This was an unannounced inspection carried out on 7 March 2018. Our last inspection took place on 6 and 9 June 2017 when we found people received care which was not safe and well-led as there were continued breaches of regulation in relation to safe care and treatment, specifically in regard to the management of medicines. We rated the service overall inadequate and placed it into special measures. We carried out this inspection to check whether the necessary improvements had been made to the service. We saw some improvements had been made, although we continued to have concerns about the safe management of medicines.

Thomas Owen House is a care home which specialises in supporting people with mental health needs. It was registered with the Care Quality Commission in September 2010 to provide support for up to 35 people.

At the time of our inspection there was a registered manager in post. The registered manager told us they would be moving to a new ‘sister’ home operated by the same registered provider. Their successor, a nurse who had worked in the home for two years, was working through a handover period with the 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 management of medicines was not safe as storage arrangements were not sufficiently robust, people who regularly refused medicines did not have their health actively monitored, Some PRN protocols were not explicit and medication audits and nurses meeting minutes did not evidence actions identified had been followed up. Out of stock medicines were not always re-ordered in a timely way to replenish these items.

Complaints were responded to and the provider had recently carried out a survey. They were planning to share the results with people. . This meant there were opportunities to feedback about the service provided.

People were satisfied with the meals provided. Kitchen staff were aware of people’s specific dietary requirements and records reflected these needs. People were complimentary about the staff who provided their care and support. We saw people were enabled to live as independently as possible and they enjoyed an activities programme which was a strength of the service. We saw staff respected people’s routines as well as their privacy and dignity.

People felt safe living at Thomas Owen House. Recruitment processes were safe, although we recommended the registered provider adds a record of competency based questions to their interviews for nursing staff. Checks were made with the Nursing and Midwifery Council to ensure nursing staff were safe to practice.

Staffing levels were appropriate to meet the needs of people who lived at this service.

The recording of people’s capacity was decision specific and staff demonstrated a clear understanding around offering people choice, consent to care and people refusing care. Deprivation of Liberty Safeguards had been applied for where required and authorisations granted by the local authority were all in date.

People were supported to receive timely access to healthcare services. People felt staff were suitably trained and training records demonstrated showed training had been booked where any gaps existed. The only exception was End of Life Care which clinical staff had not received. The compliance manager responded to this on the day of inspection. Staff were supported through supervision, appraisals and staff meetings.

People’s equality, diversity and human rights were responded to by the registered provider as they were meeting their cultural and religious care needs. The registered provider worked in partnership with the local community.

Individual risks to people had been identified, assess and rev

This was an unannounced inspection carried out on 6 and 9 June 2017. Our last inspection took place on 11 February 2016 when we gave the service an overall rating of ‘Requires Improvement’. We found five breaches of the legal requirements in relation to the safe management of medicines, fit and proper persons employed, the assessment of mental capacity, lack of supervision for staff and good governance.

Thomas Owen House is a care home which specialises in supporting people with mental health needs. It was registered with the Care Quality Commission in September 2010 to provide support for up to 39 people.

At the time of our inspection there was 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.

At our two previous inspections, we found the registered provider had breached the regulations concerning the safe management of medicines. At this inspection we found medicines were still not safely managed as records showed people did not consistently receive their medicines as prescribed. Protocols for the use of ‘as and when required’ medicines were not always in place, room temperatures in the area where medicines were stored were found to be outside the recommended range and were not being recorded. Management oversight of medicines was insufficient as audits only checked stock held against recorded amounts.

The recording and understanding of people’s dietary needs was not consistent and sufficiently detailed. People told us they liked the food served and were given choice around what they wanted to eat. People were able to help set up and clear away for lunch.

The registered provider had reported all notifiable events to us, with the exception of one incident. Most risks to people had been identified, assessed and reviewed. Fire safety checks had been carried out and the registered provider was on target to be compliant with a compliance notice issued by the fire service following an inspection requested by the registered provider.

Recruitment practices were found to be safer at this inspection as relevant background checks had been carried out. People and their relatives felt they were safe living at this service. Staffing levels were found to be sufficient as there were enough suitably qualified staff, appropriately deployed in the service.

Staff received appropriate support through their induction and training programme. Staff had received regular supervision and appraisals which were found to be effective. The staff team worked well together and felt they were well supported by the management team.

Care plans were found to be person-centred and easy to follow. These were kept up-to-date with regular reviews capturing relevant information. People’s equality, diversity and human rights were maintained as people were supported with, for example, their religious needs. The privacy and dignity of people living in the home was respected by the staff team.

Staff demonstrated a sound knowledge of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). We saw sufficient recording of people’s capacity and DoLS applications and authorisations were in place where needed.

Staff knew the people they cared for well and were able to describe their care needs and preferences. Interactions between staff and people were found to be positive through the inspection. People were supported to regularly access the local community for a variety of events. We saw evidence which showed people had access to a range of healthcare professionals.

Not all audits completed by the registered provider were sufficient in ensuring compliance with the regulations. Not all breaches identified at our last inspection had bee

The inspection took place on 11 February 2016 and was unannounced. The service was last inspected during January 2015, at which time we found that there was a breach of Regulation 13 management of medicines of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that the service had not made the necessary improvements to meet this regulation.

Thomas Owen House provides nursing care and support for up to 39 adults with mental health needs and/or a physical disability. There were 34 people living at the home at the time of the inspection. Accommodation is provided mainly in single rooms with one double occupancy room. There are a variety of communal areas, including a dining area and several lounges, a hairdressing room, a kitchen, a laundry and bathrooms. There is also access to gardens and paved areas.

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.

People told us that they felt safe living at the home, and staff had a good understanding of how to safeguard people from harm.

There were risk assessments in place for identified and perceived risks. Some risk assessments were good, however they were not always effective as the information used to create them was incorrect.

There were personal emergency evacuation plans in place for everyone who lived at the home, and the safety checks were in place and current.

There were enough staff to meet people’s needs safely. There were some concerns about the pre-employment checks which had been carried out for some staff. This was a breach of regulation 19 (2) (a) fit and proper persons employed of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Medicines were not always managed safely. This was a breach at our last inspection and the provider had not made all the necessary improvements to meet the regulation. This was a breach of Regulation 12 (2) (g) safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff had undertaken a full induction and were regularly refreshed on their training. There was a wide range of additional training available which staff were accessing.

Staff were not receiving regular supervision or appraisals. Some staff had not received any supervision during 2015 or 2016. This was a breach of Regulation 18 (2) (a) Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were appropriate Deprivation of Liberty Safeguards in place; however the mental capacity assessments which had been carried out were inconsistent and incomplete in some cases.

The registered provider had not sought or gained consent from people who lived at the home for personal care, this had not been sought on their behalf and we did not see best interest decisions to show they were unable to give their consent.

This is a breach of Regulation 11 (1) Consent of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People enjoyed the food they were served and told us they had plenty to eat and drink.

Most of the staff interactions we saw were kind and caring, although there were some staff who were detached and did not interact with the people they were supporting.

People’s bedrooms were nicely decorated and personalised with their own belongings.

Some of the people who lived at the home were not supported with their grooming needs, with unclean hair, holes in their clothing and food stains on their clothing.

Care plans were in some cases detailed and comprehensive; however this was not consistently the case. The care files were disorganised and information was difficult to find. Reviews were not

This inspection took place on 6 January 2015 and was unannounced. At the last inspection on 10 & 14 July 2014 enforcement action was taken due to breaches in regulations which related to safeguarding, supporting staff and quality assurance. There were six other breaches in regulation which related to respecting and involving people, care and welfare, consent, nutrition, safety and suitability of the premises and complaints. The provider sent us an action plan which showed improvements would be made by the end of November 2014. At this inspection we found improvements had been made to meet the relevant requirements.

Thomas Owen House provides nursing care for up to 39 adults with mental health needs and/or a physical disability. There were 35 people living at the home when we visited. Accommodation is provided in single bedrooms, although there is one shared room for two people. There is a variety of communal lounge and dining areas, a hairdressing room, a kitchen, laundry and bathrooms. There are gardens to the rear of the property.

The home did not have a registered manager. The registered manager left following the inspection in July 2014. A new manager had been appointed in December 2014 who was in the process of applying for registration with the Care Quality Commission. 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 found the change of management had resulted in improvements in the service which benefitted people who lived in the home. People told us they felt safe and we saw people had more freedom as staff promoted a positive approach to risk taking and used distraction and intervention techniques to manage any behaviour that challenged.

Staff understood the legal requirements relating to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). DoLS were in place for four people and the provider was complying with the conditions applied to the authorisation.

People told us they were involved in decisions about their care and felt their views were listened to. Staff engaged with people at every opportunity and we observed people were comfortable and relaxed around staff. Care plans had improved and focussed on people’s individual needs. Some contained detailed information, although others needed updating.

Staff induction, training and supervision had improved and staff understood their roles and told us they felt better supported. There were enough staff to meet people’s needs and people told us they were able to participate in a wide variety of activities both in and outside the home. People said they enjoyed the food and now had a great choice at mealtimes.

Medicines were stored and administered to people safely, although we found the morning medicine round took over three hours which meant some people did not receive their medicines until late morning. We also found some controlled medicines had not been disposed of in a timely way and the competencies of staff in medicine administration had not been assessed.

We looked round the home and found the premises were clean and well maintained. Records we saw showed equipment was regularly serviced and environmental risk assessments had been completed.

Some quality assurance processes had been implemented, although they required further development to ensure that the improvements found at this inspection were sustained and enhanced to deliver high quality care to people.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan and in a way that was intended to ensure people's safety and welfare. Care plans were clear and easy to understand. People told us that staff were always available to them if they needed support and were anxious about anything. One said "no one ever says they don't have time". All service users were seen to be well dressed and clean.

There were effective systems in place to reduce the risk and spread of infection. As we walked around the home we noted the cleanliness in all the areas we visited which included bedrooms and bathrooms.

We saw medicines correctly stored, sensitively given to service users, and recorded accurately.

We inspected the suitability of the premises and whilst some shortfalls were noted the manager assured us that corrective action would be taken.

We observed that people were cared for in an unhurried and carring way which suggested that adequate staff were available. Staff we spoke with confirmed our observational findings. Staff told us they had all progressed through a period of induction at the commencement of their employment. We saw that staff undertook a range of training courses to increase their knowledge and skills.

We carried out an additional inspection due to concerns we had regarding the lack of supervision and appraisal. Inspection of that outcome showed that the regulation was not being met.

We looked at three sets of care records and spoke with four members of staff. The staff told us they had regular supervision, training and, felt supported by the manager. The care records we reviewed were up to date and information about the care provided was clearly documented.

We used a number of different methods to help us understand the experiences of people using the service because most of these people had complex needs which meant they were not able to tell us their views. We spoke with four people who use the service and two relatives. They all spoke highly of the care staff and were happy with the care they received.

People told us that they were involved in making decisions about their care. One person told us, “They never tell you to do anything; I was asked”. Two relatives whom we spoke with told us that the place was always clean and that their relatives were well looked after. They also told us that they were regularly informed about their relative's change in health status.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014. 

This was an unannounced inspection carried out on 10 and 14 July 2014. At the last inspection in November 2013 we found  a breach of legal requirements as staff were not properly supported through supervision and appraisal. An action plan was received from the provider which stated they would meet the legal requirements by 22 April 2014. At this inspection we found improvements had not been made with regard to this breach.

Thomas Owen House provides nursing care for up to 39 adults with mental health needs and/or a physical disability. There were 33 people living at the home when we visited.  Accommodation is provided in single bedrooms, although there is one shared room for two people. There is a variety of communal lounge and dining areas, a hairdressing room, a kitchen, laundry and bathrooms. There are gardens to the rear of the property.

The home has a registered manager.  A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us contradictory things about the service they received. While most people were happy, some were not. Our own observations and the records we looked at did not always reflect the positive comments some people had made.

People’s safety was being compromised in a number of areas. This included how well equipment and the building were maintained and how the balance between protection and freedom was managed. Staff were not always following the Mental Capacity Act 2005 for people who lacked capacity to make a decision. For example, the provider had not made an application under the Mental Capacity Act Deprivation of Liberty Safeguards for three people, even though their liberty had been restricted.

People told us there were enough staff to give them the support they needed and this was confirmed in our observations. While staff told us they had received induction and training, the records did not always reflect this.  There were no induction records for some staff and records showed many staff had not received refresher training. This meant people could not be confident staff had the skills to meet their needs. People enjoyed the food, but choice and independence in accessing food and drink was not promoted. People’s nutrition and hydration needs were not always being met.  People were not always receiving the health care support they required as their care was not planned or delivered consistently.

Although people spoke positively about staff, we found caring relationships varied between individual staff members, some of whom were warm, compassionate and caring in their approach.  In contrast, others did not engage with people or show empathy. 

We saw care was task orientated, rather than centred on people’s needs and preferences. There was a wide variety of group activities but no opportunities for people to pursue their own hobbies or go out independently. People we spoke with did not know how to make a complaint.

Leadership and management of the home was poor and there were no systems in place to effectively monitor the quality of the service or drive forward improvements. There had been a lack of action in addressing shortfalls identified at the previous inspection.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.