Teme Court Residential Care Home

Temecare Limited – Teme Court Residential Care is a residential care home providing personal care to 16 people aged 65 and over at the time of the inspection, some of whom may be living with dementia. The provider can accommodate up to 21 people in one adapted building.

People’s experience of using this service and what we found

People and their relatives were happy with the care they received and felt safe because of the support provided by staff who knew their needs.

The provider had processes in place to protect people from avoidable harm and abuse. Staff were aware of their responsibilities in relation to this and were clear about the way to escalate any concerns they identified. Risks to people were identified using best practice tools and guidance, and care was planned so people’s safety was maintained.

The home environment was clean and tidy, and staff worked to reduce the risk of infection. When accidents or incidents occurred, learning was identified to reduce the risk of them happening again.

Staff were available to provide a timely response to people and provide safe care. People received

their medicines as prescribed and medicines were managed so people’s health needs were met.

People received an assessment before they moved into the home. Care plans reflected people's needs and were reviewed at set intervals or when a person's needs changed to ensure they reflected the latest care people needed.

Staff received training relevant to their roles and had regular supervision. People’s nutritional and health needs were promoted, and the home environment was maintained with ongoing improvements taking place.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People's ability to access information was assessed to ensure they had access to information relating to their care and consent to care was gained.

Staff were kind and caring. They respected people's privacy and dignity and supported people to be as independent as possible.

People received personalised care which promoted their preferences. Their care plans reflected their needs and staff understood people's needs. Ongoing action plans were in place to further improve people’s opportunities to recreational activities. Planned events took place to help people mark different times of the year.

People's wishes at the end of their lives were respected and staff worked with healthcare professionals to ensure people were pain free and comfortable.

The provider had processes in place to deal with people’s complaints should they arise. People and relatives were aware of how to raise any concerns and felt comfortable in doing so should they need to.

The registered manager worked in an open way with people, their relatives, staff and health and social care professionals to provide a good quality of life for people. There were clear leadership and people told us they could speak with staff, the registered manager, deputy manager or the provider if there were issues. Staff felt supported by the manager team and worked well as a team. Systems were in place to monitor the quality of the service and the care provided and actions were taken to continuously improve the service.

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

Rating at last inspection

The last rating for this service was requires improvement (published 31 January 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Temecare Limited - Teme Court Residential Care on our website at www.cqc.org.uk.

Teme Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Teme Court is registered to provide accommodation with personal care for up to 21 older people some of whom are living with dementia. The accommodation is split across two floors within one large adapted building. At the time of our inspection, there were 13 people living at the home.

At our previous inspection on 19 April and 16 May 2018, we rated the service as 'Inadequate,' and it was therefore placed in 'special measures.' We identified the provider continued to be in breach of five Regulations. These included the provider’s failure to maintain people's safety through strong recruitment practices and staff training. In addition, the provider had not made sure people were provided with care in a personalised way and the overall leadership and governance of the service was not effective to ensure people received high quality care.

We asked the provider to send us a report explaining the actions they were going to take to improve the service. We also imposed conditions on the provider's registration to which restricted the provider from admitting any other people into the home to live. We undertook this inspection to see whether the provider had made the required improvements.

At this inspection, the provider showed they had made sufficient improvements to the service and it was no longer rated as inadequate overall or in any of the key questions. Therefore, the service is no longer in 'special measures.' However, we found the work to improve the service was still ongoing and further time was required to evidence the improvements could be sustained in the longer term which we have reflected in the ratings.

There was no registered manager at the time of our inspection. However, the provider had recruited a new manager who would be registering with us. 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 provider and the management team had taken some steps to address and reduce the risks of infections from spreading. The improvements needed to be continued to further reduce the risks of infections particularly in communal toilet and shower rooms.

Ongoing improvements were being made to care records so these provided more detail about people, were accurate and documented the risks related to people's health and well-being. Further work was needed to ensure people’s care records consistently guided staff in providing personalised care.

Staff recruitment records had been checked since our last inspection. This was work in progress so the provider could assure themselves people’s safety was maintained because all staff were suitable to work with people who lived at the home.

Staff had now received access to training and support to meet the needs of people they cared for. The provider and management team were checking staff’s knowledge and practices to assure themselves people were provided with effective care and improvements were ongoing.

The provider was taking steps to create a dementia friendly environment. Improvement work needed to be continued so the home environment meets the needs of people who the provider had agreed to provide care for and any hazards were remedied.

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’s choices and decisions were now promoted but the documentation was not always clear to provide assurances that specific decisions were always made with people’s representatives who had the legal authority to do this.

We saw improved responses from staff when providing support to people living with dementia, and in respecting people's privacy. Staff had improved their practices in promoting people’s dignity and always respecting their choices.

People had more opportunities to have fun and interesting things to do. Staff were developing and improving the choices of recreational activities to ensure people’s interest and hobbies could be followed.

Staff were confident in recognising and reporting abuse. The management team were making improvements to the processes in place to record incidents and accidents so these were analysed so lessons could be learnt.

People needs were supported by sufficient numbers of staff who were available when people required assistance. Staff had more opportunities to discuss their work issues with management.

People were supported to remain healthy and well. The systems in place to support the provider and management team registered in monitoring medicines were mostly managed safely.

People’s mealtime experience had improved and people who were at risk of malnutrition or dehydration were getting support from staff to encourage them to eat and drink healthily.

The provider and their management team were improving their quality checks to make sure these supported people to receive safe, effective and responsive care. They had made a good start but time was needed to ensure the provider’s quality checks were effective and sustained over a period.

Further information is in the detailed findings below.

Teme Court accommodates 21 people in one adapted building. At the time of our inspection there were 14 people living at the home.

At the last comprehensive inspection on 24, 27 and 31 October 2017, we found breaches of Regulations 9, 12, 17, 18 and 19 of the Health and Social Care Act (Regulated Activities) Regulations 2014. We gave the provider an overall rating of Inadequate. The breaches related to the provider’s failure to ensure, people’s safety was maintained through robust recruitment practices and staff training. In addition, the provider had not made sure people’s care was consistently focused on each person and the provider’s quality checks had not assisted in people receiving high quality care. The provider sent us an action plan setting out the improvements they intended to make.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the provider had not shown significant improvement and is still rated as inadequate overall. Therefore, this service remains in Special Measures. As a result of our findings we took enforcement action which restricted the provider from admitting any other people into the home to live.

At the time of our inspection there was a manager in post who told us they had started the process of registering with us. 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.’

Following our last inspection the provider sent us an action plan, but at this inspection we found that all the actions identified had not been completed.

People’s care and risk management plans had not been updated to reflect people’s specific needs including any changes to these so people received consistent support to keep them safe. This was important as people relied upon staff to support them with their needs.

People’s individual needs were assessed alongside the arrangements to ensure there was sufficient staff on duty. However they did not always have sufficient time to consistently plan recreational activities. People had not been consistently supported with things to do for fun and interest as staff needed to firstly support people with their personal care. The manager had already identified this and was trying to recruit to the post of activities co-ordinator.

People were supported by staff who had not received training however the manager advised us staff would receive training and refresher training during May 2018.

Staff reported accidents and incidents to the office however; the management team did not review them to ensure appropriate action had been taken and to reduce the risk of incidents happening again. Risks to people were not fully considered and when incidents occurred action was not always taken. When people had behaviours that may challenge themselves and others all areas of risk had not been considered for these people. People were not safe as poor moving and handling was observed and the information in people's care plans was not always followed.

The provider had failed to ensure all staff working at the home had undergone a Disclosure and Barring Check {DBS] so could not be sure staff, were suitable to work at the home and keep people safe.

Environmental risks had not been addressed so people were at risk of falls over frayed and lifting carpets.

Staff did not always protect people from the risk of cross contamination due to not always using Personal Protective Equipment [PPE].

People liked the staff that cared for them; however people’s privacy and dignity was not always respected. People’s right to confidentiality was not always maintained, as personal information was left out in communal areas for anyone to read.

People's end of life wishes had not been considered and recorded in their care plans.

People and their relatives knew how to make a complaint.

There was a lack of consistency in how well the service was managed and led. Although staff told us they were well supported by the manager. However, during the inspection we found that management had not been effective at identifying quality and safety concerns or addressing them.

The provider had not taken steps to ensure the systems used to monitor and check the quality and safety of services provided were consistently effective and supported improvements.

The provider had failed to display their current inspection ratings, which is a legal requirement to show people had access to the ratings to inform their judgments about services.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We identified a number of continued breaches of regulation on this inspection. You can see what action we told the provider to take at the back of the full version of the report

We undertook a comprehensive inspection of this service on 24 May 2016. At that inspection the provider was rated good overall.

Following our inspection in May 2016 we received concerns in relation to how people were safely cared for. As a result we undertook an unannounced comprehensive inspection to look into those concerns on 24 and 27 October 2017. The inspection was carried out by two inspectors. On 31 October 2017 one inspector and an inspection manager returned to the home to have further discussions with the registered provider.

There was a manager in post but they had not yet applied to register with the Care Quality Commission. 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 provider had not checked staff's suitability to deliver care and support during the recruitment process. Staff had not received an induction and on-going training to carry out their role effectively. The manager had identified staff required further training to ensure they had the awareness and understanding to support people living at the home

Risks to people's health and safety were not always assessed and planned for. Some risk management plans had not been updated to reflect changes in people's needs to ensure people received consistent support to keep them safe. Improvements were needed in the storage management of medicines.

The provider had not taken actions to ensure people were supported safely and in an environment where they were not placed at risk. There was a culture of complacency where known risks were not reduced or monitored.

People did not consistently receive care that was individualised to their needs. People told us staff were kind and caring, but were so busy doing tasks they had little time to interact with them.

People did not always have interesting things to do on a regular basis. When people living at the home lacked stimulation. There were not dementia specific activities on offer.

The lack of quality auditing in the home had led to many risks to people’s safety not being identified and acted upon.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as longer be in special inadequate for any of the five key questions it will no measures.

There was 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.

People told us they felt safe living at the home. Staff understood their responsibilities to identify and report potential harm and abuse. They knew who to contact if they had any concerns for people’s well-being. The registered manager and provider regularly reviewed accidents and incidents to reduce the possibility of people being harmed. Staff knew the risks to people’s well-being and health, and worked with external organisations so people would receive the right care.

People, relatives and staff thought there was enough staff to care for people in a safe way and to meet their care needs. The registered manager had undertaken checks on the suitability of people who worked at the home, so people’s safety was promoted. Staff who administered people’s medicines had received training and checks were undertaken so the registered manager could be sure people were receiving their medicines in a safe way.

Staff had received training and support to develop their skills and knowledge, so they could provide care which met people’s needs. Staff showed a good understanding of the principles of the Mental Capacity Act, (2005) and applied their knowledge so people’s rights were protected. The registered manager had followed the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) where this was needed for people’s safety.

People were able to make choices about the food and drink they had. Staff knew what people’s individual dietary requirements were, and staff checked that people were eating and drinking enough so they would remain well.

People were cared for by staff that were caring and kind. Staff knew about people’s individual life histories and their preferences. Staff spent time chatting to people about things which interested them. Staff respected people’s dignity and privacy and made people’s visitor’s feel welcome at the home.

People and their relatives knew how to raise any concerns or complaints. The registered manager used feedback from people living at the home, so the care they received could be developed further. Where people had made suggestions these had been actioned.

The registered manager and the provider had developed systems to monitor the quality of the service people received. We saw action plans were developed for improving the home further for the benefit of the people living at the home.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We followed up on issues identified at our inspection in August 2013. The provider had re- assessed people's needs and had supplied sufficient staff to meet these needs.

The provider had also improved the cleanliness of the environment so that people lived in a more hygienic home. This meant that systems had been put in place to make sure that risks to people were reduced and ensured the service improved.

Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. There were no current applications in place at the time of our inspection. Staff told us that they had received training and provided examples that individual circumstances had been considered and applications had been made where appropriate. This meant that people would be safeguarded as required.

Records we saw had been reviewed and updated. These were kept securely to protect the information held about the people who lived at the home.

Is the service effective?

During our inspection we saw that staff asked people and gained their agreement before they gave care and support. One member of staff told us: 'I make sure they are happy for me to continue with care'. This meant that staff ensured people agreed to any provision of care before they carried it out.

We saw a mental health assessment had been made where one person did not have the capacity to make a specific decision. We saw that the provider had held a meeting to reach a decision about what was in the person's best interests. This meant that suitable arrangements were in place to obtain consent from people in relation to their care and treatment.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. A relative told us: 'We are comfortable with the home and feel that both (anonymised) are happy here'.

Staff we spoke with had a good knowledge of people's individual needs, and knew how to support people so that their needs were met. Staff spoke about people as individuals and we observed that staff listened to people's views and opinions.

Is the service responsive?

People attended a range of activities in the service and staff supported people to take part in these activities.

We saw the home had been responsive to people's changing needs and had responded to professional advice that had been provided. For example, we saw the home had requested a speech and language assessment for one person due to their changing needs. Appropriate support had been arranged to meet the person's needs until the assessment had been completed.

Is the service well-led?

The provider had a quality assurance system in place to look at the care people received and the home environment. For example, audits had been completed that looked at medicines, health and safety and care plans. We saw records that identified shortfalls and the actions that had been taken to address them. The provider listened and responded to people, staff and visitors who had left comments and suggestions.

Staff told us they were clear about their roles and responsibilities. Staff told us that they felt the home met people's care and welfare needs. They told us that the system in place meant they felt supported in their role and where to find information when needed. For example, there was information about each person for the staff to follow and they recorded the care provided.

We carried out this inspection to check that the provider had taken action and we found improvements had been made. We spoke with some of the people who lived at the home and with some of the staff on duty. We spoke with visiting relatives and with relatives on the telephone. We spoke with the provider and the manager.

We looked at care records for four people and other supporting documents for the service. Staff told us that: 'Things have improved here'.

The provider had systems in place to assess, monitor and review the service provided. Relatives told us about a meeting that had taken place following our last inspection. One person told us: 'We talked about the concerns we had and about the last report'.

We will carry out a further inspection of this service at a future date to ensure that improvements are maintained.

We were unable to hold meaningful conversations with the people who lived at Teme Court due to their dementia type illnesses. Two people who lived at the home however, told us they: 'Like the home, they are really good here' and they: 'Like the staff; they are very good'.

We found that people's plans of care had not been reviewed regularly to make sure people received the care they needed. The care and support people received had not always met their needs. We saw that staff were kind and caring in their approach to people who lived at the home. Staff told us they were aware of each person's needs and how they gave care and support to meet those needs. People told us they were: 'Happy' with the staff who worked at the home.

We found that people were not protected from the risk of cross infection because the hygiene and cleanliness of the home and the equipment used had not been fully maintained.

We found that there were not always enough staff on duty to meet the changing needs of the people who lived at the home.

We found that the provider had not monitored the quality of the service provided. Records had not been kept up to date when people's needs had changed. Policies and procedures had not been reviewed and updated.

People had care plans in place to give staff all the information they needed to help them give the care and support to meet each person's needs. A visiting relative told us they were: 'Very happy with the level of care given'.

A complaints procedure was in place and this was made accessible to people who used the service and their relatives or carers.

In this report the name of one registered manager appears who was not in post and not managing the regulatory activity at this location at the time of the inspection. Their name appears because they were still the registered manager on our register at the time.