This inspection took place on 12 October 2018 and was unannounced.

Thompson Court is a ‘care home.’ 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. The care home can accommodate up to 37 older people and older people living with dementia in one purpose built building, divided into four units. Accommodation is provided on one level. Thompson Court provides rehabilitation, assessment and emergency respite care although five people were receiving long term care. On the day of inspection there were 23 people receiving care and support and one of the units was closed for refurbishment.

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.

Staff were being recruited safely and there were enough staff to take care of people and to keep the home clean. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff were supported by the registered manager and were receiving formal supervision where they could discuss their ongoing development needs.

People who used the service and their relatives told us staff were helpful, attentive and kind. We saw people were treated with respect and compassion.

Care plans were up to date and detailed what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. People felt safe at the home and appropriate referrals were being made to the safeguarding team when this had been necessary.

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’s healthcare needs were being met and medicines were being stored and managed safely.

Staff knew about people’s dietary needs and preferences. People told us there was a reasonable choice of meals and said the food was generally good. The registered manager was working to improve food choice and appearance. There were plenty of drinks and snacks available for people in between meals.

Activities were on offer to keep people occupied both on a group and individual basis. Visitors were made to feel welcome.

The home was spacious, well decorated, clean and tidy. A programme of refurbishment was underway, planned with attention to people’s needs and reference to good practice guidelines.

The complaints procedure was displayed. Records showed complaints received had been dealt with appropriately.

People and staff praised the registered manager and said they were approachable and supportive. The provider had effective systems in place to monitor the quality of care provided and where issues were identified they took action to make improvements.

We found all the fundamental standards were being met. Further information is in the detailed findings below.

Our inspection of Thompson Court took place on 26 September 2017 and was unannounced. At the last inspection, the service was rated as 'requires improvement' with no breaches of regulations.

Thompson Court is a purpose built facility providing rehabilitation, assessment and respite care to a maximum of 37 people requiring support without nursing. They are supported by the GP surgery which is in an attached building and district nurses. Physiotherapy and occupational therapy was available to those people in the rehabilitation unit. At the time of our inspection, there were 26 people living at the service.

A new registered manager had commenced employment at the service approximately one month before the 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.

Although safeguarding policies and procedures were in place, we saw safeguarding incidents were not always reported to the local authority or the Commission. Staff knowledge of safeguarding reporting was varied. Incidents and accident reporting was in place although more evidence of actions taken needed to be present.

Appropriate risk assessments were mostly in place and reviewed. However, we saw one person had recently been admitted with a number of allergies. There was no risk assessment in the person's care records although the cook had been notified about these.

The premises was clean and a planned programme of refurbishment was underway. Gloves and aprons were readily available and seen to be used by staff when providing personal care.

Staffing levels were sufficient to keep people who used the service safe and staff had time to spend quality time with people. Staff recruitment was mostly safe although photographic ID needed to be stored in staff records. Staff told us training was good and gave them the required skills to offer safe and effective support. The registered manager had plans to re-establish regular supervision and appraisal and we saw some of these had been completed already. Staff felt supported by the management team and regular staff meetings were in place.

Overall, we found medicines were safely managed. Medicines administration charts were well completed although further information about 'as required'(PRN) medicines was needed.

The service was compliant with the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, two staff we spoke with had limited understanding of MCA and DoLS. People's consent was sought regarding care and support.

People received a nutritionally balanced diet and were offered sufficient fluids to keep them hydrated.

People's health care needs were supported with access to a range of professionals including GPs, district nurses and physiotherapists. Appropriate equipment was in place to meet people's health care needs.

A complaints process was in place and people knew how to raise concerns.

Staff were kind, caring and supportive and knew people's care and support needs. We saw good interactions and that staff respected people's dignity and privacy.

Care records were detailed and regularly reviewed. The registered manager was working to make these more person centred and to reflect people's likes and dislikes. More evidence was needed of involving the person and/or their relatives. A large emphasis was placed on increasing people's independence as much as possible.

A good range of activities was on offer and people praised the work the activities co-ordinator carried out.

Complaints were documented and evidenced actions taken as a result.

The new registered manager was well respected by staff and people alike and had a programme of improvements underway. They were a

We inspected Thompson Court on 11 July 2016. The visit was unannounced.

The service had previously been inspected in August 2014 and was found to be compliant with all of the legal requirements inspected at that time.

Thompson Court offers respite, rehabilitation and long stay care for up to 37 people. At the time of the inspection there were 34 people using the service.

A registered manager was in place. 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 they felt safe at the service and able to speak with staff or the registered manager if they had any concerns. No-one we spoke with had any concerns on the day of our inspection. Staff understood how to keep people safe and what to do in an emergency situation. The service had robust safeguarding procedures and individual risk assessments were in place to keep people safe.

People and their relatives we spoke with told us they were happy with the service. They spoke particularly positively about the caring and kind attitude of the staff and how the service treated them as individuals, encouraging choice and independence. We saw many caring interactions during the course of the inspection.

Staff had a good understanding of the people they cared for, including likes, dislikes and individual preferences.

People’s needs were assessed and a range of appropriate care plans put in place. Staff understood people’s plans of care and how to meet their individual needs.

Improvements were needed to some medicine management practices such as ensuring medicines were signed for after being administered rather than beforehand.

Staff were safely recruited to help ensure they were of suitable character to work with vulnerable people.

Overall, there were generally sufficient numbers of staff deployed although the service needed to review the numbers of staff deployed at peak times to ensure levels consistently allowed for safe care and support.

Staff received a range of training which was kept up-to-date. Staff received supervisions and appraisals although these needed to be kept more up to date.

There was a range of activities on offer, according to people's choice.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act (MCA).

A range of audits and checks were undertaken by the service to monitor, identify issues and take action to resolve them. However, some issues were not always effectively addressed.

People who use the service, staff and healthcare professionals praised the registered manager and management team and said they could approach them with any concerns.

We saw evidence people’s views were sought to making positive changes in the service.

A complaints policy was in place and people had information about how to make a complaint in their bedrooms. Where a complaint had been raised, we saw the service had taken this seriously, taken appropriate actions and held meetings to discuss concerns with the people involved wherever possible.

During our inspection we looked for the answers to five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

Is the service safe?

We saw people were treated with respect and dignity by the staff. People that used the service told us they are treated in a respectful manner and they felt safe within the service. Systems were in place to make sure lessons were learnt from accidents in order to improve the safety of the service.

Is the service effective?

People’s needs were taken into account and the layout of the building was taken into account for the people that used the service. Specialist mobility and equipment needs had been taken into account and included in people’s plans of care.

Is the service caring?

We saw people were supported by kind and attentive staff. People told us they were not rushed and had their needs met while living at Thompson Court. People using the service and their relatives filled out a feedback questionnaire. Where shortfalls or concerns were raised these were addressed. People’s likes, dislikes and ambitions had been recorded and care and support was provided in accordance with their wishes.

Is the service responsive?

People told us they knew how to make a complaint if they were unhappy. We saw recordings of what action was taken and the outcome of complaints. People were asked if they were happy with the outcomes of any action taken. Regular audits were completed and when issues were brought to the services attention, action was taken.

Is the service well-led?

The service benefitted from a GP’s surgery next door, and a physiotherapist and occupational therapist on site. We saw evidence that when someone’s identified needs were changing, appropriate individuals were contacted and a joint way of working was started. Staff told us they were clear about their roles and responsibilities and were aware of the quality assurance systems within the home.

We talked to ten people who used the service, and observed how staff interacted with people whilst they provided support and care. People told us they were satisfied with the care and support they had received and the staff were helpful, approachable and always attended to them when they asked for support.

We found staff sought people’s agreement and people were provided with the opportunity to make decisions about their care and treatment.

Care and treatment needs were assessed and people had experienced care and support which had met their needs.

There were systems in place to ensure people received the medication they required safely and promptly.

Also Thompson Court had effective systems in place which identified assessed and managed the risks to the health, safety and welfare of people who used the service and others.

We spoke with seven people using the service, two were on respite care and the others were on the rehabilitation unit. They all told us they received good care whilst they were at Thompson Court and the staff were excellent. They told us they felt safe at Thompson Court and if they had any complaints they would speak to the Registered Manager.

Some of the comments people made were;

“It’s very nice here and the food is very good”

“I don’t mind coming in they always look after me but there is no place like home”.

“They always knock before they come in as well”.

“I ring when I am ready to get up and the staff come and help me”.