Thatcham Court Care Home

Thatcham Court Care Home is a care home which provides accommodation and personal care or nursing care to older adults who may be living with dementia. The care home accommodates 60 people across three separate floors, each of which has separate adapted facilities. One of the floors specialises in providing care to people living with dementia. At the time of our inspection, 60 people received care.

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

The service was exceptionally well-managed. There was a very positive workplace culture, which ensured the care provided was to excellent standards. There was a clear focus on continuous improvement and ensuring people could lead their best life possible. The service used nationally produced best practice guidance to shape the provision of people’s care. In addition, the management team looked for innovative programmes to promote people's lives. The manager ensured audits and checks were completed regularly to ensure the safety and quality of people’s care. Improvements to the service were made based on the feedback of people, relatives, staff and others. There was an excellent link with the local community to promote an inclusive culture.

People received safe care. Any risks to them were assessed, documented and mitigated to protect against avoidable harm. People were protected against abuse, neglect and discrimination. There were enough staff deployed to ensure people were safe. The premises and equipment were well-maintained, clean and tidy. Accidents and incidents were recorded, people received appropriate support afterwards and the service learnt lessons if things went wrong.

Staff were knowledgeable and skilled. They were competently able to provide the support people required. They were provided with frequent training in relevant areas of care specific to the service, which included additional complex skills. There were very good links with community care professionals which ensured people maintained a healthy lifestyle. People received effective support which met their individual needs. A holistic assessment was carried out which included people’s cultural, religious and lifestyle histories. We made recommendations about the staff training in oral hygiene and the publication of food allergens.

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.

We observed people’s support was very caring. Relatives, commissioners and professionals described the service as very caring and staff as kind. Without exception, people were routinely treated with dignity and respect. One person’s feedback stated, “The staff were always caring and did their jobs well, but they now receive the leadership and guidance to help them become the best they can be.”

There were improvements to care planning. People’s care was specifically tailored to their individual needs and life. There was a clear emphasis on supporting people to lead full and active social lives. People were encouraged to enjoy themselves and follow a broad range of activities. All staff were motivated and committed to provide people with personalised experiences that met expectations. Staff valued people's individual differences and responded in line with their preferences for support. People’s diversity was recognised and promoted by the staff. People were supported to follow their faith and culture, and to maintain important family relationships.

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 2 June 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.

A requirement notice was issued with respect to the breach of Regulation 12 (Safe care and treatment). The registered provider sent us an action plan in June 2016 outlining the improvements they were going to make in order to meet the requirements of the regulation.

The inspection of 27 and 28 April 2017 was a comprehensive inspection to follow up and ensure the requirement notice for Regulation 12 (Safe care and treatment) had been met and to make a judgement about the overall compliance of the service. We found the service had made the necessary improvements to meet the requirements of the regulations.

Thatcham Court Care Home provides accommodation for up to 60 people who may be living with dementia and need personal and nursing care. The service was purpose built as a care home and provides accommodation over three floors. There is a well maintained garden which provides safe outdoor space for people to enjoy.

At the time of the inspection there were 50 people living at the service. The manager had applied to register with the Care Quality Commission to manage the service and was registered on 5 May 2017 following the inspection. 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 living at Thatcham Court Care Home received safe care from staff who knew them well. There were sufficient staff with the appropriate skills and knowledge to support people in a safe and effective manner. People were protected from the risk of abuse by staff who were knowledgeable with regard to safeguarding people and understood their responsibilities. People’s medicines were managed safely and they received their medicines at the required times. Risks relating to people and the environment were assessed and managed. Staff knew how to respond to emergencies, they had received updated fire safety training and taken part in practice fire drills.

Staff felt supported and they praised the manager for the support she provided. They received appropriate training to acquire the skills necessary for their role and they refreshed their knowledge regularly. 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. Where people were unable to make decisions for themselves staff met with relatives and other professionals to make decisions in their best interests. When people’s freedom had been restricted for their own safety appropriate authorisations were in place under the Deprivation of Liberty Safeguards. People had a choice of food and drink which they enjoyed. When necessary their nutrition was monitored to help ensure their well-being. People received appropriate health care support from health and social care professionals who were contacted promptly when necessary.

People were treated with kindness and compassion. They were respected and had their privacy and dignity maintained by staff who understood these values. Visitors were welcomed at the service. There were no restrictions on visiting times and people were encouraged to maintain relationships important to them. People and staff interacted positively with each other, choices were offered and explanations provided when staff assisted people with daily living activities. There was a relaxed and friendly atmosphere and we observed people laughing and smiling with staff as they went about their daily business.

People and when appropriate their relatives had been involved in planning the support and care they required. Care plans were reviewed regularly, however, relevant information was not always updated and therefore there was a risk that appropriate care may not be received. There were mixed responses from relatives regarding the responsiveness of the service in meeting their family member’s needs. Where concerns had been raised the manager had arranged to meet with families to discuss and address them. Other relatives were positive and felt their family member’s needs were responded to well. A wide range of activities were available for people. Extremely positive feedback was received about the variety and choice of activities available which people clearly enjoyed. People and their relatives were aware of how to raise complaints if necessary.

There was an open and friendly atmosphere in the service. People, their relatives and staff spoke highly of the manager. The manager had a clear vision to improve the service and they were held in high regard by the staff team who valued their leadership. Regular checks and audits were carried out to monitor the quality of the service and the results used to plan and instigate change for the better. People’s views were sought and they were asked for feedback on their experience of the service. This was used to drive improvement and the manager had a detailed plan outlining the future developments she intended to implement.

Thatcham Court is a detached modern purpose-built home situated in the centre of Thatcham in West Berkshire, close to local shops and other amenities. People have their own bedrooms and use of communal areas that includes an enclosed private garden. The people living in the home live with dementia and other health related conditions and need care and support from staff at all times. The service is registered to provide care and nursing care for up to sixty people. There were fifty-eight people in residence during our visit.

There is a registered manager running the service. 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. The registered manager was not available at the service, which is being managed by an interim manager with support from a deputy manager.

There were systems to regularly assess and monitor the quality of service that people received, but the registered manager had not used these effectively to ensure people’s safety and well-being.

Staff had not received the refresher health and safety training they needed to promote people’s safety. They had not been supported with their development needs until the recent deployment of an interim manager and recruitment of a deputy manager. People, their relatives and staff told us they felt listened to by these two managers, who had endeavoured to improve the overall safety and well-being of people, whilst supporting and developing the staff team.

People’s care plans were not up to date to fully reflect their care needs and/or fully identify individual risks. For example, to promote falls prevention, people’s skin viability and to support people who displayed behaviours that could cause distress or harm to themselves and/or others. Staff did not receive an effective handover to make sure they were fully aware of people’s changing needs. These issues were being reviewed and improved by the interim manager and deputy manager during the two days of our visit. They recognised the need for further improvements. Staff were receiving support to change the ethos of the home to promote person-centred care and improve communications.

There were enough staff to meet people’s needs. Further improvements were being made by the managers to make sure staff numbers promoted person centred care. However, until February 2016, staff absences were not fully covered by agency staff. This left staff short on the floor or having to work excessive hours. From this date the interim manager and deputy manager made sure there were enough staff to promote a safe service.

People’s nutritional needs were met with meals that were appetising and cooked to meet individual needs. Staff treated people with respect and kindness and embraced the support they needed to improve the quality of services to promote person centred care. People were encouraged to live a fulfilled life with activities of their choosing and were supported to keep in contact with their families. However, people who remained in their room through choice or frailty were at risk of social isolation and further improvements were needed to make the environment more dementia friendly.

There were robust processes in place to monitor the safety of giving people their medicine. Recruitment and selection process helped to ensure staff of good character supported people. Staff knew how to recognise and report any concerns they had about the care and welfare of people to protect them from abuse.

The service had taken the necessary action to ensure they were working in a way that recognised and maintained people’s rights. They understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and consent issues, which related to the people and their care.

There were various formal audits and quality monitoring visits by one of the organisations area managers. One of those visits identified concerns. They notified the Care Quality Commission and local authority of their findings and of actions, they had taken to promote the wellbeing and safety of people.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured staff received refresher fire safety training to be confident of their actions to promote people’s safety should there be a fire within the home. You can see what action we told the provider to take at the back of the full version of the report.

People's care plans detailed how they wanted their needs to be met and supported choices they had made. These included people's nutritional needs that were continually reviewed. People were provided with a choice of meals and told us they enjoyed the quality of the food.

The home was clean and had effective systems in place to reduce the risk and spread of infection.

Staff received appropriate professional development and support to safeguard and deliver care to the people who lived in the home.

People and their relatives were kept informed, were listened to and given opportunity to provide their views of the services provided. Comments included, 'a little hard pressed to grumble here' and 'I've complained once and the home handled it very well'.

People told us that there were enough staff on duty to support them. We were told that they did not have to wait too long if they called for assistance. We saw that staff were always in attendance in the lounges and communal rooms when they were in use.

People spoke favourably about the staff. One person told us, "They are all very good and are very kind towards me'. Another said, "They are good to everybody here and I would hate to have to leave' A family member told us, "I think they are friendly, caring and very respectful towards my mum'. They also told us that staff answered call bells promptly and responded to requests for assistance quickly.

Equipment used in the home was clean and well maintained.