Templemore Care Home

Templemore Care Home is a residential care home providing personal and nursing care for up to 65 older people, younger adults or people with dementia. At the time of our inspection the service was supporting 59 people in one adapted building. The service was separated into 3 units. People lived in the unit which best met their individual needs.

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

People were cared for safely. Risks to people’s health and wellbeing had been identified and plans were in place to mitigate risk. They could be assured they lived in a clean and well-maintained environment. Staff knew how to protect people from harm and staff had been recruited safely. People’s medicines were managed, and they received them on time.

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.

Staff understood people’s needs and had the skills and knowledge to deliver individualised care. People’s nutritional needs were met, and they were supported to access other health and social care professionals. Staff were trained and encouraged to develop their knowledge and practice.

People could be assured they received care that was person-centred from staff who knew them well. Staff supported people to remain in contact with family and friends and provided them with a variety of activities and entertainment to stimulate and occupy them.

People were listened to and knew how to raise a complaint if they needed to. People and staff were confident the registered manager would act upon any concerns they raised.

Staff were supported through supervisions and enabled to give their feedback and share ideas. People’s feedback was sought, and people were encouraged to take part in the running of the home through assisting with staff recruitment and being involved in decisions about décor.

The registered manager had good oversight of the service and strived to continuously improve the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Rating at last inspection and update: The last rating for this service was requires improvement (published 02 November 2021) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Templemore care Home is a residential care home providing accommodation and personal care for up to 65 older people, younger adults or people with dementia. At the time of the inspection the service was supporting 61 people in one adapted building. The service was separated into three units.

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

Risk assessments required further information recorded regarding risks, strategies and health conditions. Records of care tasks were not always consistently recorded to evidence tasks had been completed.

Records of injuries required improvement. Unexplained injuries were not always investigated to establish a cause and not all injuries had the required information needed to ensure staff could complete follow up checks.

Staffing deployment requires reviewing. Although staffing levels were assessed and maintained. The lay out of the building made it difficult to ensure staff were in the right place when needed. We recommended the provider review how staff are deployed within the building.

People’s needs were assessed before they moved into the service. However, not all care plans held enough detailed information regarding their health conditions to support staff to know what to do in the case of an emergency.

Systems and processes to ensure oversight of the service were not always fully effective. Improvements were required to audits to ensure they captured all the information and actions could be implemented to make improvements.

Cleaning schedules were not always consistently recorded. However, the home appeared clean and staff used personal protective equipment (PPE) effectively to reduce to risk of infections.

People were supported by staff who were kind, caring and compassionate. Staff interacted well with people and knew individual needs. People told us staff were respectful and promoted their independence.

People told us the food was nice and they had choices of meals offered daily. People were regularly offered drinks. People were supported to access health and medical appointments as required. People received medicines as prescribed by trained staff who followed best practice.

The environment was safe and appeared clean. The hallways had dementia friendly signs and handrails to support mobility within the home. Activities were offered and encouraged by staff.

People were supported to stay in contact with their friends and families. Relatives were kept up to date on their loved ones changing needs or any incidents that may have occurred

People, relatives and staff knew who the registered manager was and felt comfortable raising any concerns, complaints or suggestions. The registered manager was visible in the service and operated an ‘open door policy’ for anyone who needed to discuss anything. People and their relatives were asked to feedback on the service annually.

Staff felt supported by the registered manager and received regular supervisions and meeting to discuss the service and to ensure staff had the information required to fulfil their roles and responsibilities.

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.

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 good (published 23 May 2019)

Why we inspected

The inspection was prompted in part due to concerns received about lack of interactions with people and personal hygiene tasks not being supported by staff. A decision was made for us to inspect and examine those risks.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to oversight of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

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

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.

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 understanding of people's needs and preferences.

People were listened to, their views were acknowledged and acted upon and care and support was delivered in the way that people chose and preferred. Care plans reflected how people’s needs were to be met. Records showed that people and their relatives were involved in the assessment process and the on-going reviews of their care. They were supported to take part in activities within the service and the local community. There was a complaints procedure in place to enable people to raise complaints about the service.

The registered manager and senior staff were positive role models, which encouraged communication and learning. People, relatives and staff were encouraged to provide feedback about the service and it was used to drive continuous improvement. A range of quality checks were in place and used regularly to ensure people received a high quality service driven by improvement.

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.

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.

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.

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.

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.