Thameside

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

The governance systems of the service did not support the service to consistently improve and sustain safe care delivery. There were quality assurance processes in place, but these did not always identify areas for improvement including potential risks to people's safety and environmental issues.

We made a recommendation about the variety of available activities. Care plans were in place for people which set out how to meet their needs in a person-centred way. Information was provided to people in a way that was accessible to them. Systems were in place for dealing with complaints, and complaints were dealt with in accordance with the provider’s complaints policy.

The service had enough appropriately skilled staff to meet people's needs and keep them safe. People and relatives told us there were sufficient staff to care for their family member. However, some staff felt staffing levels in certain areas of the home would benefit from more staff. The provider had a safe staff recruitment process in place. Staff received appropriate training, support and development which enabled them to meet people's needs.

People’s needs were assessed before moving into Thameside. This was to ensure the service could meet these needs. People received care and support from staff who had were appropriately recruited and trained to recognise signs of abuse and how to safely support people. Staff understood people’s risks and ensured people had as much choice and control of their lives as possible.

Referrals were made appropriately to outside agencies when required. For example, GPs, community nurses and speech and language therapists. Notifications were completed to inform CQC and other outside organisations when events occurred. Healthcare professionals told us staff were knowledgeable about people's healthcare needs and followed their recommendations.

People 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. They were supported with their nutritional needs. Specialist diets were in place when required and people were monitored to help them retain a healthy weight. Their health care needs were monitored, and staff ensured when support from external health professionals was required this was sought in a timely manner.

Family members spoke positively about staff engagement with their relatives and told us they were treated in a caring and respectful way. People and their relatives had the opportunity to express their views on their care and staff worked in a way which supported people's dignity and privacy.

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 good (published 09 November 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider had employed three Welfare Assistants who supported people during the COVID-19 restrictions to contact friends and families using technology, such as tablet computers. Staff told us this had helped to reduce the impact on people from not being able to access the local community.

The provider had created an isolation area in preparation for a second wave of COVID-19. Staff had allocated changing areas and bathrooms in this area to change into their uniforms and put on Personal Protective Equipment (PPE).

The inspection took place on 17 October 2018 and was unannounced.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission 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.

Why the service is rated Good.

Risks to people were routinely assessed with clear plans to keep people safe. Where incidents had occurred, staff responded appropriately and the provider analysed incidents. Staff understood their roles in safeguarding people from abuse. People's medicines were managed and administered safely. The provider had robust systems in place to reduce the risk of infection. There were enough staff to safely meet people's needs. The provider had carried out appropriate checks on staff to ensure that they were suitable for their roles.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to access the healthcare they needed and staff worked alongside relevant agencies to meet people's health needs. People received a thorough assessment before coming to live at the home and individual needs and choices were documented and met. People told us they enjoyed the food and it met their dietary needs. People were supported by staff that had received appropriate training to carry out their roles with confidence. The building was adapted to meet people’s needs.

People were supported by kind and caring staff that they got on well with. People were routinely involved in their care and staff offered people choices each day. People's privacy and dignity was respected by staff. People's cultural, spiritual and religious needs were catered for with access and links to a local church. Visitors were welcomed and encouraged to become involved in the care home through activities and care.

People had access to a range of activities' that reflected their interests. People's care was planned in a person-centred way. People's wishes regarding end of life care were documented. People were informed about how to raise a complaint and the provider regularly asked people for feedback.

Regular audits were undertaken to measure the quality of the care that people received. The provider regularly implemented improvements to the service. There was clear leadership at the home and staff told us that they felt supported by management. The provider had developed links with local organisations and agencies and people benefitted from these.

Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. The registered manager had informed the CQC of significant events including significant incidents and safeguarding concerns.

Further information is in the detailed findings below

The inspection took place on the 3 February 2016 and was unannounced.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission 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.

People and their relatives gave positive feedback about the service they or their family member received. People were very happy. One person said “They look after me well.”

People told us care staff treated them properly and they felt safe. One person said; “The staff are kind, I feel safe.” We saw staff had written information about risks to people and how to manage these in order to keep people safe. One person had been assessed as being at risk of skin breakdown, we saw a skin risk action plan detailing actions for staff to undertake to minimise the risk to the person which detailed the appropriate pressure mattress settings, repositioning schedules, and reference to nutrition care plans to promote skin healing.

People were kept safe. Staff had received training in safeguarding adults and were able to tell us about the different types of abuse and signs a person may show if they were being harmed. Staff knew the procedures to follow to raise an alert should they have any concerns or suspect abuse may have occurred. One staff member said “I would go to the team leader if I had any concerns and that there was an on-line system to call if support was needed.” Another member of staff told us they would discuss anything with the manager and there was a whistleblowing Anchor line that could be used.

Incidents and accident were fully investigated by the registered manager, and actions put in place to reduce the risk to people of accidents happening again such as people falling.

People received their medicines as they were prescribed and when they needed them. Processes were in place in relation to the correct storage, disposal and auditing of people’s medicines. One person told us “That the staff adjusts the timing of medicines to fit in with outings away from the home.” They felt this supported them having a social life.

Care was provided to people by a sufficient number of staff who were appropriately trained and deployed. People did not have to wait to be assisted. One person said; “I am happy with everything, staff are good’.” Another person said “there are always plenty of staff around.”

Staff recruitment processes were robust and helped ensure the provider only employed suitable staff to care for people.

People and their families had been included in planning and agreeing to the care provided. We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided. Staff ensured people had access to healthcare professionals when needed.

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. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When people lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. We saw related assessments and decisions had been properly taken.

Staff had the specialist training they needed in order to keep up to date with care for people. Staff demonstrated best practice in their approach to the care, treatment and support people received. Some staff had NVQ in health and social care and other staff were working towards them. Staff received appropriate induction. The registered manager had put in place the care certificate for staff to undertake as well as the providers set induction process.

People were provided with a choice of freshly cooked meals each day and facilities were available for staff to make or offer people snacks at any time during the day or night. Specialist diets to meet medical or religious or cultural needs were provided where necessary. One person said “‘The food is good.”

People were treated with kindness, compassion and respect. Staff took time to speak with the people who they supported. We observed some positive interactions and it was evident people enjoyed talking to staff. People were able to see their friends and families as they wanted and there were no restrictions on when relatives and friends could visit. One person said “It’s an enlivening place if you put your trust in it.” The activities on offer to people were varied. People could attend quiz nights, arts and craft, church services, exercise classes, board games, etc. A Valentine’s Day dinner was being arranged and external activities come in to the home such as singers or musicians.

People’s views were obtained by holding residents’ meetings and sending out an annual satisfaction survey. People knew how to make a complaint. Complaint procedures were up to date and people and relatives told us they would know how to make a complaint if they needed to. The policy was in an easy to read format to help people and relatives know how to make a complaint if they wished. Staff knew how to respond to a complaint should one be received.

The provider had quality assurance systems in place, including regular audits on health and safety, infection control and medication. The registered manager met CQC registration requirements by sending in notifications when appropriate. We found both care and staff records were stored securely and confidentially.

During our inspection of 3 December 2013 we noted that the provider had made improvements within the home. We spoke with four people who lived at the home, two relatives and six staff members, which included the registered manager.

We found that the home was clean and the carpets and furniture had been cleaned. Some carpets and furniture had been replaced and there was a plan to replace the remaining carpets in the communal areas. One person told us 'I have no concerns, it's always clean.'

We saw that the provider had recruited additional staff and that there were more activities in place for people to take part in. People who used the service and their relatives told us they thought there were 'Always staff around when you need them' and 'There is usually something going on.' We saw that activities were available and people's daily records confirmed that people attended these.

We looked at five people's care records and found that these were regularly reviewed and up to date.

Staff told us that they asked people for their consent before any treatment or care was carried out. People who used the service told us that staff asked them for consent most of the time.

Throughout our visit we saw that staff interacted with people with kindness and respect. Most people told us that the care they received was good. One person told us 'I get very good care. I couldn't ask for anything better'.

During our inspection we identified some concerns about cleanliness. For example. There was a strong, unpleasant odour in two of the living and communal areas.

We did a visual inspection of the home and saw that the premises were purpose built and equipment was mainly in good order and serviced regularly. For example, the passenger lift, fire extinguisher and hoist servicing had taken place.

Staffing levels were not sufficient to provide the care and activities people required. One person told us 'You can't get a member of staff when you want one. There aren't enough staff'.

We saw that there was a complaint policy and staff told us they knew how to respond if they received a complaint. Most people told us that they felt confident that if they made a complaint it would be acted upon.