This inspection took place on the 16 November 2018 and was unannounced.

Thornwood 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.

Thornwood is a care home providing accommodation for up to 16 people with a dementia type illness. There were 15 people living there at the time of our inspection.

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.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. Care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, nutritional risks including swallowing problems and risk of choking, and moving and handling. Pressure relieving mattresses and cushions were in place for those who were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes. Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns. Staff had a clear understanding of making referrals to the local authority and CQC. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. People said they felt comfortable and at ease with staff and relatives felt people were safe.

Staff had received training to ensure they provided safe and effective care and there were opportunities for additional training specific to the needs of the service. This included the care of people with specific health needs such as diabetes and dementia. Staff had formal personal development plans, including two monthly supervisions and annual appraisals. The provider assessed people's capacity to make their own decisions if there was a reason to question their capacity. Staff and the registered manager had a good understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people's care plans contained restrictions on their liberty, applications for legal authorisation had been sent to the relevant authorities as required by the legislation.

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People were very complimentary about the caring nature of staff. People told us care staff were kind and compassionate.

A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff. Activities were provided throughout the day and were developed in line with people's preferences and interests. Staff had received training in end of life care supported by the Local

The inspection took place on 31 March and 04 April 2016 and was unannounced. Thornwood was last inspected on January 2014 and no concerns were identified.

Thornwood is a care home for up to 16 older people that require support and personal care and who live with a dementia type illness. At the time of the inspection there were 14 people living in the home. The home is owned by Thornwood Care Ltd and is located in Bexhill, East Sussex.

There was a registered manager in post. 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 home was well maintained and communal lounges comfortable and homely. However communal bathrooms and some peoples’ bedrooms were stark and unwelcoming. This was identified as an area for improvement and on the second day we found that improvements had already been progressed.

Not everyone could tell us of their experiences, but those that could spoke positively of the home and commented they felt safe and well cared for. Our own observations and the records we looked at reflected the positive comments people made. However some people also told us they were ‘bored’. We were told that “Not a lot goes on.”

Care plans provided basic information about people in a person-centred way. People’s personal histories had been recorded and their preferences, likes and dislikes were documented so that staff knew how people wished to be supported.

There were enough staff to ensure people were supported safely and when required to accompany people to appointments. Some people went to out with family during the day and staff supported people to remain in contact with families. Complaints were dealt with in line with the provider’s policy.

People had confidence in the staff to support them and we observed positive interactions throughout our inspection.

People were protected from harm by trained staff who knew how to keep people safe and what action to take if they suspected abuse was happening. Potential risks to people had been identified and assessed appropriately. When accidents or incidents occurred, risk assessments were updated as needed. There were sufficient numbers of staff to support people and safe recruitment practices were followed. Medicines were managed safely.

Staff had received all essential training and there were opportunities for them to study for additional qualifications. All staff training was up-to-date. Regular supervision meetings were organised and annual appraisals were undertaken. Team meetings were held and staff had regular communication with each other at handover meetings which took place between each shift. Consent to care and treatment was sought in line with the requirements of the Mental Capacity Act 2005. The registered manager was and had, sought authorisation for people under the Deprivation of Liberty Safeguards legislation. People were supported to have sufficient to eat and drink and to maintain a healthy diet. They had access to healthcare professionals.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and these were communicated to staff in a variety of ways – verbally and through physical gestures or body language. People were involved in decisions about their care as much as they were able. Peoples’ privacy and dignity were respected and promoted. Staff understood how to care for people in a sensitive way and ensured people were listened to.

People and visitors felt they could express their views and discuss any issues or concerns with staff and with the registered manager. The provider organised annual surveys for friends, relatives and staff to feedback their views about the service. The culture of th

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people who used the service had complex needs which meant they were not able to tell us their experiences.

Staff told us that they worked as a team, and that they felt supported by the senior staff. One new member of staff member said, "I really love working here." Another said, "Great place to work."

We found that people who used the service were involved as much as possible in care decisions and in life choices. Care was delivered in a way that ensured their dignity was promoted.

Care plans and delivery of care for people was person specific and in line with their plan of care.

We looked at systems in place in relation to the cleanliness and infection control. The standard of cleanliness and hygiene had improved.

We reviewed a range of information during our visit and found that there were good standards of recording in place.

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people who used the service had complex needs which meant they were not able to tell us their experiences. We used the Short Observational Framework for Inspection (SOFI). Those that could, told us, "I am okay" and "I would like more to eat."

Staff told us that they worked as a team, and that they felt supported by the senior staff. One staff member said, "I enjoy working here." Another said, "We need more staff sometimes."

We found that people who used the service were not fully involved in care decisions and in life choices. Care was not always delivered in a way that ensured their dignity was promoted. Care plans and delivery of care for some people was more task orientated than person centred. We saw that staff were not promoting safe infection control practices in respect of soiled laundry.

Appropriate checks were undertaken before staff began work however we found that there were not enough qualified, skilled and experienced staff to meet people’s needs.

Due to people’s complex needs, many people were not able to tell us about their experiences. We used a number of different methods such as observation of care and reviewing of records to help us understand the experiences of people using the service.

People we were able to speak with who lived in the service told us they liked living at Thornwood. We were told “nice staff, nice food” and “I have a nice room here, very comfy”.

We also spoke with relatives and visitors. One visiting professional told us “I have never had any issues, there is always someone senior around if you need to speak to them, the staff are very helpful”.