The Thatched House

The Thatched House provides accommodation with personal care for people over age of 65, some of whom were living with dementia. The service is registered to accommodate up to 20 people in one adapted building. There were 18 people living in the home at the time of this inspection.

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

Some areas of the home, including people’s bedrooms, were not well maintained and hygienic, and systems for managing and preventing infections were not robust. This increased risks to people, had an impact on their comfort and did not support their dignity. Relatives were consistent in their views that the environment, including people’s bedrooms and bathrooms, needed attention.

The provider’s recruitment practice did not promote safety because suitable checks had not always been completed and documented. Systems for supporting and training staff were not consistent. Systems for monitoring the quality of the service and supporting improvements were not effective.

People told us they were happy at the home and relatives spoke highly of the care provided to people. Their comments included, “The care is very good” and, “Staff are all nice and kind, people are well looked after.”

There were enough staff to provide safe care and people were protected from risks of abuse. Staff were trained to administer medicines to people and staff were knowledgeable about people’s individual needs.

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.

Staff supported people to access the health care services they needed and worked effectively with other agencies. People were supported to have enough to eat and drink and spoke highly of the food and the choices on offer. One person said, “Mealtimes are very enjoyable.”

There was an open and inclusive culture where people and staff were encouraged to contribute their views and ideas. Staff were proud of their work at the home, one staff member told us, “It is a lovely place to work, people are very well cared for here.”

People and their relatives spoke highly of the provider. One relative told us, “Communication is very good, they are on the ball with keeping us informed.”

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 16 September 2021)

Why we inspected

We received concerns in relation to infection prevention and control, hygiene and maintenance standards at the home. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Following the inspection, the provider sent us information about the improvements that they had already put in place. These will be considered at a future inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Thatched House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the management of risks, maintenance of the premises, recruitment procedures, record keeping and management oversight and governance at this inspection.

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..

The Thatched House provides accommodation with personal care for people over age of 65, living with the frailties of old age and/or dementia. The service is registered to accommodate up to 20 people in one adapted building. The service was providing accommodation and personal care to 20 people at the time of the inspection. Any nursing needs were provided by community nursing services.

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

The service was welcoming, and people told us that they felt safe. They said there were enough staff to support them and they were listened to and treated with kindness. Systems were in place to protect people from the risk of abuse and improper treatment and staff knew how to identify potential harm and report concerns.

Positive and caring relationships had been developed between staff and people. People were treated with kindness and compassion and staff were friendly and respectful. People and their relatives spoke positively about staff and the care they received. People were treated with dignity and their independence promoted respectfully by a kind, caring staff team. Staff were well trained and understood how to calmly and positively support people living with dementia.

People received their medicines safely and their personal preferences were respected. Medicines were audited by the registered managers to ensure any errors were quickly addressed.

There were systems and processes in place to assure quality of service delivery and identify trends. Actions were taken to manage risks and learn lessons when things went wrong.

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.

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

The last rating for this service was Good (published 22 May 2019).

Why we inspected

The inspection was prompted in part due to concerns received about people getting up very early, moving and positioning practice, poor quality food and weight loss. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Thatched House on our website at www.cqc.org.uk.

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.

The Thatched House provides accommodation with personal care for people over age of 65. The service is registered to accommodate up to 20 people and was providing personal care to 19 people at the time of the inspection. Any nursing needs were provided by community nursing services.

People’s experience of using this service:

People received care and support that was safe. One person said, “I feel very safe living here, the staff support me well. They help me where I need help and encourage me to stay independent where I can.”

People were supported by staff who received training and were able to identify and respond appropriately to abuse. Risks to people were assessed, monitored and reviewed. There was a robust recruitment programme which meant all new staff were checked to ensure they were suitable to work with people. There were enough staff to support people with their daily living and activities.

People received effective care and support. One person said, “I think the staff do know what they are doing. They make sure I am offered drinks, and there is plenty of food. When I need my doctor, they make those arrangements.” Training and observation of staff practice as well as supervision ensured staff were competent in their roles. People enjoyed a healthy balanced and nutritious diet based on their preferences and health needs. 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.

People received care from staff who were kind and caring. One person said, “The staff are very caring. We are one big family. I like living here.” People told us staff always respected their privacy and dignity. Staff supported people to be fully involved in their care planning and reviews.

People received responsive care and support which was personalised to their individual needs. There was clear guidance for staff on how to support people in line with their personal wishes, likes and dislikes. Records showed the service responded to concerns and complaints and learnt from the issues raised.

People were supported by a team that was well led. Staff said the management team was open to suggestions and approachable. There were systems to monitor the quality of the service, ensure staff kept up to date with good practice and to seek people's views. The management team worked professionally with agencies outside of the service and ensured a transparent, honest and open approach to their work which was valued by others.

Rating at last inspection:

At the last inspection in March 2018 the service was rated Requires Improvement (report published on 23 May 2018). At that inspection we found three breaches of Regulations.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At this inspection the service has made enough improvements to be rated Good and the provider is no longer in breach of the Regulations.

Follow up:

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

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

The Thatched House is registered to provide accommodation and personal care for 20 older people, people who live with dementia and people who have physical/sensory adaptive needs. There were 19 people living in the service at the time of our inspection visit.

The service was run by a company who was the registered provider. The company had three directors. There were two registered managers in post both of whom were also directors of the company. 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. In this report when we speak about both the company and the registered managers we refer to them as being, ‘the registered persons’.

At the last comprehensive inspection on 4 December 2015 the overall rating of the service was, ‘Good’. However, there were three beaches of the regulations. This was because there were shortfalls in the arrangements made to safeguard people from situations in which they may experience abuse. Also, background checks on new care staff had not always been completed in the right way. Furthermore, people had not always been provided with safe care and treatment because medicines had not consistently been managed in line with national guidance.

After the inspection the registered persons told us that they had addressed each of the breaches. We completed a focused inspection on 15 December 2016 to confirm that the necessary improvements had been made. We found that suitable provision had been made to safeguard people from the risk of abuse and that recruitment checks were being completed in the right way. However, we found that further progress still needed to be made to ensure that people’s medicines were consistently managed in line with national guidance. As a result we said that there was a continuing breach of the regulations.

Although the overall rating of the service remained as being, ‘Good’, we told the registered persons to take action to make improvements to the management of medicines. At the present inspection we found that these particular improvements had been made. However, we also found that an additional improvement needed to be made to ensure that people’s medicines were consistently managed in the right way. There were also other shortfalls that had reduced the registered persons’ ability to provide people with safe care and treatment. This was because people were not fully protected from the risk of injury in the event of a fire safety emergency. In addition, suitable provision had not been made to prevent and control the risk of infection.

These shortfalls had reduced the registered persons’ ability to consistently provide people with safe care and treatment. Therefore, this was a continuing breach of the regulations.

There were two further breaches of the regulations. This was because there were shortfalls in the arrangements that had been made to ensure that people were consistently treated with respect and dignity including promoting their right to privacy. Also, the registered persons had not established robust systems and processes to assess, monitor and improve the quality and safety of the service.

You can see what action we have told the registered persons to take in relation to these breaches of the regulations at the end of the full version of this report.

Our other findings were as follows. People had not been fully safeguarded from the risk of financial mistreatment. However, there were enough care staff on duty and background checks had been completed before new care staff were appointed. Also, lessons had been learned when things had gone wrong.

Some parts of the accommodation were not designed, adapted and decorated to meet people’s needs and expectations. However, suitable arrangements were in place to assess people’s needs and choices so that care was provided to achieve effective outcomes. This included providing people with the reassurance they needed if they became distressed. Although in practice care staff knew how to care for people in the right way, some of them had not received all of the training that the registered persons considered to be necessary. People were helped to eat and drink enough to maintain a balanced diet. Also, suitable arrangements had been made to help people receive coordinated care when they moved between different services. Although not fully recorded, in practice suitable steps had been taken to obtain people’s consent to the care they received.

People were given emotional support when it was needed. Also, they had also been supported to express their views and be actively involved in making decisions about their care as far as possible. This included them having access to lay advocates if necessary. Furthermore, confidential information was kept private.

Although people received responsive care that met their needs for assistance, information was not always presented to them in an accessible manner. People had been offered sufficient opportunities to pursue their hobbies and interests and to engage in social activities. Furthermore, suitable arrangements had been made to promote equality and diversity. This included the registered persons recognising the importance of appropriately supporting people who chose gay, lesbian, bisexual and transgender lifestyles. Furthermore, there were suitable arrangements for managing complaints and suitable steps had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

There were registered managers who had promoted an inclusive culture in the service and people who lived there had been consulted about its development. Furthermore, care staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. Also, the registered persons were actively working in partnership with other agencies to support the development of joined-up care.

This report only covers our findings in relation to these specific area / breaches of regulation. This is within the 'Safe' domain. The other domains 'Effective', 'Caring', 'Responsive' and 'Well led' were not assessed at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Thatched House on our website at www.cqc.org.uk.

The inspection was prompted, in part, by notification of an unexpected death and potential concerns about how staff would respond to a medical emergency. We identified during the inspection that the provider had systems and procedures to guide and support staff on how to respond in an emergency and that staff understood their responsibilities in responding to medical and other emergencies.

The Thatched House is registered to provide accommodation for 20 people who may require nursing or personal care. At the time of this inspection, 18 people were living at the home, some of whom were living with dementia.

A registered manager was in post. The registered manager was also the owner and provider of the home. 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 Thatched House is a detached thatched building with a driveway, situated in a private avenue close to the seafront in Bognor Regis. Communal areas included a large lounge with a further two sitting rooms leading to a dining area with a spacious rear garden. Rooms were single and double occupancy

At this inspection, we found that although some improvements to the safe management of medicines had been made, the service remained in breach of this Regulation.. This was because Medication Administration Records (MAR) that were in place had not been correctly completed to demonstrate medicines had been given as prescribed.

The breach of regulation related to safeguarding people from abuse or improper treatment had now been met. There were signs that incidents of abuse between people had reduced and staff were more alert to what would be considered abusive under safeguarding and how to respond to this. People were protected from the risk of abuse, avoidable harm or discrimination because staff understood their roles and responsibilities in protecting them.

The breach of regulation related to staff recruitment processes had now been met. Recruitment documentation demonstrated that all necessary checks were being undertaken before staff were employed to ensure their suitability to support people.

Staffing levels ensured people received appropriate support in an unhurried and personalised way. Staffing levels were sufficient to meet people's individual needs.

Systems were in place to identify risks and protect people from harm. Risk assessments were in place and reviewed monthly. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to health professionals as required.

The service had good systems in place that appropriately identified and managed risks to people in a proactive and enabling way. Accidents were managed safely and staff took immediate appropriate action to respond to this.

We identified one continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.