Temple Ewell Nursing Home

Updated 8 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

This inspection took place on 12 and 13 November 2018 and was unannounced. The inspection team consisted of one inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some information about the service, what the service does well and improvements they plan to make. We reviewed previous reports and notifications received by the Care Quality Commission. A notification is information about important events, which the provider is required to tell us about by law, like death or a serious injury.

We looked at eight people’s care plans, associated risk assessments and medicines records. We looked at management records including three recruitment files, training and support records, resident and staff meeting records, audits and quality assurance. We observed staff spending time with people.

We spoke with the registered manager, clinical lead, care plan administrator, two nurses, three care staff, activities worker and the administrator. We spoke with 11 people living at the service and eight relatives. We did not use the Short Observational Framework for Inspection as people were able to speak to us about their experience living at the service or spent their time in their room.

We spoke with one health care professional during the inspection.

Updated 8 December 2018

This inspection took place on 12 and 13 November 2018 and was unannounced.

Temple Ewell 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. Temple Ewell accommodates up to 44 people in one adapted building. At the time of the inspection there were 41 people receiving nursing care.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We inspected Temple Ewell in October 2017 and the service was rated ‘Requires Improvement’ overall with two breaches of regulation. Following the last inspection, we asked the provider to complete an action plan to show how they would meet the regulations. At this inspection, we found that improvements had been made and the regulations had been met. The service was now rated Good overall.

At the last inspection, we found the registered person had not managed medicines safely and people had not received their medicines as prescribed. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection, people’s medicines were now managed safely. Systems had been put in place to make sure people received their medicines and these had been effective. Medicine records were now accurate.

At the last inspection, we found the registered person had failed to maintain accurate records in respect of each person. They had failed to act on quality monitoring audits for continuous improvements.

At this inspection, checks and audits to measure the quality of the service had been completed. When shortfalls had been identified, an action plan was put in place and signed off when completed. Records such as care plans were now accurate and reflected the care being given.

Potential risks to people’s health and welfare had been completed, there was detailed guidance for staff to mitigate the risk and keep people safe. Accidents and incidents had been recorded and analysed to identify patterns and trends, action had been taken to reduce the risk of them happening again. Checks had been completed on the environment and equipment to make sure it was safe.

Care plans contained detailed guidance about people’s choices and preferences. Care plans were reviewed regularly and with people where they were able or their representative. People were supported to remain comfortable at the end of their lives.

Staff met with people before they moved to the service to make sure that staff could meet their needs. Staff monitored people’s health and referred them to healthcare professionals when their needs changed. Staff followed the guidance given by health professionals to keep people as healthy as possible. People had access to professionals such as the dentist and optician. People were encouraged to lead as healthy lifestyle as possible, for example, moving in their chair or bed. People had a choice of meals and were supported to eat a balanced diet.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible, the policies and systems in place supported this practice.

People were supported to be as independent as possible and where possible were involved in developing their care and support. People had access to activities they enjoyed and these reflected their interests. People were treated with kindness, staff respected people’s dignity and privacy. People were relaxed in the company of staff and staff understood how to support people when they were anxious.

People were protected from harm and abuse. Staff knew how to recognise signs of abuse and how to report any concerns. Staff were confident that the registered manager would deal with their concerns appropriately. The registered manager would deal with concerns to the local safeguarding authority and followed the guidance given.

There were enough staff to meet people’s needs, who had been recruited safely. Staff had received supervision and appraisal to discuss their development and training needs. New staff received an induction, staff received training appropriate to their role and staff competency was checked.

There was an open culture within the service, people and staff told us the management team was approachable. The provider had a complaints policy, this was displayed in the main reception, complaints that had been received were recorded and investigated following the policy.

People, staff, relatives and professionals were asked their opinions about the service and the feedback was mainly positive. The results of the surveys had been analysed and a plan had been put in place to address any issues raised. The management team held ‘open surgeries’ each month, where staff and relatives could raise any concerns they may have.

The registered manager worked with other agencies such as the clinical commissioning group to improve the care that people receive. The management team attended local forums and training to continuously improve the quality of the service.

The service was clean and odour free, staff used gloves and aprons when needed to reduce the risk of infection. The building had been adapted to meet people’s needs.

Services that provide health and social care to people are required to inform the Care Quality Commission (CQC), of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in a timely manner.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. That is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the provider had conspicuously displayed their rating on a notice board in the entrance hall and on their website.