This inspection took place on 11 December 2017 and was unannounced.

This was the third comprehensive inspection carried out at Thorpe House Nursing Home.

Thorpe House Nursing Home 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 care home accommodates up to 50 people in one adapted building. On the day of our visit, there were 43 people using the service.

The service 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 and associated Regulations about how the service is run.

Following the last inspection in October 2016 we asked the provider to complete an action plan to show how they were going to become compliant with the regulations relating to staffing and person centred care. During this inspection we found that the action plans had been implemented and had driven improvements in all areas of care people received. There were enough staff deployed to meet people’s needs and care was provided in a person centred way.

The registered manager provided an open and learning culture which involved staff, people who used the service and their relatives to feedback about the service and have their comments responded to. The registered manager had used people’s experiences to analyse the quality of their care and had changed the way staff provided care and monitored the quality of the service closely.

Staff understood their roles and responsibilities to safeguard people from the risk of harm. Risk assessments were in place and were reviewed regularly; people received their care as planned to mitigate their assessed risks.

Staffing levels ensured people's care and support needs were safely met. Safe recruitment processes were in place. People received care from staff who had received training and support to carry out their roles. People were supported to have enough to eat and drink to maintain their health and well-being.

People were supported to access relevant health and social care professionals. There were systems in place to manage medicines in a safe way.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff demonstrated an understanding of the Mental Capacity Act, 2005 (MCA). Staff gained people's consent before providing personal care. People were involved in the planning of their care which was person centred and updated regularly.

People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff. Staff had a good understanding of people's needs and preferences.

People were listened to, their views were acknowledged and acted upon, and care and support was delivered in the way that people chose and preferred.

People using the service and their relatives knew how to raise a concern or make a complaint. There was a complaints system in place and people were confident that any complaints would be responded to appropriately.

We made a recommendation that the provider seeks advice on how to improve communication with people who have a sensory loss.

We carried out our inspection visit on 13 October 2016. The inspection was unannounced.

The service provided nursing care for up to 50 older people living with dementia and similar health conditions. At the time of our inspection there were 47 people using the service. Some of the people that used the service had advanced levels of dementia.

The service 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 felt safe living at Thorpe House. The provider had systems in place for reporting and investigating accidents and incidents. Staff were aware of and practiced the provider’s protocols of reporting incidents of concern. However, they demonstrated a varied understanding of what may constitute of abuse or avoidable harm to people.

There were not enough staff to meet people’s needs. People that used the service, their relatives and the staff that supported them expressed concerns that the staffing levels did not meet people’s needs. Following our visit, the registered manager informed us that they had reviewed their staffing levels and support people required and had increased the number of staff on duty during the day shifts.

People were supported to have their medicines as prescribed by their doctor. Trained nurses supported them with this task.

Staff had access to an induction and training programme to support them to gain the skills they required to fulfil their role. We found that staff had not all completed the training they required. Some staff did not feel they had the skills to support people with dementia. Following our visit, the registered manager informed us that they had arranged for staff to complete relevant training.

People’s liberty was not deprived unlawfully. This was because the provider had made applications to the local authority for DoLS authorisation for people that required this. The staff we spoke with demonstrated a good understanding of Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People did not receive the support that they required to meet their nutritional needs. Staff were not deployed in a way that met their needs at mealtimes.

People received the support that they required to meet their health needs. They had prompt access to healthcare services when they needed them.

Staff were kind and compassionate to people. They maintained positive relationships with the people they supported and treated them with dignity and respect. They provided the support that people needed to be involved in decisions about their care.

People’s care plans were comprehensive. Their relatives were involved in planning their care and support.

People were socially isolated. They were not supported to engage in meaningful activities. Following our visit, the registered manager informed us that they had appointed a member of staff to be responsible for supporting people with social activities and had advertised for an activity co-coordinator.

People had opportunities to provide feedback about the service they received. They told us that staff listened to them but some people felt they did not always use their feedback to bring about a better experience of care.

Staff felt supported by the registered manager to meet the standard expected of them. The registered manager was approachable and within easy access to staff and people.

You can see what action we have told the provider to take at the back of the full version of this report.

This inspection took place on 1 October 2014 and was unannounced.

At the last inspection on 30 August 2013 we found that the service was meeting with the regulations we looked at.

Thorpe House Nursing Homes provides accommodation and nursing care for up to 50 people with health conditions, physical and sensory needs including dementia. On the day of our visit there were 40 people living at the home. The accommodation was provided over two floors.

The service 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 and associated Regulations about how the service is run.

The home had a passenger lift that had been out of order since April 2014. Whilst the provider had taken appropriate action to minimise the risks to people and staff, this had impacted on the provider’s ability to meet some people’s needs fully. We found some concerns with regard to fire safety. We reported our concerns to the fire and rescue service.

Staff had received training on how to protect people who used the service from abuse or harm. They were aware of their role and responsibilities in keeping people as safe as possible.

People who used the service had received an assessment of their needs that identified any risks to them or others. Risk assessments informed staff of how to manage and minimise risks from occurring.

Staffing was determined by people’s assessed needs and the registered manager regularly reviewed staffing levels. People received their medicines as prescribed by their doctor. Medicines were stored and managed appropriately.

The provider supported staff by an induction and ongoing support, training and development. The Mental Capacity Act (MCA) is legislation that protects people who may lack capacity to consent to their care and treatment. We found some examples that the registered manager was following this legislation. However, MCA assessments and best interest decisions were not always fully recorded. Improvements were required to ensure people’s capacity to consent to specific decisions were assessed appropriately

People who used the service had their dietary and nutritional needs assessed and planned for. People received a choice of what to eat and drink that supported them to maintain their health. Plans of care were developed and reviewed regularly for changes. Referrals to health professionals were made in a timely manner and people received support to maintain their general day to day health.

Records used to monitor people’s health needs were not always fully completed. There was a need to improve recording to ensure that staff had the information they required to deliver safe care at all times.

People told us that staff were caring, compassionate and respectful. People who used the service including relatives, also said they were able to participate in discussions and decisions about the care and treatment provided. Information about advocacy and other sources of useful information was available for people.

The provider had quality monitoring procedures in place. We found concerns that the systems in place had not identified areas that required improvement.

People using the service told us they were satisfied with the support they received to manage their medication. A visiting relative also complimented the staff with regards to the care and treatment provided to their family member and said: “I’m very grateful that he’s well looked after here.”

The provider had taken steps to improve the medication administration records for medicines administered. The provider had implemented a robust system to regularly audit and monitor the management of medicines, which meant people were protected. All medicines were appropriately handled and arrangements were in place for ordering, storage and disposal of medicines.

We spoke with six people using the service, visiting relatives, friend, a health care professional and staff. We also made observations throughout our inspection visit. We reviewed four care records including medicines records and staff records.

People were complimentary about the meals and said there was always a choice of meals. People’s dietary needs were met because information about their preferences and dietary requirements were identified and reviewed on a regularly. Care plans were supported with risk assessments to ensure risks associated with eating and drinking were managed safely. One person said: “Wonderful meals, I had roast turkey today.”

Arrangements were in place for ordering, storage and disposal of medicines. People received their medication at the appropriate times. However, gaps were found the in the medication administration records for medicines administered. This showed staff did not follow procedures in relation to missing signatures and reporting omissions. Improvements were needed.

Staff were provided regular support, training and development for their job roles. There were formal arrangements were in place to ensure staff skill mix, knowledge and practice was kept up to date.

People were confident that their information was kept secure and up to date. Other records relating to the staff and the management of the service were kept up to date and stored securely. Staff were aware of their responsibilities to maintain accurate records.

People told us they were well cared for and supported. They felt staff were kind and helped them with their daily care and support needs. They said staff were available and helped them when required. Our observations showed staff were available and responded to people’s needs. Visiting relatives gave us mixed views about the whether there were sufficient numbers of staff on duty but said their family member’s needs were usually met.

The provider had reviewed the staffing levels and dependency level of the people using the service. The provision of appropriate gloves and aprons ensured staff met people’s care needs safely. Ongoing appointments of new staff to increase the staffing level and more robust monitoring of experienced, qualified and skilled staff ensured people’s needs were met.

People told us they were well cared for. People said they were treated with respect and involved to make sure their care and supports needs were provided in a manner that suited them. One person said: “The manager is very good; in fact everyone here works well together to look after us.”

People had a range of assessments and care plans in place that detailed the care and treatment they needed. Records showed people’s health and care needs were monitored and reviewed regularly. Medicines prescribed and were administered safely. Arrangements were in place to support people safely and to deal with foreseeable emergencies.

People were protected because there were effective staff recruitment and selection processes in place. Records showed appropriate checks were undertaken before staff began work.

Staffing levels were not sufficient to safely and promptly meet people’s increased care needs. This meant people had to wait longer or placed them at risk because staff were always not available. Improvements were needed.

The provider had an effective quality assurance system, which monitored the day to day running of the service. These included audits and checks on the environment, and the management and delivery of care, staff and health and safety. There were opportunities for people to comment about the service through review meetings, surveys and using the complaint procedure. One person said: There’s nothing to complain about.”

During our site visit to the home the people we spoke to told us they were satisfied with the service they received. They appreciated the welcoming and friendly environment and felt that the staff who worked there looked after them well.