Thistle Hill Hall

Updated 24 June 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection visit was carried out by one inspector.

Service and service type

Thistle Hill Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Our inspection was informed by evidence we already held about the service. We sought the views of Healthwatch Nottinghamshire. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We also sought the views of external health and social care staff, and commissioners from the local authority. Commissioners are people who work to find appropriate care and support services which are paid for by the local authority or by a health clinical commissioning group. Commissioners also undertake monitoring of the quality of services. We asked the provider to send us a Provider Information Return (PIR), and they did. This is a form that asks the provider information about the service, what the service does well and improvements they plan to make. We used all of this information to plan our inspection.

During the inspection

During the inspection visit we spoke with four people who used the service and two relatives. We spoke with two nurses, one care staff, two technical instructors, maintenance and catering staff. We also spoke with the deputy manager, registered manager and nominated individual for the provider. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We looked at a range of records related to how the service was managed. These included five people’s care records and we looked at how medicines were managed for four people. We also looked at staff recruitment and training files, and the provider’s quality auditing system. During the inspection visit we asked the registered manager to send us additional evidence about how the service was managed, and they did this.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We sought feedback from six professionals who visit the service.

Updated 24 June 2020

About the service

Thistle Hill Hall is a residential care home providing personal and nursing care to 21 people at the time of the inspection. The service can support up to 23 people who are living with mental health conditions. People who use the service have access to a rehabilitation programme to support their recovery and promote their independence. The service is based around each person's individual needs and is therefore not time limited. The home provides five self-contained flats and 18 single bedrooms, over two floors. There are three communal lounges, a dining room, activities room, gym and a large garden.

People’s experience of using this service and what we found

Thistle Hill Hall continued to maintain an outstanding quality of care for the people living there. The provider and staff team had a proactive approach to continuous development, always looking for new ways to support people to recover and maintain their independence. For example, since our last inspection, the provider had developed skills training for people to include personal safety awareness, bespoke first aid training, and was trialling virtual-reality (VR) enabled therapy designed to offer graded exposure to situations in a safe environment.

People felt safe living at the service, and their safety and well-being was a priority for the staff team. People were empowered to play a full part in recognising risks to their mental and physical health and encouraged to take positive risks in their daily lives. Health and social care professionals knew the staff team had a strong culture of managing risks in people’s care and balancing this against the need for people to develop more independent lives.

People were supported with managing their medicines safely, and staff had a proactive approach to reducing the use of medicine to manage mental health symptoms that caused people distress. The staff team supported people to find other positive ways of managing symptoms of their mental health conditions, whilst being mindful of the part medicines also played in keeping people well. For example, there was an emphasis on maintaining physical well-being through a variety of activities. People also had access to a range of therapy activities such as art therapy and yoga, to give them different ways of managing stress and anxiety.

People were supported by a diverse staff team with a wide mix of skills, including specialist nursing staff and technical instructors. Staff described a thorough induction process, and confirmed they felt very supported and well trained by the registered manager and provider. The staff team was committed to working collaboratively with external health and social care professionals to achieve the best outcomes for people’s recovery. Feedback from external health and social care professionals continually emphasised the excellent teamwork all staff at Thistle Hill Hall demonstrated when working together with people to improve their mental health care.

People told us staff were creative and enthusiastic when it came to supporting them to live healthier lives and access external healthcare services. The provider took innovative approaches to ensure people were supported to maintain their health. People had access to an expert team of specialist mental health professionals, who worked with each person to provide a tailored approach to recovery.

The staff team remained committed to maximising people’s ability to have control and choice in their lives. People’s rights were protected because staff understood and acted in accordance with the relevant legislation. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were respected and valued as individuals. People, relatives and external health professionals were consistently positive about the exceptional care provided by the staff team. People’s wellbeing, recovery and empowerment was at the centre of the staff team’s ethos. Care and support was designed by people, relatives, the staff team and external professionals collaboratively, and was based on combining people’s needs and wishes for their recovery with nationally accepted best practice in mental health care. We saw how equality and respecting people’s diversity and individuality was embedded in the staff team’s approach to enabling people to live the lives they wanted.

The service was exceptionally person-centred and responsive to people's individual needs. People’s individual and diverse needs were recognised throughout the assessment and care planning process. The provider was open-minded and innovative when it came to providing care to people. This included the use of technology to support people become more independent and confident.

The staff team were very focussed on delivering person-centred care and were responsive to people’s changing needs. People were strongly encouraged to continue with their favourite activities and hobbies and supported to develop new ones if this was what they wanted. People and relatives spoke positively about the range of structured activities that were available at Thistle Hill Hall, describing how these enabled them to move toward their goal of recovery and independent living.

People were listened to and there were systems in place to obtain people's views about their care. People were encouraged to provide regular feedback on the service and felt they could raise concerns. Complaints were taken seriously, investigated and responded to sensitively.

The service was exceptionally well-led. Everyone we spoke with was consistently positive about the service and the way in which people were supported to live the lives they wanted. The staff and management team at Thistle Hill Hall were dedicated, creative and determined to ensure people were at the heart of service. Staff were highly motivated and clearly took pride in the high-quality compassionate care they offered.

The registered manager and provider demonstrated consistently excellent leadership qualities. The provider worked with the management team and staff to deliver a clear vision of the service, which was focussed on recovery and empowering people to live independent lives. The service maintained excellent links with health and social care professionals and other organisations in the local community. There was a strong emphasis on continuous improvement and development of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Outstanding (published 2 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.