We undertook an unannounced inspection on 18 December 2018.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.