Thornlea Rest Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The staff and management team had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The provider’s organisational values were in alignment with CQC’s ‘Right support, right care, right culture’ guidance. The registered manager told us they sought to provide the best care and support that people deserve. Risk assessment for people and care planning processes resulted in care plans acknowledging people’s diverse needs.

Thornlea had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The management team had systems in place and allocated tasks to seniors and other members of the management team. For example, writing staff rotas, auditing of policies and reviewing care plans. The registered manager then checked to ensure these tasks had been completed and any issues identified had been actioned.

Thornlea fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff told us they were aware of the whistleblowing policy and the path to take should they need to raise concerns. A staff member said, “All safeguarding training is up to date.” Staff were also aware they could report and concerns directly to the Care Quality Commission and the local safeguarding teams.

The management team valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

The management team had policies and procedures around equality, diversity and inclusion. We found guidance and information was also available in the employee’s handbook. Staff felt the management team considered their equality, diversity and inclusion and treated people equally and fairly. For example, where staff needed to work in a flexible way, this was discussed with the registered manager and changes to their working pattern would be made.

The management team had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

Quality monitoring processes were in place and completed consistently. Audits such as competency checks for medicines and the building had been undertaken and the management team. They had oversight on the quality of care people were receiving. Where audits such as domestic checks and daily walk rounds had been completed, we found any identified issues found had been actioned in a timely manner.

The management team understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The management team and staff collaborated with relevant professionals and agencies. For example, district nurses and general practitioners. Staff communicated and recorded information provided from health professionals when they visited people. This was confirmed by a recent local authority contract monitoring exercise.

The staff team focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Staff told us they felt they were involved in decisions and encouraged to share ideas to continue the development of Thornlea. A staff member said, “We are one family and involve everyone in sharing ideas to continue to learn and improve life for everyone.”