Our inspection of Thompson Court took place on 26 September 2017 and was unannounced. At the last inspection, the service was rated as 'requires improvement' with no breaches of regulations. Thompson Court is a purpose built facility providing rehabilitation, assessment and respite care to a maximum of 37 people requiring support without nursing. They are supported by the GP surgery which is in an attached building and district nurses. Physiotherapy and occupational therapy was available to those people in the rehabilitation unit. At the time of our inspection, there were 26 people living at the service.
A new registered manager had commenced employment at the service approximately one month before the inspection. 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.
Although safeguarding policies and procedures were in place, we saw safeguarding incidents were not always reported to the local authority or the Commission. Staff knowledge of safeguarding reporting was varied. Incidents and accident reporting was in place although more evidence of actions taken needed to be present.
Appropriate risk assessments were mostly in place and reviewed. However, we saw one person had recently been admitted with a number of allergies. There was no risk assessment in the person's care records although the cook had been notified about these.
The premises was clean and a planned programme of refurbishment was underway. Gloves and aprons were readily available and seen to be used by staff when providing personal care.
Staffing levels were sufficient to keep people who used the service safe and staff had time to spend quality time with people. Staff recruitment was mostly safe although photographic ID needed to be stored in staff records. Staff told us training was good and gave them the required skills to offer safe and effective support. The registered manager had plans to re-establish regular supervision and appraisal and we saw some of these had been completed already. Staff felt supported by the management team and regular staff meetings were in place.
Overall, we found medicines were safely managed. Medicines administration charts were well completed although further information about 'as required'(PRN) medicines was needed.
The service was compliant with the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, two staff we spoke with had limited understanding of MCA and DoLS. People's consent was sought regarding care and support.
People received a nutritionally balanced diet and were offered sufficient fluids to keep them hydrated.
People's health care needs were supported with access to a range of professionals including GPs, district nurses and physiotherapists. Appropriate equipment was in place to meet people's health care needs.
A complaints process was in place and people knew how to raise concerns.
Staff were kind, caring and supportive and knew people's care and support needs. We saw good interactions and that staff respected people's dignity and privacy.
Care records were detailed and regularly reviewed. The registered manager was working to make these more person centred and to reflect people's likes and dislikes. More evidence was needed of involving the person and/or their relatives. A large emphasis was placed on increasing people's independence as much as possible.
A good range of activities was on offer and people praised the work the activities co-ordinator carried out.
Complaints were documented and evidenced actions taken as a result.
The new registered manager was well respected by staff and people alike and had a programme of improvements underway. They were a visible presence in the service and people knew who they were. There was a positive culture within the service.
A range of quality assurance and audit processes were in place to drive improvements within the service. However, these needed to be fully embedded with the improvements identified by the new registered manager.
Regular resident's meetings were held and actions seen to be taken as a result of concerns raised.