14 Thornhill

We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. We found the provider only partly met the principles of right support, right care and right culture. Right care was seen in the way staff treated people day to day. However, right support and right culture were less consistent because communication approaches, management oversight, environmental safety and person-centred planning were not always effective.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations relating to consent and governance. The provider has been asked to produce an action plan explaining how these issues will be addressed.

Systems used to support people's care, safety and wellbeing were in place and staff demonstrated a good understanding of the people they supported. Additional evidence submitted demonstrated that Individual Support Plans, Easy Read documentation, STEP plans, healthcare planning systems, governance arrangements, training oversight processes and organisational learning systems were in operation during the assessment period. Staff worked proactively with healthcare professionals, supported people to access healthcare services and activities, and generally provided care that reflected people's preferences and individual needs. The staff team was stable and people benefited from support from staff who knew them well.

However, whilst systems and documentation were present, they were not always consistently recorded, clearly structured or sufficiently robust to provide effective assurance. Care planning, risk management, governance records and decision-making processes did not always clearly evidence how people's needs, preferences, rights and outcomes were consistently assessed, reviewed and monitored. Governance systems had not consistently identified or addressed all of the concerns found during the assessment. As a result, improvements were required to ensure that person-centred care, oversight arrangements and outcome monitoring were consistently evidenced and embedded across the service.

We also found concerns about consent and the use of the Mental Capacity Act. Mental capacity assessments were not completed for specific decisions, and best-interest decisions were not always made consistently. As a result, systems were not always effective in protecting people’s rights, safety and wellbeing.

At the previous inspections in 2016 and 2019 shortfalls were identified in how the service was operated and the registered manager’s oversight of the home. We continued to find systems for monitoring outcomes and improving the service were not effective and lessons were not learnt.

Feedback was not always formally collected or reviewed, and there was limited evidence to show that lessons learned from incidents or feedback had led to lasting improvements.

We saw many examples of compassionate care and positive relationships between staff and people using the service.

People were supported by a caring and stable staff team who knew them well and treated them with kindness, dignity and respect. People were supported to access healthcare and stay connected with family, friends and their local community. Staff worked well with healthcare professionals to meet people’s needs and respond to changes in their health and wellbeing.