Thames House provides accommodation and nursing care to people with Huntington's disease, acquired brain injury and other physical disabilities. It is purpose built with 20 en-suite bedrooms. There are fully accessible shared spaces for activities and private use.

The service were last inspected in September 2015 when the service did not meet all the regulations and were given an action for Regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as staffing levels were insufficient for both nursing and care staff and they had not received formal supervision regularly. We found they met the regulations at this inspection. We undertook this inspection on 20 and 21 December 2016.

The service did not have 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The CQC place a limiter on the well-led domain which cannot be assessed as anything other than requires improvement if there is no registered manager.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, which included the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. Their competency was checked regularly.

The home was clean and tidy. The environment was maintained at a good level and homely in character. We saw there was a maintenance person to repair any faulty items of equipment.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

Most staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

People were given the information on how to complain with the details of other organisations if they wished to go outside of the service.

Staff and people who used the service all told us managers were approachable and supportive.

Meetings and supervision with staff gave them the opportunity to be involved in the running of the home and discuss their training needs.

The manager conducted suffic

This was an unannounced inspection which took place on the 3 September 2015. The service was last inspected on the 9 May 2014 were it was found to be compliant.

Thames House provides accommodation and nursing care to people with Huntington’s disease, acquired brain injury and other physical disabilities. The service is registered to provide nursing care for up to 20 people. There were eleven people living in the service on the day of our inspection.

The service did not have a registered manager in place at the time of our 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.

We had received a notification from the provider to inform us he registered manager left their employment with the service on the 27 May 2015 and were informed that a peripatetic manager was in place in the service until such time as a replacement manager was employed. The peripatetic manager was on annual leave on the day of our inspection.

During this inspection we found breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

We observed staffing levels that were insufficient. Staff struggled to take time for their lunch and the one registered nurse on duty was unable to administer medicines at the correct time.

Liquid medicines had been opened and some did not contain the date when they were opened. We observed medicines that should have been administered at 12 noon were given late owing to insufficient staff being on duty, although staff had signed the Medicine Administration Record (MAR) to confirm this was administered at 12 noon. We have made a recommendation in relation to the recording and storage of medicines within the service.

The training matrix showed that a significant number of staff had not received training in some areas and refresher training had not been completed for mandatory courses. Supervisions were not being conducted in time frames set by the service.

Equipment was available throughout the service to support people with limited or no mobility. Records showed all equipment was checked on a regular basis to ensure this was safe to use.

Robust recruitment processes were followed to ensure people’s suitability to work within the service. This included Disclosure and Barring Service (DBS) checks and written references.

We looked at fire safety within the service and found that people had Personal Emergency Evacuation Plans (PEEP’s) in place, there was a fire risk assessment and regular fire drills were completed.

The majority of people who used the service were unable to communicate verbally. However staff were able to communicate with people in other ways, such as picture boards and hand gestures.

The service had considered the Mental Capacity Act (MCA) 2005. We found notes from best interest meetings and decisions were in place for those people who used the service who lacked mental capacity. Deprivation of Liberty Safeguards (DoLs) applications had been submitted for all the people who used the service.

People who used the service had access to a range of healthcare professionals in order to meet their health needs such as specialists in Huntington’s Disease, GP’s and dieticians.

Bathrooms within the service were well equipped with hoists and other mechanical aids. Sensory equipment was also installed such as coloured lights and music.

People who used the service were offered a range of activities on a regular basis. These included going to the cinema, boat trips and attending the theatre. Festivals such as Halloween and St Patrick’s Day were also celebrated with a themed day.

Care records contained enough information to guide staff on the care and support required and contained information relating to what was important to the person. These were reviewed regularly and evidenced family involvement.

Quality assurance systems that were in place were sufficiently robust to identify areas for improvement. Policies and procedures were also in place and accessible for staff to follow good practice.

Annual satisfaction surveys were given to people who used the service, staff members and relatives to gain feedback on the service.

During our inspection visit we spoke with two people who used the service, four members of staff, the manager and the operations manager. There were no visitors present at the home during our inspection. We also looked at records to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that people were treated with dignity and respect. One person said, “It’s the best place.” Safeguarding procedures were in place and members of staff understood their role in safeguarding the people they supported. Members of staff had received training about the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards to understand when an application should be made, and how to submit one.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home was clean, warm, well ventilated and free from offensive odours. We saw the home was well maintained and suitable for the lifestyle of people who used the service.

The duty rota provided details of the grades and number of staff on duty for each shift. Discussion with the manager and operations manager confirmed that staffing levels were determined by the health and social care needs of people who used the service.

Is the service effective?

People’s health and care needs were assessed with them or their relatives and they were involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Care plans were reviewed regularly and amended to reflect people’s changing needs.

We found that people’s weight and appetite was monitored. When any problems were identified advice was sought from the doctor, speech and language therapist and dietician. We saw that care workers were attentive to people’s needs at lunch time and sat next to the people who required assistance to eat their meal.

There was a rolling programme of training in place so that all members of staff were kept up to date with current practice.

Is the service caring?

We saw that care workers were attentive to people’s needs and offered appropriate encouragement and assistance when necessary. One person said, “The staff are all brilliant.” Each person had a care plan which contained information about their care needs and the support and assistance they required from members of staff in order to ensure their individual needs were met. Care plans also included details of people’s personal preferences and interests.

People who used the service and their relatives were also given the opportunity to complete annual satisfaction questionnaires. These were evaluated at the company’s head office in order to identify any areas for improvement

Is the service responsive?

We asked people what they did all day. One person explained they liked to go shopping and sit outside when it was sunny. Another person said, “There’s plenty to do.” The activities organiser told us about the activities she organised. These included, arts and crafts, reading, quizzes, pamper sessions and individual activities chosen by people who used the service. People were supported by members of staff to go shopping and visit other local amenities such as the cinema, theatre, pub, and bowling alley. People were also encouraged and supported by staff to pursue their own interests and hobbies.

People who used the service were encouraged to express their views about the care and facilities provided at the home at regular meetings. The manager explained that she met individually with people who were unable to attend the group meetings.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

There were systems in place for assessing and monitoring the quality of the service provided. We saw that audits completed regularly by the manager covered all aspects of the service provided.

Discussion with members of staff confirmed that they had received appropriate training and understood their roles and responsibilities. This helped to ensure that people who used the service received the care and support they needed.

We received an action plan in September 2013 that stated a weekly stock check would be introduced to identify any medication that needed to be renewed. We looked at the stock checking systems and saw weekly audits were now in place and people were receiving their medications in time.

We received an action plan in September 2013 that stated all mattresses were to be checked and the cleanliness recorded on a weekly basis. We visited the home on 14 January 2014 and 12 February 2014 and saw there were now appropriate systems in place to check mattresses.

We were unable to speak with any of the people who were using the service as part of this inspection due to the nature of their medical conditions.

However, we saw that the people using the service looked happy and well cared for. We saw regular interaction between the staff and the people using the service.

We did not speak with any people who use the service as part of this inspection.

People told us they were involved in planning their care and support and they were supported to make choices and decisions about matters which affected them.

People had no concerns about their care, treatment and support; they said they felt safe with the staff.

They told us they were treated with dignity and their privacy was respected. They said they were encouraged to be as independent as possible and that the care they received was very good.

They knew about their care plans which explained to care workers what they needed to do to support them and to help meet their needs.

People said they were being consulted about the service and were always asked what their needs were.