Thorndene

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were safe at the service. They were supported by staff who understood how to identify safeguarding concerns and what action to take to keep people safe. Staff understood the risks people faced to their health and well-being and knew how to support people without limiting people. There was enough staff to support people. Staff were well trained and supported. There were safe recruitment processes in place and staff were positive about the induction process.

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.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives told us they felt the service was safe. One relative said, “[My relative] is safe because the staff are so diligent and professional.”

People were supported by staff who understood how to protect people from the risks of abuse, discrimination, neglect and harm. Staff knew when and how to raise a safeguarding concern and were able to give an example of when they had escalated a concern. Staff said they were able to raise any concerns with the manager and felt confident the right action would be taken to keep people safe. Staff told us, “Safeguarding training is done annually. I had something at the beginning of the year. A resident disclosed something which we had to raise as a safeguarding. I explained I couldn’t keep it to myself and had to hand it to managers. The person understood” and, “I have no doubt about raising safeguarding. I have confidence in [the manager] to deal with anything that is raised”.

People were supported by staff to stay as safe as possible. For example, we observed staff providing an arm to support people while walking around the service and when supporting people to go out and enjoy their time outside the service. Staff communicated with people in the way that suited them best. We observed staff sitting at eye level with people and looking at them whilst they spoke with them. Staff engaged with people in a positive way.

There were clear safeguarding and whistleblowing policies and processes which staff understood. Staff had completed safeguarding training and understood how to report any concerns. When incidents happened, they were investigated, reported to the local authority and CQC were informed when appropriate. Incidents and accidents were reviewed to identify any potential patterns, such as behaviour changes or a deterioration in health. This enabled external health care professionals to be contacted for further advice. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. People can only be deprived of their liberty when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). There were effective systems in place to ensure authorisation had been sought where people were deprived of their liberty.

People and their relatives told us staff knew how to support people with risks to their health. One person said, “They take care of me when I am poorly. They listen to you.” One relative told when their loved one was unwell “The staff instinctively understood what was needed, and because staff were able to keep them calm [they were able to avoid] a traumatic hospital visit.”

Staff had a good understanding of the risks people faced and how to provide support. For example, staff understood how to support people at risk from choking and what to do if the person did choke. Staff understood how to reduce risk through supporting people to maintain routines where this was important to people. Staff told us people had individual risk assessments which gave them guidance about how to keep people safe. A member of staff spoke with us about people taking positive risks and said, “We are looking holistically at the whole situation. We encourage them to understand and assess risks. For example, kitchen skills. Not everyone would be safe to use knives, but we encourage people to participate safely and promote their independence.”

Staff supported people to remain safe. For example, staff were attentive when supporting one person to move about the service, ensuring the person was supported to do so safely but with as much independence as possible. Another person needed encouragement to eat well. When they declined lunch staff knew to wait a little while and offered again, the person was then happy to eat their lunch. Staff spoke with people in a gentle manner. They maintained eye contact with people and engaged people’s attention when needed and in an appropriate way. People were busy and there was plenty of activity, but it was in a calm atmosphere and people appeared relaxed.

There was guidance for staff on people’s risks and how to provide support for those risks. For example, where people had epilepsy there was information on what their seizures looked like, and how they impacted people. There was guidance for staff on how to support the person during and after a seizure. Staff were told what information to record, so changes in the persons health could be identified, and concerns raised with medical professionals as needed.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives were happy there was enough staff to provide them with support. One person said, “Sometimes I have to wait, but not a long time.” One relative said, “Yes, there is always enough staffing – they try not to use agency staff whenever possible; they use their own people. The manager is incredibly committed to the staff.” Another relative said, “The staff are extremely kind, and the home is like a home from home.”

Feedback from staff was positive. One staff said, “There is enough staff here. The training is really, really good. We are encouraged to learn new things which is good.” One team leader said, “We ensure staff are able to do their role in the best of their ability.” The provider told us the new manager had made improvements to staffing. They said, “[The manager] has improved training so there is more face-to-face training. They have improved staffing levels and retention. The culture and induction have improved.” One staff said, “I used to work for and agency and get shifts here, I asked to come work here. The environment is lovely, and everything is well organised and nice.” The service had seen agency use increase prior to the current manager coming in to post. The manager told us they were now only needed agency on occasion to cover sickness.

There were sufficient staff to support people. People came and went during the day as they went out on activities supported by one to one, or two to one staff to do so. When people chose to remain at the service or came back for lunch there was sufficient staff to assist them. For example, we observed one person’s hearing aid was loose and the member of staff supporting noticed quickly and supported the person to resolve this.

Staffing levels were based on people’s assessed needs which included people’s one to one and two to one support as well as any shared hours they were assessed as needing. There were systems in place to plan the rota to ensure people’s hours were met. Staff had the training they needed to provide support to people, this included a mixture of face to face and online learning. Training included areas such as safeguarding people, autism, epilepsy and positive behaviour support. New staff shadowed more experienced staff to learn about people and their needs prior to working alone. Staff competency to undertake medicine administration had been checked as appropriate. Staff were provided with support and supervision. People were supported by staff who had been safely recruited. The recruitment process was efficient, and records were stored electronically. Full employment histories were recorded and any identified gaps had been discussed. Checks were completed, such as rights to work in the UK and references from previous employers. Disclosure and Barring service checks were completed to make sure new staff were safe to work with people.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.