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Inspection carried out on 26 March 2019

During a routine inspection

About the service: Templemore Care Home is a care home providing accommodation and personal care to a maximum of 65 people aged 65 and over. At the time of the inspection 63 people were living at the service.

People’s experience of using this service:

People experienced good care however they did not always receive timely support and had to wait to have their care needs met.

People and their relatives told us they felt safe at the home.

Potential risks to people’s health and welfare were assessed and effectively monitored.

Safe staff recruitment practices were followed.

Medicines were safely managed.

Staff received appropriate training and supervision to perform their roles.

Mental capacity assessments were completed, and any best interests’ decisions were made with the involvement of people’s representatives and relevant health care professionals.

A variety of nutritious meals were provided, and people were able to eat, and drink sufficient amounts.

People’s care was personalised to meet their individual needs. Their diversity, cultural and religious needs were promoted and respected.

People’s privacy and dignity was maintained.

Positive caring relationships had been developed between people and the staff team.

People and their relatives were involved in all aspects of care planning where appropriate.

People had opportunities to take part in activities that were of interest to them.

The provider operated an open and transparent culture with a focus on responding to people’s individual needs.

Systems were in place for people to raise any concerns or complaints.

Systems were in place for people, their relatives and staff to provide feedback and influence service development.

Robust quality monitoring systems and processes were followed and action was taken to make improvements.

The provider, registered manager and staff team worked well with professionals and external organisations. They effectively used good practice guidance to enhance people’s quality of life.

The registered manager maintained excellent community links with the general public, local schools and a children’s nursery, and participated in community events.

Rating at last inspection: Last comprehensive inspection rated Requires Improvement (published 28 March 2018). Focussed inspection changed overall rating to Good (published 7 September 2018).

Why we inspected: This was a planned inspection based on the rating at the last comprehensive inspection.

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

Inspection carried out on 8 August 2018

During an inspection looking at part of the service

On 12 February 2018 we completed an unannounced comprehensive inspection and found a breach of the legal requirements. After the inspection, the provider sent us an action plan to show what they would do to meet the legal requirements in relation to the breach.

Following that inspection we received concerns about an incident in which one person sustained serious injuries. We also received concerns about the staffing levels. As a result, on 8 and 13 August 2018 we undertook a focused inspection to consider those concerns and to check that the provider had followed their action plan and to consider if the service now met legal requirements.

The team inspected the service against two of the five questions we ask about services: is the service well led and is the service safe.

This report only covers our findings in relation to the concerns and the requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Templemore Care Home) on our website at www.cqc.org.uk.

Templemore 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.

Templemore Care Home accommodates up to 65 people in one adapted building split across three separate units, each of which have separate adapted facilities. Two of the units specialise in providing care to people living with dementia. At the time of this inspection the home had 58 people living there.

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.

At our last inspection in February 2018 we rated the home as ‘requires improvement’ and found that there had been a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Staffing. The provider had failed to ensure suitable numbers of staff were deployed to meet people's needs at peak times of day. At this inspection we found that improvements had been made, and we were satisfied that the home was no longer in breach of this regulation. However, further improvements were required to ensure that staff were effectively deployed across the service. This was to ensure safe care was being provided to meet individual’s needs and to enhance people’s mealtime experiences.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. Risk assessments were in place to manage potential risks within people’s lives.

Statutory notifications were submitted by the registered manager. Investigations evidenced learning from incidents and changes to practice.

The provider had quality assurance systems in place to review the quality of the service and took action to make improvements where required. People and staff had opportunities to provide their feedback and this was fully considered and acted upon.

Inspection carried out on 12 February 2018

During a routine inspection

This inspection took place on 12 February 2018 and was unannounced.

Templemore 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 service supports older people, including those living with dementia. Templemore Care Home offers long-term residential care, short stays and respite breaks. The service accommodates 65 people across three separate units, each of which have separate adapted facilities. Two of the units specialise in providing care to people living with dementia and one is for people requiring residential care. At the time of our inspection, 61 people were using the service.

At the last inspection in November 2015, this service was rated as good. At this inspection, the service has been rated as requires improvement. This was because we found that staffing levels were not always sufficient to meet people’s needs at peak times of the day.

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 service was not able to demonstrate that staffing levels were sufficient to meet people's needs. People did not always receive the support they needed to eat their meals and there was a lack of staff presence for long periods in communal areas. Staff were often rushed and were focused on tasks rather than individuals.

Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse. People had risk assessments in place to cover any risks that were present within their lives, but also enable them to be as independent as possible. All the staff we spoke with were confident that the registered manager would follow up any concerns they raised appropriately. The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

People received their medicines safely and as prescribed. There were systems in place to ensure the premises were kept clean and hygienic so that people were protected by the prevention and control of infection. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

People’s care needs were assessed and their care provided in line with up to date guidance and best practice. Staff received an induction process when they first commenced work at the service and in addition received on-going training to ensure they were able to provide care based on current practice when supporting people.

People received enough to eat and drink and had a choice of meals and snacks. People were supported by staff to use and access a variety of other services and social care professionals. The staff had a good knowledge of other services available to people and we saw these had been involved with supporting people using the service. People were supported to access health appointments when required to make sure they received continuing healthcare to meet their needs.

People’s diverse needs were met by the adaptation, design and decoration of premises and they were involved in decisions about the environment. Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA) and they gained people's consent before providing personal care.

People developed positive relationships with the staff who were caring and treated people with respect, kindness and courtesy. People were encouraged to make decisions about how their care was provided staff had a good under

Inspection carried out on 7 November 2016

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on December 2015 and rated the service as overall good.

The Commission carried out a focused inspection on 7 November 2016, this inspection sought to look at the improvements that had been made following the coroner’s report on preventing future deaths. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Templemore Care Home on our website at www.cqc.org.uk

This service is registered to provide accommodation and personal care for up to 64 people; at the time of our inspection there were 63 people living in the home.

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.

Care records contained risk assessments to protect people from identified risks and helped to keep them safe. They gave information for staff on the identified risk and informed staff of the measures to take to minimise any risks.

Staff were able to monitor people’s health and detect signs of early infections which resulted in quicker treatment for people and also reduced the risk of falls.

People’s needs were assessed before they came to the home to ensure the service could meet their needs. Care plans and risk assessments were in place which identified people’s mobility needs and risk of falls as soon as the person moved in to the home.

Staff were trained on identifying the risks of falls and accident and incident forms were completed after every incident including falls which also identified what immediate remedial action could be put in place to reduce the risk of further falls.

Inspection carried out on 07 December 2015

During a routine inspection

This unannounced inspection took place on 7 December 2015. Templemore Care Home provides personal care and support for up to 72 people. The service offers long term residential care for the elderly, specialist dementia care and short breaks (respite care). At the time of our inspection 63 people were living at the home.

The service is required to have a registered manager. 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.

Staffing levels in one area of the home did not always ensure people’s needs were met; however this was addressed by the management team by the end of the inspection. Risk assessments were in place but required more detail for staff on how to mitigate the risks identified.

People demonstrated that they felt safe in their own home. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. The recruitment practice protected people from being cared for by staff that were unsuitable to work at the home.

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

Staff were highly skilled; plans were in place for new staff to complete the Care Certificate which is based on best practice. The provider’s mandatory training was updated annually.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People felt safe and there were clear lines of reporting safeguarding concerns to appropriate agencies and staff were knowledgeable about safeguarding adults.

Care plans were written in a person centred approach and focussed on empowering people; personal choice, ownership for decisions and people being in control of their life. They detailed how people wished to be supported and people and their families were fully involved in making decisions about their care. People participated in a range of activities both in the home and in the community and received the support they needed to help them do this. People were able to choose where they spent their time and what they did.

People had caring relationships with the staff that supported them. Complaints were appropriately investigated and action was taken to make improvements to the service when this was found to be necessary. The registered and deputy manager were accessible and worked alongside care staff to monitor the quality of the service provided. Staff and people were confident that issues would be addressed and that any concerns they had would be listened to.

The management team were passionate about people receiving person centred care and people and staff being involved and included in decisions about the future.

Inspection carried out on 14 and 31 October 2014

During a routine inspection

This unannounced inspection took place over two days the 14 and 31 October 2014.

Templemore Care Home provides accommodation for people requiring personal care. The service can accommodate up to 72 people. At the time of our inspection there were 62 people using the service. The home is divided into three areas and people live in the area that is best suited to their needs. The residential unit provides care for older people and both of the Cedar units provide care for people living with dementia.

There was a registered manager in post at the time of 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.

The provider had systems in place to safeguard people from the risk of abuse.

Staff recruitment procedures were in place to ensure staff were of good character and there were enough staff on duty to support people with their care.

Medicines were administered in a safe way and there were systems in place to prevent people receiving unsafe care.

Staff received training and development and were suitably supported by their manager to do their jobs.

The registered manager and staff were aware of their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). There were procedures in place to assess people’s ability to make decisions about their care. Staff understood how to make best interest decisions when people were unable to make decisions about their care.

There was a choice of nutritious food and drinks on offer; however people had not always received support and encouragement to eat their meals.

People received support to maintain their health and wellbeing and staff worked well with health professionals to ensure people received the treatment and care they needed.

People received support to undertake a range of social interests and hobbies.

The provider had a system in place to manage people’s complaints. However, complaints were not always recorded appropriately. This made it difficult to evidence how people’s complaints were fully investigated and resolved.

There were systems in place to assess and monitor the quality of service provided and people and their relatives gave their feedback on the quality of service received.

Inspection carried out on 22, 23 October 2013

During an inspection looking at part of the service

We visited on the 22 October 2013 to review the improvements that the provider had made to meet the staffing outcome following an inspection visit carried out during May 2013. We spoke with five people and two relatives of people living at the home. We also spoke with seven staff and the registered manager and reviewed four people�s care records.

People and relatives of people who used the service told us that they were happy with the level of care provided by staff and that there were enough staff on duty to meet their care needs. One person said �There are enough staff to help and the staff are nice�. Another person said �More often than not the staff are available and if I need them urgently they come quickly�. A relative told us that the staff had been �brilliant� and that their family member received good care. They also told us that they visited the home during the day and evening time and found that there were enough staff to meet their family member�s care needs.

During our inspection visit, we found that there were enough staff working at the service to meet the care needs of people living at the home.

Inspection carried out on 10 May 2013

During a routine inspection

We visited Templemore Care Home to review the improvements that had been made following an inspection visit during January 2013.

We spoke with five relatives of people living at the home, six members of staff and a social care professional visiting the home. We also reviewed the care records of five people. The relatives we spoke with told us that their family members received good quality care. One relative told us that their family member was �very happy here�. Another relative told us that their family member received regular reviews of their plan of care and that staff discussed with them their changing needs. A visiting professional to the home also told us that the standard of care provided to people was good.

We found that improvements had been made to the care people received at the home and that people were well supported with their mobility and walking equipment to reduce their risk of having a fall. We also found that staff received regular training and supervision to ensure that they provided people with good care.

However, we had concerns about the staffing levels at the home during busy periods of the day. We were also unable to find out how staffing levels were calculated in line with meeting people�s assessed needs.

Inspection carried out on 24 January 2013

During an inspection looking at part of the service

We went back to review the improvements that had been made following an inspection visit during September 2012. We spoke with staff and a visiting professional and reviewed four care plans.

We found that some improvements had been made to people�s care plans. A visiting health professional told us the staff communicated with them on a regular basis where they had any concerns about the healthcare needs of people who used the service. A relative of a person using the service told us their family member was at risk of falls and the staff made sure their walking frame was always available and they supported the person to move around safely. They also told us that the staff had sought the advice of health professionals, such as a falls prevention advisor to make sure their family member received safe care and the risk of falling was managed appropriately.

Although we had been told that the staff had sought the advice of health professionals, we found the advice from the health professionals was not always being acted upon. There continued to be a high number of falls and the systems in place to protect people from the risk of falls were not being followed. This meant that some people using the service were not receiving effective care and treatment to ensure their safety and welfare.

Inspection carried out on 21 September 2012

During a routine inspection

We spoke with three people living at the home and four relatives. We spoke with eight members� of staff on duty and two health professionals who visited the home on a regular basis.

The relatives we spoke with told us that they had been involved in making decisions regarding the care of their family members. We also saw that people�s care plans showed that people and their relative�s had been involved in making decisions about their care. Two people and their relatives told us that they thought staff working at the home were well trained and suitably experienced. They also told us that the staff had a good understanding of their needs and provided care in line with their care plan.

Most of the people and the relatives we spoke with told us that they were happy with the level of care that was provided at the home. However one relative raised a concern about their family member�s safety. They told us that their family member was at risk of having a fall and that the home had put measures in place to reduce the risk. They also told us they were worried the measures did not provide enough protection against the risk of having a fall.

We saw that most people had access to the equipment, which they needed to keep them safe. However, we saw one person who had a recent fall did not have access to their walking aid. We were concerned about this because the walking aid may have prevented them from the risk of having a fall.

Inspection carried out on 23 February 2012

During an inspection in response to concerns

There were 68 people living at the service when we visited on 23 February 2012.

We spoke with three people in residence and they told us they received the support they needed. One person said, �I like it here.� Another person told us that the home was �wonderful.�

One relative who was visiting told us the home was �marvellous.� Another visitor said there had been �no problems� with their relative�s care.

We spent some time in communal areas of the home with people, observing and assessing the quality of support they received. We observed that people received good support from staff.

Inspection carried out on 20 December 2010

During an inspection in response to concerns

People we met at the time of the visit said that they were happy living at Templemore and were well cared for.

People who use the service said that the food was well prepared and that there was always plenty to eat and drink.

People met at the visit said that they felt safe living at the home.

People we spoke with said that the staff were very helpful.