This inspection took place on 28 and 29 June 2018 and was unannounced. Thackeray House is a purpose built residential care home that provides accommodation for up to 39 older people, some living with dementia. At the time of this inspection 37 people were using the service. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection in March 2017 the service was rated requires improvement overall. We rated the key question ‘Safe’ Requires Improvement because people’s medicines were not always managed safely and there was an insufficient number of staff to meet people’s needs. We also found that the provider’s systems to assess and monitor the quality of care people received were not effective. After the inspection the provider sent us an action plan detailing how and when the required improvements would be made. These actions have been completed.

The home had a registered manager 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. The registered manager had many years’ experience working in adult social care and knew what was necessary to provide good quality care.

People felt safe living in the home. The design and layout of the home was appropriate for the needs of people living there. Records confirmed that staff had received safeguarding training. They knew how to recognise abuse and report any concerns. Senior staff conducted risk assessments and devised care plans which guided staff on how to manage the risks identified. The provider recorded and monitored accidents and incidents in order to identify trends, and put systems in place in order to minimise recurrence.

The home was well-maintained and was in the process of being refurbished during our inspection. We have made a recommendation that the provider improves the environment in a way which assists people living with dementia. The home remained clean and free of unpleasant odours. People were protected from the risk and spread of infection. Equipment used to support people was clean, in a good state of repair and was regularly serviced.

The provider had appropriate arrangements in place to help ensure people received their medicines safely. People received their medicines as prescribed. Staff supported people to maintain good health; people were appropriately referred to external healthcare professionals. People had sufficient to eat and drink and people who required support at mealtimes had the support they required.

Appropriate recruitment checks were conducted before staff were allowed to work with people alone. The provider supported staff through induction, supervision, training and appraisal. Staff had the knowledge and skills required to meet people’s needs; they knew people well and understood how to meet their needs. Staff were caring and treated people with respect.

People’s rights were protected. The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. People had been consulted about their care and support needs which were assessed before they moved into the home. Care plans and risk assessments included information and guidance for staff about how people’s needs should be met.

Staff supported people to maintain their independence There were organised activities inside and outside the home for people to participate in if they wished to do so. People were enabled to maintain relationships with their family and friends; visitors were made to feel welcome.

The provider recognised the importance of moni

We inspected Thackeray House Nursing Home on 27 March 2017. The inspection was unannounced.

Thackeray House Nursing Home is registered to provide nursing and personal care for up to 39 adults. At the time of our inspection there were 29 elderly adults living in the home.

We previously inspected Thackeray Nursing Home in November 2015 and found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to there being an insufficient number of staff to meet people’s needs, the lack of consistency with staff supervision and appraisal, failure to follow the provisions of the Mental Capacity Act 2005 and the lack of effective systems to assess and monitor the quality of care people received. The provider sent us an action plan setting out when the required improvements would be made. Some of these actions have been completed.

The home had a registered manager. 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 had many years experience working in adult social care.

People felt safe from abuse living at Thackeray House. Staff treated them with kindness and respect. Staff had been trained in protecting adults from abuse and had good knowledge of how to recognise abuse and report any concerns. Assessments completed by the service identified any risks to each person and gave guidance to staff on how to manage those risks.

We found there was an insufficient number of staff to meet people's needs, particularly people who required assistance with their mobility.

Staff were appropriately supported by the provider to provide effective care through an induction, relevant training, supervision and appraisal. People received care and support from a consistent group of staff who knew them well and understood their needs and preferences.

Each person had an individualised support plan to help staff understand the support they required. People were supported to have choice and control of their lives and staff supported people in a way and at a pace that suited people. People were satisfied with the range of activities available to them. However, three of the people we spoke to felt that more could be done to support people to participate in activities outside the home.

People were supported to maintain their health and access external healthcare providers. There were appropriate arrangements in place for ordering, storing and disposing of medicines. However, people did not always receive their medicines safely and the systems in place to monitor this were not always effective.

People’s independence and privacy were respected. Visitors were made to feel welcome and staff enabled people to maintain relationships with their families and friends. There was a choice of nutritious food which took into account people’s cultural and personal preferences. People were satisfied with the quality and amount of food they received.

The provider's policies and procedures were up do date and regularly reviewed. People's records were appropriately stored and well organised. The home was clean and free of unpleasant odours. There were appropriate arrangements in place to help ensure people were protected from the risk and spread of infection.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to there being an insufficient number of staff to meet people’s needs, because people did not always receive their medicines safely and the lack of effective systems to assess and monitor the quality of care people received. You can see what action we told the provider to take at the back of the full version of the report.

We looked at the personal care records for eleven people using the service and found that up to date individual care plans were in place which addressed their care and support needs and protected them from risks. A person using the service told us "I feel safe here. The staff always look after me even when they're busy."

We found that people were asked for their consent before they received any care or treatment and staff acted in accordance with their wishes. There were procedures in place to assess where people did not have the capacity to consent and the provider acted in accordance with legal requirements. A staff member told us "I always ask the person if it is alright to do something for them such as lifting or turning them."

We found that people were protected from the risks associated with the unsafe use and management of medicines as appropriate arrangements were in place for obtaining, storing, recording, administering and disposal of medicines.

We saw there were effective recruitment and selection procedures in place which ensured that people's individual needs and wishes were met by suitably skilled, trained and experienced staff.

People's personal records, staff records and other records related to the management of the service were in most respect accurate, up to date and fit for purpose. We found that staff were aware of the requirements to keep people's information confidential and the principles of the Data Protection Act 1998.

During our visit we spoke to a number of people and overall they all expressed satisfaction with the care they were receiving. Staff helped them in the way that they prefer and they had their wishes, privacy and dignity respected. The views of people who were able to comment on their experience can be summarised as follows. “I am happy living here”,” The staff are good to me and I do not have any concerns” and “staff are kind and helpful”.

During our visit we spoke to a number of people and overall they all expressed satisfaction with the care they were receiving. Staff help them in the way that they prefer and they have their wishes, privacy and dignity respected. However one relative had some concerns regarding her husband’s care, we spoke to the manager who agreed to look into them. The views of people who were able to comment on their experience can be summarised as follows. “I like it here”,” The staff are kind and look after me well” and “staff are very good and they do their best”.

We inspected Thackeray House on 11 and 12 November 2015. The inspection was unannounced. Thackeray House is registered to provide nursing and personal care for a maximum of 39 adults. At the time of our visit there were 34 people living in the home.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 felt safe. Staff had a good understanding of how to protect people from abuse and avoidable harm. Care was planned and delivered to ensure people were protected against identified risks.

People received their medicines safely and in accordance with their care plan. Staff controlled the risk and spread of infection by following the service’s infection control policy.

People living in the home, their relatives and staff told us they were concerned there was an insufficient number of suitable staff to always meet people’s needs. We observed that people did not always receive care when they needed it because there was not sufficient staff available.

The provider did not adequately support staff to deliver care effectively through regular supervision and appraisal. Staff had received training in the mandatory areas required for their role such as, safeguarding people from abuse, moving and handling people and infection control. However, staff had not been trained in areas such as the Mental Capacity Act 2005 and end of life care. This meant the care people received was not always as effective as it could be.

People were as involved in their care planning as they were able. Where appropriate, their relatives were also involved. Care plans provided information to staff about how to meet people’s individual needs.

People were satisfied with the quality of their meals and told us they had a sufficient amount to eat and drink. Staff worked with a variety of external healthcare professionals to support people to maintain good health.

Staff were recruited using an effective procedure which was consistently applied. People told us the staff were kind and caring. People were treated with respect and their dignity was maintained. People were supported to express their views and give feedback on the care they received.

There were systems in place to assess and monitor the quality of care people received. However, where these systems identified areas for improvement, action was not always taken in a timely manner.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to there being an insufficient number of staff to meet people’s needs, the lack of consistency with staff supervision and appraisal, the failure to follow the requirements of the Mental Capacity Act 2005 and associated code of practice and the lack of effective systems to assess and monitor the quality of care people received. You can see what action we told the provider to take at the back of the full version of the report.