About the service:

The Thatched House provides accommodation with personal care for people over age of 65. The service is registered to accommodate up to 20 people and was providing personal care to 19 people at the time of the inspection. Any nursing needs were provided by community nursing services.

People’s experience of using this service:

People received care and support that was safe. One person said, “I feel very safe living here, the staff support me well. They help me where I need help and encourage me to stay independent where I can.”

People were supported by staff who received training and were able to identify and respond appropriately to abuse. Risks to people were assessed, monitored and reviewed. There was a robust recruitment programme which meant all new staff were checked to ensure they were suitable to work with people. There were enough staff to support people with their daily living and activities.

People received effective care and support. One person said, “I think the staff do know what they are doing. They make sure I am offered drinks, and there is plenty of food. When I need my doctor, they make those arrangements.” Training and observation of staff practice as well as supervision ensured staff were competent in their roles. People enjoyed a healthy balanced and nutritious diet based on their preferences and health needs. 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 received care from staff who were kind and caring. One person said, “The staff are very caring. We are one big family. I like living here.” People told us staff always respected their privacy and dignity. Staff supported people to be fully involved in their care planning and reviews.

People received responsive care and support which was personalised to their individual needs. There was clear guidance for staff on how to support people in line with their personal wishes, likes and dislikes. Records showed the service responded to concerns and complaints and learnt from the issues raised.

People were supported by a team that was well led. Staff said the management team was open to suggestions and approachable. There were systems to monitor the quality of the service, ensure staff kept up to date with good practice and to seek people's views. The management team worked professionally with agencies outside of the service and ensured a transparent, honest and open approach to their work which was valued by others.

Rating at last inspection:

At the last inspection in March 2018 the service was rated Requires Improvement (report published on 23 May 2018). At that inspection we found three breaches of Regulations.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At this inspection the service has made enough improvements to be rated Good and the provider is no longer in breach of the Regulations.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

We inspected the service on 13 March 2018. The inspection was unannounced. The Thatched House 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 Thatched House is registered to provide accommodation and personal care for 20 older people, people who live with dementia and people who have physical/sensory adaptive needs. There were 19 people living in the service at the time of our inspection visit.

The service was run by a company who was the registered provider. The company had three directors. There were two registered managers in post both of whom were also directors of the company. 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. In this report when we speak about both the company and the registered managers we refer to them as being, ‘the registered persons’.

At the last comprehensive inspection on 4 December 2015 the overall rating of the service was, ‘Good’. However, there were three beaches of the regulations. This was because there were shortfalls in the arrangements made to safeguard people from situations in which they may experience abuse. Also, background checks on new care staff had not always been completed in the right way. Furthermore, people had not always been provided with safe care and treatment because medicines had not consistently been managed in line with national guidance.

After the inspection the registered persons told us that they had addressed each of the breaches. We completed a focused inspection on 15 December 2016 to confirm that the necessary improvements had been made. We found that suitable provision had been made to safeguard people from the risk of abuse and that recruitment checks were being completed in the right way. However, we found that further progress still needed to be made to ensure that people’s medicines were consistently managed in line with national guidance. As a result we said that there was a continuing breach of the regulations.

Although the overall rating of the service remained as being, ‘Good’, we told the registered persons to take action to make improvements to the management of medicines. At the present inspection we found that these particular improvements had been made. However, we also found that an additional improvement needed to be made to ensure that people’s medicines were consistently managed in the right way. There were also other shortfalls that had reduced the registered persons’ ability to provide people with safe care and treatment. This was because people were not fully protected from the risk of injury in the event of a fire safety emergency. In addition, suitable provision had not been made to prevent and control the risk of infection.

These shortfalls had reduced the registered persons’ ability to consistently provide people with safe care and treatment. Therefore, this was a continuing breach of the regulations.

There were two further breaches of the regulations. This was because there were shortfalls in the arrangements that had been made to ensure that people were consistently treated with respect and dignity including promoting their right to privacy. Also, the registered persons had not established robust systems and processes to assess, monitor and improve the quality and safety of the service.

You can see what action we have told the registered persons to take in relation to these breaches of the regulations at the end of the full version of this report.

Our other findings were as follows. People had not been fully safeguarded from the risk of fina

This focused inspection took place on 15 December 2016 and was an unannounced. At the last comprehensive inspection on 4 and 8 December 2015, the service was rated as Good overall; however, we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches of regulation related to safeguarding people from abuse or improper treatment, robust staff recruitment processes and safe management of medicines. The provider sent us an action plan on 18 February 2016, which stated how and when they would make improvements to meet the legal requirements. At this inspection, some improvements had been made but further action was still needed.

This report only covers our findings in relation to these specific area / breaches of regulation. This is within the 'Safe' domain. The other domains 'Effective', 'Caring', 'Responsive' and 'Well led' were not assessed at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Thatched House on our website at www.cqc.org.uk.

The inspection was prompted, in part, by notification of an unexpected death and potential concerns about how staff would respond to a medical emergency. We identified during the inspection that the provider had systems and procedures to guide and support staff on how to respond in an emergency and that staff understood their responsibilities in responding to medical and other emergencies.

The Thatched House is registered to provide accommodation for 20 people who may require nursing or personal care. At the time of this inspection, 18 people were living at the home, some of whom were living with dementia.

A registered manager was in post. The registered manager was also the owner and provider of the home. 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 Thatched House is a detached thatched building with a driveway, situated in a private avenue close to the seafront in Bognor Regis. Communal areas included a large lounge with a further two sitting rooms leading to a dining area with a spacious rear garden. Rooms were single and double occupancy

At this inspection, we found that although some improvements to the safe management of medicines had been made, the service remained in breach of this Regulation.. This was because Medication Administration Records (MAR) that were in place had not been correctly completed to demonstrate medicines had been given as prescribed.

The breach of regulation related to safeguarding people from abuse or improper treatment had now been met. There were signs that incidents of abuse between people had reduced and staff were more alert to what would be considered abusive under safeguarding and how to respond to this. People were protected from the risk of abuse, avoidable harm or discrimination because staff understood their roles and responsibilities in protecting them.

The breach of regulation related to staff recruitment processes had now been met. Recruitment documentation demonstrated that all necessary checks were being undertaken before staff were employed to ensure their suitability to support people.

Staffing levels ensured people received appropriate support in an unhurried and personalised way. Staffing levels were sufficient to meet people's individual needs.

Systems were in place to identify risks and protect people from harm. Risk assessments were in place and reviewed monthly. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to health professionals as required.

The service had good systems in place that appropriately identified and managed risks

This inspection took place on the 4 and 8 December 2015 and was unannounced.

The Thatched House is registered to provide accommodation for 20 people who may require nursing or personal care. At the time of this inspection 19 people were living at the home, some of whom were living with dementia.

A registered manager was in post. The registered manager was also the owner and provider of the home. 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 Thatched House is a detached thatched building with a driveway, situated in a private avenue close to the seafront in Bognor Regis. Communal areas included a large lounge with a further two sitting rooms leading to a dining area with a spacious rear garden. All rooms were single occupancy.

We found the home to be clean and tidy and maintained to a high standard. A calendar on the wall displayed the day and date in large letters to help orientate people. The home operated an open door policy. Many relatives and friends were visiting that day and gave their views on the care and support provided. People, relatives and visitors to the home were able to share very positive views on their experiences of the home. Staff spoke kindly and respectfully to people, involving them in all aspects of their care. Staff knew people well and had a caring approach. Staff demonstrated how they would implement the training they received. The food offered to people, relatives and visitors smelt and looked appetising. Additional drinks and snacks were offered in between meals and staff knew people’s preferences and choices of where and what they liked to eat.

During the inspection we found some aspects of care not to be safe. The registered manager had systems and processes in place to record all accidents and incidents. An incident of potential physical abuse had not been reported to the West Sussex Safeguarding team. Therefore the necessary measures had not always been taken to keep people safe. There were some gaps in pre-employment records for staff. Checks had not been undertaken to ensure that new staff were safe to care for adults at risk.

Staff administered medicines in a personalised and professional manner. The home used a monitored dosage system with a single box for each medicine round. However there were failings noted surrounding the management and the safe storage of medicines.

Some people did not have capacity to consent to their care and measures were in place to ensure decisions were made in people’s best interests.

An improvement plan was in place and was continuously being updated by the registered manager. An audit check system was being used which logged ‘spot check’ visits to monitor the care that was being provided. Any actions required were noted and filtered down to the staff team who then took the appropriate action.

We have identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.  You can see what action we have told this registered manager to take at the back of the report.