This inspection was carried out on 27 September 2018 and was unannounced.

Thomas house is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. The home is situated within the St Helens area. The home offers accommodation and support for up to 28 people. At the time of our visit there were 22 people living at Thomas house.

The home did not have a registered manager. A registered manager is a person who is 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection, the service was rated good.

The registered provider had policies and procedures in place that were regularly reviewed and updated. We identified some disparity of information relating to the complaints policy. The Statement of Purpose held out of date information including details of a previous regulator. The registered provider stated they would immediately review and update these documents to ensure they held the correct information.

The registered provider continued to have safe recruitment processes in place. All staff had completed an induction at the start of their employment and undertaken shadow shifts with an experienced member of staff. Mandatory training was consistently completed along with refresher training updates as required in accordance with good practice guidelines. Staff received regular support through supervision and team meetings.

The registered provider had safeguarding policies and procedures in place. Staff felt confident and knew what they needed to do if they had any concerns. Staff had received training and were able to describe what abuse may look like. They thought any concerns they had would be listened to.

People had their needs assessed before they moved into the home and this information was used to create individual care plans that included clear guidance for staff to follow to meet people’s needs. People’s needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process. Care plans were reviewed and updated regularly.

Staff had developed positive relationships with people living at the home. People told us they had support from regular staff that respected their privacy and promoted their independence where possible. We observed positive interactions between people and staff that supported them throughout our inspection. Staff were caring and demonstrated kindness and patience. People’s privacy and dignity was respected. A variety of activities were available for people to participate in.

Medicines were ordered, stored, administered and disposed of in accordance with best practice guidelines. The registered provider had medicine policies and procedures in place. Medicine administration records (MARs) were fully completed and regularly audited for accuracy. Staff that administered medicines had all received training and had their competency regularly assessed.

People were supported by staff with their food and drink needs. When people had been identified as having specific assessed dietary needs staff had guidance available to support this. People spoke positively about the food and drink.

Quality assurance systems were in place that were consistently completed. Areas for development and improvement had been identified and action taken to complete these. Accidents and incidents were analysed to identify trends and patterns within the home. Health and safety checks, equipment testing and servicing and fire checks were regularly undertaken within the home.

The Care Quality Commission is required b

This was an unannounced inspection carried out on the 21 February 2016.

Thomas House is a residential care home in St Helens. The service offers accommodation and support for up to 28 people. The building is arranged across two floors with lift access to the upper floor. The service has 24 ensuite bedrooms and two shared rooms without ensuite facilities. There were 25 people living at the service at the time of our visit.

The service has 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 last inspection of Thomas House was carried out on 22 October 2013 and we found that the service was meeting the regulations we reviewed.

People we spoke with and their visiting relatives told us they were satisfied with the care and support they received at Thomas House. People told us they had developed good relationships with the staff and said they were treated with dignity, kindness and respect and they felt safe living at the home.

Before using the service the registered manager visited people to assess their support needs. Individualised care plans were developed with the person and where appropriate, with their relatives to agree how care and support would be provided.

Risks to people were identified, managed and reviewed and the staff understood how to keep people safe. There were sufficient numbers of suitably qualified staff to meet people’s needs and promote people’s safety. We saw that staff listened to people and encouraged them to make choices and decisions about their care. Staff sought people’s consent before they provided care and support.

Some of the people who lived at the service did not have the ability to make decisions about some parts of their care and support. Staff had completed training and understood the requirements of the Mental Capacity Act 2005 (MCA). They knew the main principles of the Act and showed good knowledge of the Deprivation of Liberty Safeguards (DoLS) and when a DoLS may be required.

People who lived in the service said the food was good; people’s nutritional needs had been assessed, and people’s specific dietary needs had been provided for in accordance with their care plans.

People were supported to access healthcare professionals whenever they needed to. The service responded promptly if people required a GP or district nurse visit due to ill health or a routine medical appointment.

Staff recruitment procedures were robust and ensured that appropriate checks were carried out before new staff commenced employment. There were sufficient qualified, skilled and experienced staff to meet people’s needs. Staff received a thorough induction and on-going training to ensure they had up to date knowledge and skills to provide the right support and care to people. Members of staff also received regular supervision and annual appraisals.

Staff had received training in how to recognise and report abuse. All staff were clear about how to report concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

People who lived at the home and their relatives said they were confident that any issues or concerns they raised would be responded to appropriately by the registered manager or the registered provider.

We saw that there was an open and honest culture within the service and staff confirmed this. Staff said that the registered manager was approachable and caring. People and relatives made positive comments about the registered manager, which included “she is lovely” and “she really cares about the people living here”.

There were effective systems in place to monitor the quality of the service people received. The views of peopl

We inspected Thomas House to determine whether the provider had complied with a warning notice for the administration of medication and compliance actions made at the previous inspection visit on 07 June 2013.

At the last inspection we found assessment and care planning documentation did not contain all the information staff required, which placed people at risk of unsafe or inappropriate care. As a result of this we had issued a compliance action. We found these concerns had been addressed and the care documentation we reviewed was reflective of people’s care needs. We also found the provider had plans in place to improve the effectiveness of the quality assurance of care within the home.

We checked the medicines administration records for ten out of the 26 people living in the home and spoke with four of them about their medicines. Comments about the way medicines were managed in the home were positive and nobody raised any concerns. One person said ‘’Staff are very, very kind’’, another said ‘’no problems with my medicines I think they give them to me okay.’’ A third person told us ‘’staff are lovely they help me with my medicines and make sure I have enough.’’ Overall we found improvements had been made since our last visit and medicines were safely handled.

People living in the home told us they were cared for very well. Staff were helpful and kind. All the staff knew what they wanted and treated them well. They were supported to access other health and social care services they needed. Comments such as, “They’re lovely”, “Very good”, “Always helpful” and “A bit of fun” were made. Staff were also described as “friendly and approachable” and “really nice”.

People told us there were no rigid routines they were expected to follow such as the time they went to bed. They usually pleased themselves what they wanted to do. Staff took into account their views and respected their right to privacy and independence. They always knocked on their door and waited to be invited in. They could have visitors when they wanted and staff made them very welcome.

People said staff were respectful when they spoke to them. They responded to all requests for assistance in a timely manner. They said they got the help they needed and described staff as "excellent" and "very nice". One person told us, "I don’t bother them much, but if I need help I can use my bell and they come.”

People told us they were confident to raise issues of concern with the manager if ever the need arose. There were arrangements in place to safeguard people and staff had been trained in adult protection.

People said they lived in a clean and tidy environment. They told us they liked their bedrooms and were able to furnish them with their own belongings and possessions. Some people said it would be nice to have a lock on their door. Staff always knocked before they came in, but they could not lock their bedroom doors.

People told us they had regular chats with the staff and had meetings. They could discuss anything they wanted with the manager. They were very pleased with all their care and support they received and were very happy living in the home.

We had previously visited Thomas House in January 2013. At that time we raised concerns about the management and administration of medication and the effectiveness of the quality assurance systems in place. At this inspection we found those concerns had not been addressed. In addition, we found assessment and care planning documentation did not contain all the information staff required, which placed people at risk of unsafe or inappropriate care.

We spoke with four people who were able to tell us about their views and experiences of living at Thomas House. People told us they were satisfied with the care and support provided to them and that they were treated with dignity and respect. One person said, “The staff are great and very caring.” People told us the food was enjoyable and that their food preferences were always taken into account.

We spent time with people in the dining room while lunch was being served. The atmosphere was calm and relaxed and people were given plenty of time to eat their meals. We observed positive interactions between people who lived in the home and members of staff. People told us they enjoyed the food and there were choices available. We found each of the three people on the table had chosen a different meal. One person said, “The food here is always good and you always get something you like.”

We asked three people who lived in the home about what they would do if they had any concerns or wanted to make a complaint. All said they would speak to the manager. One person said, “If I have any concerns I would go and see the manager Barbara. She always makes sure everything is okay.” We also spoke with a visitor who had come to see their relative. They told us about a concern they had raised and how it had been managed by the home. They were very satisfied that their concern was listened to and promptly addressed by the manager.