Thameside is a residential care home for 61 people. On the day of our inspection, 61 people were living in the home. The home is divided into five areas with 12 to 14 people receiving care and support in each living area. Many people were living with dementia.

The inspection took place on 17 October 2018 and was unannounced.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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.

Why the service is rated Good.

Risks to people were routinely assessed with clear plans to keep people safe. Where incidents had occurred, staff responded appropriately and the provider analysed incidents. Staff understood their roles in safeguarding people from abuse. People's medicines were managed and administered safely. The provider had robust systems in place to reduce the risk of infection. There were enough staff to safely meet people's needs. The provider had carried out appropriate checks on staff to ensure that they were suitable for their roles.

People were 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 supported this practice.

People were supported to access the healthcare they needed and staff worked alongside relevant agencies to meet people's health needs. People received a thorough assessment before coming to live at the home and individual needs and choices were documented and met. People told us they enjoyed the food and it met their dietary needs. People were supported by staff that had received appropriate training to carry out their roles with confidence. The building was adapted to meet people’s needs.

People were supported by kind and caring staff that they got on well with. People were routinely involved in their care and staff offered people choices each day. People's privacy and dignity was respected by staff. People's cultural, spiritual and religious needs were catered for with access and links to a local church. Visitors were welcomed and encouraged to become involved in the care home through activities and care.

People had access to a range of activities' that reflected their interests. People's care was planned in a person-centred way. People's wishes regarding end of life care were documented. People were informed about how to raise a complaint and the provider regularly asked people for feedback.

Regular audits were undertaken to measure the quality of the care that people received. The provider regularly implemented improvements to the service. There was clear leadership at the home and staff told us that they felt supported by management. The provider had developed links with local organisations and agencies and people benefitted from these.

Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. The registered manager had informed the CQC of significant events including significant incidents and safeguarding concerns.

Further information is in the detailed findings below

Thameside provides care and accommodation for up to 61 people. On the day of our inspection, 57 people were living in the home. The home is divided into five with 12 people receiving care and support in each living area. Many people were living with dementia.

The inspection took place on the 3 February 2016 and was unannounced.

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.

People and their relatives gave positive feedback about the service they or their family member received. People were very happy. One person said “They look after me well.”

People told us care staff treated them properly and they felt safe. One person said; “The staff are kind, I feel safe.” We saw staff had written information about risks to people and how to manage these in order to keep people safe. One person had been assessed as being at risk of skin breakdown, we saw a skin risk action plan detailing actions for staff to undertake to minimise the risk to the person which detailed the appropriate pressure mattress settings, repositioning schedules, and reference to nutrition care plans to promote skin healing.

People were kept safe. Staff had received training in safeguarding adults and were able to tell us about the different types of abuse and signs a person may show if they were being harmed. Staff knew the procedures to follow to raise an alert should they have any concerns or suspect abuse may have occurred. One staff member said “I would go to the team leader if I had any concerns and that there was an on-line system to call if support was needed.” Another member of staff told us they would discuss anything with the manager and there was a whistleblowing Anchor line that could be used.

Incidents and accident were fully investigated by the registered manager, and actions put in place to reduce the risk to people of accidents happening again such as people falling.

People received their medicines as they were prescribed and when they needed them. Processes were in place in relation to the correct storage, disposal and auditing of people’s medicines. One person told us “That the staff adjusts the timing of medicines to fit in with outings away from the home.” They felt this supported them having a social life.

Care was provided to people by a sufficient number of staff who were appropriately trained and deployed. People did not have to wait to be assisted. One person said; “I am happy with everything, staff are good’.” Another person said “there are always plenty of staff around.”

Staff recruitment processes were robust and helped ensure the provider only employed suitable staff to care for people.

People and their families had been included in planning and agreeing to the care provided. We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided. Staff ensured people had access to healthcare professionals when needed.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When people lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).We checked whether the service was working

During our inspection of 3 May 2013 we identified some concerns in relation to the cleanliness of the home. For example, some areas of the home were not clean and there were some unpleasant odours. We also had some concerns about staffing levels. We judged that this had an impact on people’s care and welfare. For example, we noted that people did not have many opportunities to engage in social and leisure activities. We also noted that some people’s care records were not up to date.

During our inspection of 3 December 2013 we noted that the provider had made improvements within the home. We spoke with four people who lived at the home, two relatives and six staff members, which included the registered manager.

We found that the home was clean and the carpets and furniture had been cleaned. Some carpets and furniture had been replaced and there was a plan to replace the remaining carpets in the communal areas. One person told us “I have no concerns, it’s always clean.”

We saw that the provider had recruited additional staff and that there were more activities in place for people to take part in. People who used the service and their relatives told us they thought there were “Always staff around when you need them” and “There is usually something going on.” We saw that activities were available and people’s daily records confirmed that people attended these.

We looked at five people's care records and found that these were regularly reviewed and up to date.

During our visit we spoke to ten staff including the registered manager and the care manager. We spoke to five people who used the service as well as three relatives who were visiting that day.

Staff told us that they asked people for their consent before any treatment or care was carried out. People who used the service told us that staff asked them for consent most of the time.

Throughout our visit we saw that staff interacted with people with kindness and respect. Most people told us that the care they received was good. One person told us “I get very good care. I couldn’t ask for anything better”.

During our inspection we identified some concerns about cleanliness. For example. There was a strong, unpleasant odour in two of the living and communal areas.

We did a visual inspection of the home and saw that the premises were purpose built and equipment was mainly in good order and serviced regularly. For example, the passenger lift, fire extinguisher and hoist servicing had taken place.

Staffing levels were not sufficient to provide the care and activities people required. One person told us “You can’t get a member of staff when you want one. There aren’t enough staff”.

We saw that there was a complaint policy and staff told us they knew how to respond if they received a complaint. Most people told us that they felt confident that if they made a complaint it would be acted upon.

People told us that they were happy with the care and support they were receiving and that their needs were being met. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care.

Some people who use the service were unable to communicate and tell us what they thought of the quality of the care due to their communication difficulties. However through observation during the site visit we were able to observe staff supporting people who use the service in a respectful way and that staff took time to explain where possible the options available and supported them to make choices.

We had the opportunity to speak to a visiting Care Manager and District Nurse who commented on the service provided. In their opinion the quality of care was very good and they had no concerns, They felt staff were caring and treated people with respect and dignity.

Some people were aware that they had a care plan. They or people acting on their behalf had been involved in discussions and decisions regarding their care and support. Others could not recall whether they had active involvement in the care planning process however were satisfied with the way their needs were being met. They said staff were friendly and caring and responsive to their needs. They were satisfied with the quality of meals and had a wide choice of food.

People told us the home was always clean and housekeeping staff worked very hard. They felt safe because the home was secure. They were happy with the accommodation, appreciating in particular having an en-suite facility.

People who use the service confirmed that they were asked all about their care needs and how and when they wanted support before they came to live in the home. Once at the home they told us that staff continued to check with them that the care they provide is the support they want. One said that “staff don’t do everything, they get us to do what we can for ourselves”. Another said “I do have a care plan but I can change my mind and the staff don’t mind, you see sometimes I need more help than at other times”. People told us they had been very involved in the care and support they wanted to receive and were very happy with what staff do for them. One said that “staff always ask if its Ok to get you up, they don’t assume they can just walk in and start”

We spoke to a person’s relative who confirmed they had been included in the development of the care plan. They were very pleased with the care at the home which they visit everyday. They told us that the staff are kind and show a lot of patients with people who find communication difficult or who are severely limited by their mobility. The staff take every opportunity to offer choice. The relative told us that staff are always available for those with high care needs and that staff explain what they are doing or going to do while they are caring for each individual.

One person who uses the service did tell us that the unit she occupies had no staff cover after lunch the previous day. However once she pointed this out to staff this was rectified. The manager recorded this as complaint and investigated the situation straight away.

We spoke to six people about the meals they receive at the home. They all told us that the meals are very good and there is plenty of choice offered on the menu. The food is hot and well presented. Two said that they are asked for suggestions to go on the menu and the chef often comes to the unit to see if they are happy with the meal of the day.

People spoken to said that staff arrange transport and escorts if there relatives are not available to take them to hospital appointments. People told us that staff request the doctor if they are not well. District nurses come in to the home when needed

People who use the service and several relatives spoken to said that they have found the home to be clean but had noticed an unpleasant smell in some parts of the building. They said that staff work hard to keep the home clean and they had no real concerns about cleanliness.

People spoken to said that they are able to access different parts of the home via the lift. They can also easily access the grounds. Those spoken to felt the home is well designed and they liked having there own en-suite facilities.

People who use the service told us that they felt confident in the abilities of the staff who care for them. A relative said that when new staff start they are shown how to use the hoist their relative uses to facilitate them to be moved.

People using the service told us they thought there were sufficient staff on duty. If they ring their bell usually the staff responded within a reasonable amount of time. People told us they knew there were busy times of the day and it may take a little longer. Another person told us that the same few staff that usually provide their care, and they enjoy the chats they have and the way they know just what they want done.

People also confirmed they had been asked for their views about the service. They said they are also asked to make suggestions about what they would like to be changed or added to the service provided. People told us that they felt their personal information is confidential and that staff did not discuss other people personal information or condition.