Thurleston Residential Home is a residential care home without nursing for up to 37 people, some of whom are living with dementia. At the time of our inspection 28 people were using the service. The accommodation in Thurleston Residential Home is over two floors and is set in a rural location, just outside Ipswich.

At the last inspection on 15 October 2015 the service was rated Good; at this inspection we found the service remained Good.

On the first day of our inspection there was no manager in post. The previous registered manager had left the week before our inspection, the new manager, who was the services’ deputy manager, was in post for the second day of our inspection. The new manager had initiated the first steps to become the registered manager of the service.

The people who lived in the service told us that they felt safe and well cared for. There were systems in place which provided guidance for care workers on how to safeguard the people who used the service from the potential risk of abuse. Staff understood their roles and responsibilities in keeping people safe. There were processes in place to ensure the safety of the people who used the service. These included risk assessments which identified how the risks to people were minimised. There were sufficient numbers of trained and well supported staff to keep people safe and to meet their needs. Where people required assistance to take their medicines there were arrangements in place to provide this support safely.

Both the manager and the staff understood their obligations under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager knew how to make a referral if required. 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.

People were supported to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and access healthcare services.

We saw many examples of positive and caring interactions between the staff and people living in the service. People were able to express their views and staff listened to what they said and took action to ensure their decisions were acted on. Staff protected people’s privacy and dignity.

People received care that was personalised and responsive to their needs. The service listened to people’s experiences, concerns and complaints. Staff took steps to investigate complaints and to make any changes needed.

The manager was supported by the organisation during the run up to them taking up their position as manager. People using the service and the staff they managed told us that the manager was open, supportive and had good management skills. There were systems in place to monitor the quality of service the organisation offered people.

Further information is in the detailed findings below

Thurleston Residential Home is registered to provide accommodation for 37 older people who require personal care. There were 30 people living in the service when we inspected on 15 October 2015. This was an unannounced inspection.

When we last inspected the service on 3 November 2014, we identified shortfalls in relation to care planning, support offered to support people to eat and drink sufficient amounts, quality monitoring and staffing levels. The provider wrote to us telling us what actions they intended to take in response to these concerns. At this inspection we found that the manager had implemented the identified actions and improvements had been made.

A registered manager was 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. Care plans were detailed and related to clear assessments of need, which identified each person’s individual needs. Care plans identified how these needs would be met. Care records were regularly reviewed and showed that the person had been involved. They included people’s preferences and individual needs so that staff had clear information on how to give people the support that they needed.

People had choices of food and drinks that supported their nutritional or health care needs and their personal preferences. Staff routinely ensured that people had access to food and drink and records were maintained demonstrating regular monitoring of people who presented at risk of malnutrition.

Staffing levels had been reassessed by the manager and additional staff had been recruited. Some staff had also left the service, however permanent staff had covered gaps in the rota and safe staffing levels had been maintained. We observed staff taking time with people and responding appropriately when people presented as requiring support or assistance.

Staff were knowledgeable about identifying abuse and how to report it to safeguard people. Recruitment procedures were thorough. Risk management plans were in place to support people to have as much independence as possible while keeping them safe. There were also processes in place to manage any risks in relation to the running of the service.

Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. People had support to access healthcare professionals.

People were supported by skilled staff who knew them well and were available in sufficient numbers to meet people's needs effectively. People’s dignity and privacy was respected and they were supported by friendly and caring staff, however some improvements are required in staff’s use of language and behaviours when assisting people with eating. People were supported to participate in suitable social activities.

Staff used their training effectively to support people. The manager and staff understood and complied with the requirements of the Mental Capacity Act 2005(MCA). The manager was aware of their role in relation to Deprivation of Liberty Safeguards (DoLS) and how to support people so as to ensure they were not placed at risk of being deprived of their liberty.

The provider had commissioned a quality monitoring report from a consultant with a background in health and social care regulation and the manager had a robust system of internal auditing of key areas to ensure oversight of the operation of the service.

The service was well led. People knew the manager and found them to be a strong presence in the service. People living and working there had opportunity to say how they felt about the service and the care it provided. Their views were listened to and actions were taken in response. The provider and registered manager had robust systems in place to check on the quality and safety of the service provided and to put actions plans in place where needed.

This was an unannounced inspection which took place on 3 November 2014.

Thurleston Residential Home is a care home which provides care and support for up to 37 older people, some of who may be living with dementia. There were 30 people living in the service on the day of our inspection.

The manager has applied to the Care Quality Commission to be registered and at the time of our inspection their application was being processed. 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.

Our previous inspection of the service took place on 28 July 2014 when we found concerns with care planning, how the service met people’s nutritional needs, staffing levels and how the provider assessed and monitored the quality of the service it provided. Following our inspection the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we saw that action had been taken.

Staffing levels had improved and people told us that there were sufficient staff available to meet people’s needs, but we found there was little resilience for times of increased demand, such as meal times, or in the case of unplanned staff absence.

People living in the service told us they liked living in there and felt safe. We saw that staff provided care in a respectful and kindly manner. Staff ensured peoples privacy and dignity was maintained.

The service offered some opportunities for people to participate in social activities and employed a part time person for this role, but the service did not help people to maintain any hobbies and interests they may have had prior to moving into the service. People told us they would like more to do. There was access to a front garden, but access to the gardens was limited particularly for people living with dementia.

The manager and senior staff told us they were working to improve the way the service was led with plans for including people in regular residents meetings and newsletters for people and staff.

As part of this inspection we spoke with four people who used the service, two visiting relatives, eight staff and the manager. We looked at five people's care records. We looked at records relating to the management of the service such as audits and surveys.

The registered manager had left the service prior to our inspection. There was an acting manager managing the service. They had not, as at the time of our inspection, applied to the Care Quality Commission to be registered as the manager.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

We saw that the service did not carry out assessments in accordance with the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that we could not be sure that people’s personal choice and liberty were safeguarded.

People's care records showed that care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare. Two people did not have a care plan. This meant that staff were not aware of the care to be provided to meet people's needs safely and effectively.

We spoke with the manager about the two people who did not have care plans in place. They assured us that these would be put in place the following day. We have since received copies of these care plans.

We saw that people’s medication was managed appropriately.

Is the service effective?

People told us that they did not always get the care they required and that staff were very busy. One person told us, “They just give you your dinner and go away.” People using the service and their relatives told us that the service was not always clean.

There was no formal system in place to ensure that staffing levels were decided based on people's needs and level of dependency.

The service did not carry out regular audits to monitor the standard of the service provided.

Is the service caring?

We saw that some staff interactions were kind and respectful. However, we noted that some were not. We saw one person taken from the dining room in their wheel-chair with no explanation of where they were going.

Is the service responsive?

We saw that there was a mix of male and female staff. However, care plans did not identify if a person preferred a male or female carer.

Care was provided in a task based and not person centred manner. Carers received a list of tasks at the beginning of their shift.

Is the service well-led?

Staff told us that when they raised concerns they did not feel that the management addressed them.

There was a lack of understanding of good quality assurance principles demonstrated by the lack of audits. This meant the service lacked any drive for improvement.

When we carried out our last inspection of this service on 19 November 2012, we found that they were not compliant in outcome 10 (regulation 15), the safety and suitability of the premises. We conducted this inspection to check that the service had taken action to become compliant with the regulation.

After our inspection the registered manager had sent us an action plan telling us what they were going to do to rectify our concerns. We found that they had carried out all of the actions they had proposed and that the service was compliant with regulation 15.

We did not talk to people who used the service on this occasion. When we visited the service in November 2012 the people living in the service that we spoke with told us that they liked living there, that the care staff showed them respect and worked hard to look after them. One person told us that they were comfortable in the service, saying that the staff were, “Always kind.” Another person said that the service was, “Clean and homely.”

We talked with seven of the people living in Thurleston Residential Home. They told us that they liked living there, that the care staff showed them respect and worked hard to look after them. One person told us that they were comfortable in the service, saying that the staff were, “Always kind.” Another person said that the service was, “Clean and homely.”

The people we spoke with told us that they were consulted about the care and support they were provided with and that the staff listened and acted on what they said. One person said that the staff, "Never rush me, I have to take my time." Another person told us, "They feed you to a fashion, but always plenty and it tastes good.”

We saw that staff received training to support them in caring for older people and when talking to them we found that they were knowledgeable about safeguarding adults. People told us that they felt safe living in the service.

People told us that they were comfortable living in the service and they told us that they had not needed to make a complaint.

The building was comfortable and mostly clean and, overall, the building was well maintained. However, we identified some areas within the premises that needed improvement to maintain people’s safety and wellbeing.

People told us that they liked living at Thurleston. Staff were friendly and helpful. The food was tasty, and they could choose how they spent their time.

People told us that they liked living at the service, that the care staff showed them respect and looked after them well. They also told us that they were comfortable. One person told us, "I have what I need, they do alright by me." Another person told us that they were happy with the service they received and that, "I wouldn’t want to be anywhere else now."

To help us assess people's wellbeing we spent time sitting with them, observing the care they received. We saw that staff were attentive and that they interacted with the people in a friendly, respectful and professional manner. We saw that staff sought people’s agreement before providing any support or assistance.

We saw that people were provided with suitable and nutritious food and drink and that, if they needed extra support to maintain their weight, people had been referred to the dietician and their advice was followed.

The building was comfortable, clean and well maintained. We saw that the service had taken precautions to protect people from the risk of Infection and that staff had received appropriate training in infection control.

We found that the staff received supervision and training necessary to effectively care for older people. We also saw that checks were made before they started to work in the service to ensure that they were suitable to work with vulnerable people.

The records we looked at, including people's care records and staff records were accurate and up to date.