Background to this inspection
Updated
22 September 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 16 and 21 July 2015 and was unannounced. It was carried out by one inspector and a specialist adviser with a background in nursing care.
Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at previous inspection reports and notifications we had received. A notification is information about important events which the provider is required to tell us about by law. We also looked at information received from social care professionals.
We looked around all areas of the service, and talked with ten people who lived at the service. Conversations took place with people in their own rooms. We observed the lunch time meals and observed how staff spoke and interacted with people.
We talked with four relatives who were visiting people; eight care staff and the cook. We also spoke with the registered and deputy manager of the service.
We spoke with two health care professionals.
The previous inspection was carried out in September 2013. No concerns were identified at this inspection.
Updated
22 September 2015
The inspection visit was carried out on 16 and 21 July 2015 and was unannounced.
Temple Ewell Nursing Home is a privately owned care home providing nursing care and support to up to 44 adults who have nursing needs and who may also be living with dementia. The rooms are located on two floors; the main entrance is on the first floor accessed by a lift. There are private gardens with seating, patio areas and parking. On the day of the inspection there were 38 people living at the service.
There was a registered manager working at the service. 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 and associated Regulations about how the service is run.
Although people told us they felt safe, risk assessments to support people with their mobility were not detailed enough to show how the risks should be managed safely. The assessments also lacked guidance for staff to support people with their behaviour, so that these risks could be minimised. This left people at risk of not receiving interventions they needed to keep them as safe as possible.
There was insufficient staff on duty to ensure that people’s needs were fully met. People, relatives and staff told us that on occasions there was not enough staff on duty, especially at weekends.
Records did not confirm that the required training had been provided for all staff, and further specialist training, such as dementia, needed to be carried out for all staff. Over fifty per cent of staff held recognised qualifications in care or were completing the award. Staff met regularly with the registered manager to discuss their role and any concerns they had.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). At the time of the inspection the registered manager had applied for a DoLS authorisation for two people who were at risk of having their liberty restricted. Not all mental capacity assessments were in place to assess if other people needed to be considered for any restrictions to their freedom.
When people were unable to make important decisions for themselves, relatives, doctors and other specialists were involved in their care and treatment and decisions were made in people’s best interest. However, information was not always recorded to confirm how people had given their consent or been involved in decisions that had been made, for example, when bed rails were in place to prevent a person getting out of bed.
Care plans lacked detail to show how people’s personalised care was being provided and care plans had not been reviewed or updated since March 2015. Care plans did not record all the information needed to make sure staff had guidance and information to care and support people in personalised way. Records were not always completed accurately or properly.
People and relatives told us the staff were kind and respected their privacy and dignity. However, this was sometimes being compromised by lack of staff, which made the care more task orientated than person centred. Staff were familiar with people’s likes and dislikes and supported people with their daily routines.
Although there were some planned activities, on the day of the inspection some people remained in their rooms and were not engaged in activities. Staff were familiar with people’s likes and dislikes, such as what food they preferred.
People told us that they felt safe living at Temple Ewell. The majority of staff had received safeguarding training and they were aware of how to recognise and protect people from the risk of abuse. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the manager or outside agencies if needed. Staff recruitment systems were robust and checks had been made to ensure new staff did not pose a risk to people living at the service.
Staff were receiving support from their manager through one to one meetings. Yearly appraisals were used to ensure staff had the opportunity to develop and identify their training needs. There were regular staff meetings so staff could voice their opinions and discuss any issues.
Checks on the equipment and the environment were carried out and emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.
Accidents and incidents had been recorded and the necessary action had been taken to reduce the risks of them happening again.
Staff were attentive and the atmosphere in the service was calm and people appeared comfortable in their surroundings. Staff encouraged and involved people in conversation as they went about their duties.
People told us that they enjoyed their meals. If people were not eating enough their food was monitored. If required a referral was made to a dietician or their doctor, and supplements were provided so that they maintained a healthy diet.
Medicines were stored and administered safely. Staff had been trained and demonstrated good practice in medicine administration. People’s health was monitored and when it was necessary staff contacted their doctors or specialist services.
The complaints procedure was on display to show people the process of how to complain. People, their relatives and staff felt confident that if they did make a complaint they would be listened to and action would be taken.
There were quality assurance systems in place which had not always been effective. Health and safety checks and maintenance checks were regularly carried out. The service had systems in place for people to voice their opinions on the service and care being provided.
Staff told us that they were supported by the management team. They said the managers and nurses were approachable and that there was a culture of openness within the service. They told us they were listened to and their opinions were taken into consideration.
We found a number of 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 this report.