provided with choices so that they received healthy nutritious food.

People's healthcare needs were met and staff supported them to attend medical appointments. Staff had undertaken training in the Mental Capacity Act 2005 and were aware of their responsibilities in relation to people who might be deprived of their liberty. They ensured people were given choices and the opportunity to make decisions.

People, their relatives and professionals told us staff were consistently kind and caring and established positive relationships with them and their families. Staff valued people, treated them with respect and promoted their rights, choice and independence.

Comprehensive care plans were in place detailing how people wished to be supported. We saw people were central to the process of how their care and support was delivered.

People participated in a wide range of activities within the home and in the community and received the support they needed to help them to do this.

There was a complaints procedure in place and relatives felt confident to raise any concerns either with the staff or the registered manager if they needed to. The complaints procedure was available in different formats so that it was accessible to everyone.

We found there was an open and transparent culture in the home where staff were encouraged to share in the development of the home for the people living in it.

We found the provider had a system in place that sought feedback about the quality of the service from different people involved with the service. There were good systems in place to use the feedback received to improve the service where necessary.

We inspected Thornton Lodge on 3 May 2016 and the inspection was unannounced.

Thornton Lodge is a care home without nursing providing accommodation and personal care for up to 45 people with past or present mental health issues, older people and people with learning disabilities. On the day of our visit there were 42 people living in the home. The premises are in the form of a large residential home with ordinary domestic facilities.

There was a registered manager at the home. 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.

At the last inspection, carried out on 25 February 2015 we found that people were not adequately protected against the risks of acquiring infection because of unhygienic rooms. We also found that the registered provider needed to do more to ensure their quality assurance processes meet best practice standards and take account of the views of people and their relatives. We asked the provider to submit an action plan detailing the improvements to be made.

These actions have been completed and on this inspection we found that the relevant requirements were being met.

People's feedback about the safety of the service described it as good and that they felt safe. People were safe because the service had provided training to staff and had systems in place to protect them from bullying, harassment, avoidable harm and potential abuse.

Staff protected people's dignity and rights through their interaction with people and by following the policies and procedures of the service Feedback from people was that staff were caring in their attitude and responsive to people's needs. A caring attitude was observed during the inspection and personalised care, dignity and respect formed part of staff training.

There was a structure and system in place for regular staff supervision and each member of staff had a training record which was relevant to their role.

The service managed the control and prevention of infection well. Staff followed correct policies and procedures and understood their role and responsibilities for maintaining high standards of cleanliness and hygiene. Medicines were well managed, with staff displaying a sound understanding of the medicines administration systems, recording and auditing systems.

Deprivation of Liberty Safeguards and the key requirements of the Mental Capacity Act 2005 were understood by the manager and acted on appropriately.

People at risk of poor nutrition and dehydration were sufficiently monitored and encouraged to eat and drink. The quality of the food was good, with people getting the support they needed and the choice that they liked.

Care, treatment and support plans were seen as fundamental to providing good person centred care. Care planning was focussed upon the person's whole life, including their goals, skills, abilities and support needs.

The service protected people from the risks of social isolation and loneliness and recognised the importance of social contact and companionship. The service enabled people to carry out person-centred activities within the service or in the community and encouraged them to maintain hobbies and interests. This was supported by policies and procedures which emphasised the rights of people and developments in care planning which included people's life histories written from their own perspective, which enabled staff to work in a person-centred way.

People described the responsiveness of the service as good. People received personalised care, treatment and support and were involved in identifying their needs, choices and preferences and how they are met. People's care, treatment and support was set out in a written plan that described what staff n

We inspected Thornton Lodge on 25 February 2015 and the inspection was unannounced. A previous inspection had taken place on 27 May 2014 where the home was found to have complied with the regulations.

Thornton Lodge is a care home without nursing providing accommodation and personal care for up to 45 people with past or present mental health issues, older people and people with learning disabilities. At the time of inspection there were 42 people living in the home. The premises are in the form of a large residential home with ordinary domestic facilities.

The home was managed by 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 told us that the care staff treated them well and they felt safe. Staff had received training in safeguarding, health and safety and infection control and records were kept to ensure that this important training was kept up to date.

The home environment was safe from hazards and tidy. However, some areas were dirty and shabby looking, and where carpets were worn. Several of the rooms had very strong and offensive odours. The provider was not fully meeting regulations requiring providers to ensure appropriate standards of cleanliness and hygiene of premises. You can see what action we told the provider to take at the back of the full version of the report.

There were sufficient numbers of staff to support the people living in the home and there were adequate recruitment processes to ensure suitable checks were carried out on staff before taking up their post.

People using the service received support with their medicines from trained staff. People received their medicines safely with appropriate records kept. Where people were able to, they were supported in managing their own medicines.

We found care plans to be up to date and people’s changing needs were identified and acted upon appropriately. We discussed with the manager and the managing director the scope for developing people’s care records so that they expressed more explicitly and directly the views of the people and described the agreed plan of care from their perspective.

People using the service told us that staff treated them with respect and they were happy living at the home. People told us the food was good and we saw that the menu of the day was clearly displayed on the board and menu of the week on the dining room tables.

People said they knew how to make a complaint and felt able to approach the manager or other senior staff. We observed good professional and friendly relationships between staff and people and staff were knowledgeable about people’s needs.

The provider and manager encouraged an open culture in the home and carried out quality assurance checks by involving staff in taking lead responsibility for various aspects of running of the home. However, there was little evidence that the provider looked to external sources for advice and guidance on best practice and further professional development of the service. This meant that the provider was not able to verify that the service was being run along the lines of updated research or best practice.

We recommend that the provider and registered manager seek appropriate professional advice on how to ensure their quality assurance processes meet best practice standards and take account of the views of people and their relatives.

During this inspection visit by one inspector, we spoke with twelve people using the service, five members of staff and the registered provider. We looked at three people’s care plans as well as other records held by the provider including those kept for the administration of medicines, staff training and health and safety.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and staff told us.

Is the service safe?

People told us that the care staff treated them well and they felt safe. We found that staff had access to safeguarding training and records were kept to ensure that this important mandatory training was kept up to date. Individual staff members we spoke with understood the action to take if they suspected abuse was taking place and said that they felt able to raise any issues of concern with senior staff.

We saw the home environment was safe, clean and well maintained. People using the service commented on the cleanliness of the home saying "it's spotless and clean" and "they are always cleaning".

People using the service received support with their medicines from trained staff. We saw that they had received their medicines safely with appropriate records kept.

Is the service effective?

Care plans were found to be up to date reflecting the person, their needs and preferences. We saw people’s changing care needs were being identified and discussed by care staff through their key worker responsibilities, care plan reviews, handovers, team meetings and supervision sessions with their line manager.

People’s assessed needs were being met by staff with the necessary skills and knowledge. We saw that staff had access to the training and supervision that helped them do their jobs well.

We found that people did not always have accessible information about safeguarding, how to raise concerns or complaints and we saw the day’s menu had not been displayed for the benefit of people using the service.

Is the service caring?

People using the service told us that staff treated them with respect and they were happy living at the home. Feedback included "I'm more than settled now", "very nice here", "it's more for the elderly here" and "I get on well with them here". One person told us “things work from start to finish”.

Staff understood the importance of treating people with dignity and respect and said they were made aware of the standard of work expected of them.

Is the service responsive?

We had mixed feedback from people using the service about the activities provided within the service or in the community. Some people said they would welcome more things to do as they were sometimes bored.

People said they knew how to make a complaint and felt able to approach the manager or other senior staff.

Is the service well-led?

The service had a registered manager in post. Staff told us the home gave them support and training which helped them to meet people’s needs.

Quality assurance processes were in place however these could be developed to ensure that specific measurable action plans were being documented following meetings and surveys. This information may assist the service in ensuring that people were able to be fully involved in the running of the home. Improved recording of audits of medication would give additional assurance that medicines were being handled safely.

At the time of our inspection there were 43 people residing at Thornton Lodge. We used different methods to help us understand the experiences of people who use the service as not everyone who lived at Thornton Lodge was able to communicate verbally with us in a significant way.

On the day of our inspection we met with five people who lived at Thornton Lodge and observed how staff supported and cared for these individuals. We saw that the registered manager and staff respected people's privacy and dignity, and took account of what people had to say in relation to the way their care and support was provided. For example, we saw one person who uses the service speaking with the manager about their care plan. The manager met with the individual and helped them to seek support from health professionals in relation to their care.

We saw the service had adopted various ways to ensure that people who use the service were supported fully and individual’s needs were being met. These included monthly meetings with all people who use the service, collectively and individually and annual satisfaction surveys were completed and action plans formulated that were acted on.

People we spoke with told us that they had a very good relationship with the manager and all members of staff. One person told us “the staff are very kind and supportive” and “I have my own key so I can come and go when I please”.

People told us that they were happy living in the home. They chose how they preferred to spend their days, and their daily routines. They said “staff are kind” and “I can do more or less what I want”. One person told us “I get up and go to bed when I want to, I can go out if I want and I please myself really”. Another person told us “its one hundred percent alright”.

People told us that they thought there were enough staff in the home to help them. They told us that staff were “very kind”, and “always helpful”. We saw that staff were respectful towards people and they appeared to have a good relationship with them.

We saw that the service had developed various ways to ensure that it was meeting people’s needs.These included regular meetings for people and yearly satisfaction surveys. People’s views were used to influence future service provision.

We raised one concern that some staff training had not been updated. The manager agreed to address this.