This inspection visit took place on 4 April 2017 and was unannounced. We spoke with relatives via telephone on 19 April 2017.Thornfield Grange is a home for up to 10 people who have a learning disability and who may be on the autistic spectrum. On the day of our visit there were eight people using the service. It is situated in Bishop Auckland close to all facilities and transport links.
The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 last inspected the service on 19 February 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.
Staffing was provided at safe levels and any staff absences were mainly covered by the registered provider’s own permanent and bank staff. The service were using agency staff as they were recruiting to permanent posts and were saw these staff were checked, supported and used consistently where possible. Staff told us they felt levels were generally safe but felt that night time should be kept under review.
Accidents and incidents had been appropriately recorded and risk assessments were in place for people who used the service and staff.
We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
Staff we spoke with were aware of procedures to follow if they observed any concerns in relation to safeguarding and we saw that staff were encouraged to raise concerns through supervisions and staff meetings that took place.
Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner.
Staff were suitably trained and training was arranged for any due refresher training. Staff received regular supervisions and appraisals and told us they felt supported.
We saw that people were supported to access a wide range of activities in the community and this included staff supporting people with educational and employment opportunities. Staff did feedback to us that another vehicle would reduce the pressure on planning community outings as presently this limited the access for people due to only having one vehicle.
The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA). People are 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 were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. We experienced the lunchtime meal and saw people were given choices and support to eat a healthy and nutritious diet. Care records contained evidence of visits to and from external healthcare specialists.
Care records showed that people’s needs were assessed before they started using the service and they were supported to transition to the service at their own pace. We found that transition care plans could be more prominent and specific as the service did have people moving in and moving on from the service and there was not much written evidence of their support needs at that time.
Staff and relatives fed back that consistency of staff approach was the main challenge to the service and this could be improved.
Staff supported people who used the service with their social needs. We observed that all staff were caring in their interactions with people at the service. We saw people being treated with dignity and respect although we did raise that in records we viewed such as daily notes, meeting minutes and handover sheets that the term “unit” was used to describe the service. This was felt to be an institutionalised term and the registered manager agreed to support staff to refer to the ‘service or home’ rather than “unit”.
People who used the service and family members were aware of how to make a complaint. We saw complaints were recorded, investigated and monitored according to the registered provider’s policy.
Staff told us they felt supported by the registered manager and were comfortable raising any concerns. We saw that people and their relatives were involved in on-going reviews of care.
The service had a comprehensive range of audits in place to check the quality and safety of the service and equipment at Thornfield Grange and actions plans and lessons learnt were part of their on-going quality review of the service. We saw that the nursing files audit had not picked up outstanding documentation and we fed this back to the deputy manager for action.