We carried out an unannounced comprehensive inspection of this service on 5 January 2018. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Thurston House on our website at www.cqc.org.uk”

We undertook an unannounced focused inspection of Thurston House on 18 June 2018. The team inspected the service against two of the five questions we ask about services: is the service well led and safe. This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Thurston 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.

Thurston House is registered to accommodate up to seven people. The service supports people with mental health needs and additional learning disabilities. The service is a three-storey house with bedrooms and communal living areas, in a residential area in Newport Pagnell. At the time of our inspection, seven people were receiving care.

At the last comprehensive inspection in January 2018 this service was rated requires improvement. At this inspection the service continues to be rated as requires improvement.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 premises was clean and windows had been replaced and fitted with window restrictors to ensure people’s safety. Some window restrictors required replacing to meet with the health and safety executive best practice guidance on window restrictors in care homes.

We have made a recommendation about seeking guidance for window restrictors in care homes.

Food hygiene practices had improved and records relating to the storage and disposal of foods kept in a fridge had been maintained.

Regular testing of the fire alarms and fire drills had taken place and records relating to fire safety were adequately maintained.

People were safeguarded from harm as the provider had effective systems in place to prevent, recognise and report concerns to the relevant authorities. Staff knew how to recognise harm and were knowledgeable about the steps they should take if they were concerned that someone may be at risk.

There were sufficient numbers of experienced staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person. Recruitment procedures protected people from receiving unsafe care from care staff unsuited to the role.

People were supported to take their medicines as prescribed. Medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

People were supported by a team of staff that had the managerial guidance and suppo

This inspection took place on 5 January 2018 and was unannounced.

Thurston 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.

Thurston House is registered to accommodate up to seven people. The service supports people with mental health needs and additional learning disabilities. The service is a three-storey house with bedrooms and communal living areas, in a residential area in Newport Pagnell. At the time of our inspection, seven people were receiving care.

At the last inspection in November 2015 this service was rated good. At this inspection the service is rated as requires improvement. This is the first time the service has been rated requires improvement.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Risks to people had not always been recognised and assessed. Window restrictors were not in place on the first and second floor of the building and window pulleys were broken.

The premises was not always adequately clean and maintained. A bathroom was unclean; the ceiling and walls contained mould. Food hygiene practices required improving and routine testing of the fire alarm system had not been undertaken as often as required.

People’s privacy and dignity was not always protected and confidential information was not kept securely. We have made a recommendation about keeping records confidential.

Audits in place to monitor the quality and safety of the service were not effective and the registered manager and provider lacked oversight of the service.

There was enough staff to meet people’s needs and safe recruitment procedures were followed. There were safe systems in place for the management of medicines and accidents and incidents had been recorded an investigated appropriately.

Care plans contained information about peoples assessed needs and their preferences and people and their relatives were asked for feedback on improving the service.

People's health and well-being was monitored by staff and they were supported to access health professionals. People were supported to have sufficient amounts to eat and drink to maintain a balanced diet.

All staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and had applied that knowledge appropriately.

Staff understood the importance of obtaining people’s consent when supporting them with their daily living needs.

The service had a complaints procedure in place. This ensured people and their families were able to provide feedback about their care and to help the service make improvements where required. The people we spoke with knew how to use it.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with two people who used the service. One person told us that they enjoyed going shopping and that they did not require staff support. Another person told us that they played for a local learning disabilities football team and the staff supported them to get to the training ground and back.

We found that people were supported to live as independently as possible and were encouraged to complete activities they enjoyed. We looked at how people were supported to receive services by other providers, for example, visiting the dentist and found that adequate arrangements were in place. We looked at the checks that were made on staff and the staffing levels for each shift and we did not identify any concerns. We also looked at how complaints were handled and found that suitable arrangements were in place.

There were only two people in residence when we inspected. We met and spoke with one person who was happy for us to view their bedroom. They told us they liked the staff and got on well with them. They also said they were happy at Thurston House and they confirmed that they had received the support and encouragement they needed from staff. The second person chose to remain in their room and cheerfully declined the opportunity to meet and talk with us.

We found the staff at Thurston House were knowledgeable of the needs and abilities of the two people living there. They respected each person's choices and encouraged and enabled them to participate in meaningful community activities that they enjoyed.

The inspection took place on 29 September and 1 October 2015 and was unannounced. The service is based in Newport Pagnell High Street within close proximity of a variety of shops and amenities. The service provides care for up to seven people who have learning disabilities. At the time of the inspection seven people were using the service.

The service had 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.

The staff had a good understanding of what constituted abuse and of the safeguarding procedures to follow should they need to report any abuse.

Risks were appropriately managed to ensure that people were supported to make choices and take risks.

Staff had been recruited following safe and robust procedures and there were sufficient numbers of suitable staff available to keep people safe and meet their needs.

Systems were in place to monitor accidents and incidents so that preventative action could be taken to reduce the number of occurrences.

Robust arrangements were in place for the safe administration and management of medicines.

Staff had the skills and knowledge needed to support people appropriately and had regular training updates to maintain their skills. A programme of staff supervision and annual appraisals enabled the staff to reflect on their work practice and plan their learning and development needs.

People’s consent was sought before providing their care and treatment. People who lacked capacity to make decisions were supported following the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People benefitted from having a balanced and varied diet. Their dietary needs were monitored and advice was sought from appropriate health professionals when needed.

People had regular access to healthcare professionals and were supported to attend health appointments.

The staff treated people with kindness and compassion, dignity and respect.

People had individualised and detailed care plans in place, which reflected their needs and choices on how they wanted their care and support to be provided.

Social, leisure and purposeful activities were provided for people to meet their individual needs and aspirations.

People and their representatives were encouraged to provide feedback on the service; complaints were taken seriously and responded to immediately.

We received positive feedback from health and social care professionals involved in monitoring people’s care at the service.

The service was led by a registered manager who continually strived to provide good quality care. The vision and values were person-centred. People and their representatives were supported to be involved and in control of their care.

Effective management systems were in place to continually monitor the quality of the care.