Temple Ewell Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to obtaining consent.

This service scored 33 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people’s care, and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them. There was no evidence people, or their relatives had been involved in developing their care plans. People’s needs had not always been assessed when they first moved into the service. Staff had not completed risk assessments or care plans for all areas of people’s lives to identify people’s needs. For example, when people had bedrails in place there was not always an assessment in place to show why these were needed. Staff meeting minutes from February 2025 showed staff had been told risk assessments had to be completed within the first 48 hours after people were admitted to the service. This continued to be an issue at this inspection over a year later.

Staff had not always identified potential needs when they were living with health conditions, such as Parkinson’s disease. There was no information about how the disease affected people such as if they were stiff or shaking and how staff needed to support the person.

There were processes in place to review people’s care plans, however, these had not been effective in identifying the lack of care plans or detailed guidance for staff. There was no evidence people, and their relatives had been involved in the care plans reviews.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards. Staff completed recognised assessment tools such as Waterlow to identify skin integrity risks and a malnutrition universal screening tool (MUST). However, staff had not always used the tools correctly and risks to people’s health had not been identified. When using the MUST score, staff are required to review weight loss over the previous 3 to 6 months and action should be taken if they if they identify over 5% weight loss. We reviewed a care plan where the person had over a 10% weight loss in the past 4 months, meaning action should have been taken such as referral to the dietician. Staff had only reviewed the last months weight and the person’s current weight, which gave a weight loss of less than 5% and no action was taken. We reviewed the monthly nutritional audit completed by the clinical lead and found only the last and current weight had been used to assess everyone living at the service. By not reviewing weights for at least the previous 3 months placed people at risk of continued unidentified weight loss.

When people were at risk of weight loss, people were not offered a fortified diet in line with best practice guidance such as Kent Community Health NHS Foundation Trust ‘Food first for care homes.’ The provider bought in meals from an external catering company, staff had not fortified the meals to provide additional calories to help people maintain their weight, such as cream and butter added to the mash potato. Staff told us, people were offered additional milky drinks and prescribed nutritional supplements. However, this relied on people liking milky drinks and having the appetite to drink them as well as eat their meals to have additional calories required. This did not support people to maintain their weight following best practice guidance and potentially reduce the need for supplements.

During our onsite visit, we observed a person’s urine output in their catheter bag, which appeared low and concentrated. We discussed this with the clinical lead, who told us the person was reluctant to drink. We reviewed the person’s care plans and charts with the clinical lead. There was no guide about how much fluid should be offered or fluid chart in place to monitor how much the person was drinking or being offered to drink. The clinical lead could not confirm if staff had offered the person a drink or how this was monitored. This placed the person at risk of dehydration.

The provider did not always work well across teams and services to support people. Staff had access to people’s care plans; however, care plans were not always accurate or contain all the guidance they needed. When people transferred to hospital the information from the person’s care plan would be sent with them, but this was not always accurate and up to date, this placed people at risk of not receiving support they needed and in the way they preferred.

Staff told us they knew people well including their choices and preferences. Staff attended handovers at the start of their shifts and received updates on people’s care and any changes in their condition.

Staff worked with the local GP surgery to make sure people had access to medicines and treatments they needed. Relatives told us people had been referred to the GP when they were unwell.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future need for care and support. Care plans did not always contain information about how people with health conditions may present when they were unwell, such as epilepsy and the type of seizures they might experience. There was not always clear guidance for staff to recognise and prevent deterioration of people’s health.

People had been supported to access vaccinations when offered by the health service. Relatives told us people had access to health professionals such as a foot care professional and optician.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. People’s wounds were managed by the nursing staff; however, nurses had not documented the condition of the wounds accurately. The wound documentation was inconsistent, wound photographs had not always been taken at each dressing, when photographs had been taken, staff had not used a paper measure to show the size of the wound. Staff had recorded constantly differing measurements depending on which nurse was completing the wound care. For example, there had been no measurement of the depth of the wound until January 2026, without consistent measurements of the depth of wounds, improvements or deterioration could not be assessed. Nurses had not recorded the condition of the wounds, to identify if there was for example an infection, without this information, nurses could not make an informed clinical decision about which dressings were appropriate. There were a risk people’s wounds could deteriorate causing people pain and distress. Nurse meeting minutes from April 2025 showed nurses had been reminded about how to complete the wound documents but the issue continued at the inspection.

Some people had developed wounds, including pressure wounds, blisters or moisture lesions, while living at the service. There had been no investigation into how these wounds occurred, such as staff not washing people properly or taking action to stop areas such as people’s knees rubbing together, to make improvements to reduce the risk of them happening again.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment. There was a poor understanding of the Mental Capacity Act 2005 (MCA) at all levels of the service. When people had been assessed as not having capacity to make decisions about their care, a best interest decision should be completed by staff with relatives and when appropriate health professionals. We reviewed a person’s care plan, which stated a lap belt should be used to keep the person in their chair, which was a restriction. There was no best interest meeting recorded to show how the decision was made and who was involved. When it had been agreed with the GP medicines could be given covertly, the care plan had been updated but a best interest decision had not been completed. The registered manager confirmed there was no best interest decision recorded, to show how the decision had been made and by whom. We discussed with the registered manager when best interest decisions should be completed, we could not be assured they understood the MCA and their responsibilities under it. Other staff including the clinical lead and nurses had not completed appropriate documentation to make sure people were being supported to make decisions, or best interest decisions were recorded.

People’s care plans did not have mental capacity assessments to show which aspects of their care they could make decisions about, including bedrails. Some people lacked capacity to make complex decisions but could make simple day to day decisions, this had not been assessed. Some people who had capacity, had made decisions which affected their care such as not going to hospital for certain health conditions. While these decisions had been respected, there was no guidance for staff about how to manage the condition if the person was not to be admitted to hospital. This placed the person at risk of not receiving appropriate care and their condition deteriorating.

Following our onsite visit, mental capacity assessments had been completed for the people whose care plans we had reviewed.