CQC report explained · a nursing home
What the CQC found at Temple Ewell Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, December 2018
Temple Ewell Nursing Home was rated Good after inspectors found safer medicines management, kind care and better records than at the previous inspection.
This was an unannounced inspection on 12 and 13 November 2018. One inspector and an expert by experience reviewed eight care plans, risk assessments and medicines records. They also looked at staff records, audits and meetings, observed care, and spoke with people, relatives, staff and a health professional.
The inspectors found people were protected from abuse, risks were assessed and medicines were given as prescribed. There were enough staff overall, although one call bell was not answered for half an hour. The home was clean, staff were trained, and people received support with food, health needs, activities and end-of-life care.
People were treated with kindness and their privacy and choices were respected. Care plans and quality checks had improved. The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. This means the inspectors found the service met the required standards at this inspection.
Medicines improved
The home had corrected the medicines problems found at the previous inspection. Records were accurate and people received medicines as prescribed.
“At this inspection, people's medicines were now managed safely.” from the report
Kind and respectful care
Staff knew people's preferences, respected privacy and dignity, and supported people to remain calm when anxious.
“People were treated with kindness, staff respected people's dignity and privacy.” from the report
Personalised care
Care plans described people's choices, routines and abilities. Staff used this information to support independence and changing needs.
“Each person had a care plan, these now contained details about people's choices and preferences such as when they liked to get up and go to bed.” from the report
Improved oversight
The home completed audits and followed up identified problems. Records and care plans had become more accurate since the previous inspection.
“When shortfalls were identified, action plans had been developed and completed to rectify the shortfalls.” from the report
Call bell delay
needs fixingOne call bell was not answered for 30 minutes when a person needed help moving into their chair. The manager agreed staff should explain delays to people.
“During the inspection, a relative rang the call bell for their loved one to be assisted into their chair following their physiotherapy and this was not answered for half an hour.” from the report
Accessible complaints information
minorThe complaints policy was not available in other formats at the time of inspection. The manager said pictorial and braille versions were being prepared.
“The policy was not available in other formats.” from the report
Privacy for couples
minorThe home was developing how staff could support couples who wanted private time together. Families should ask what progress has been made.
“This was an area that was being developed.” from the report
- 01How quickly are call bells answered now, and what happens when staff are delayed?
- 02Can you show us the complaints information in pictorial, braille or another accessible format?
- 03What arrangements are now in place to support couples who want private time together?
- 04How do you check that medicines are being given and recorded correctly?
- 05How are changes in a person's health or care needs reflected in their care plan?
This was an unannounced inspection covering all five CQC questions, with improvements checked against the two breaches found at the October 2017 inspection. This explanation was written from the published report of 8 December 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2017
Rated Requires Improvement; inspectors found progress in training, staffing and health support, but medicines, records and respectful care still needed action.
This was an unannounced inspection on the first day and an announced inspection on the second. Inspectors spoke with people living in the home, relatives, staff and a health professional. They observed care and a mealtime, looked around the home, and checked care plans, medicines records, staff records and audits.
There had been improvements since the earlier inspection. Staff had received suitable training and supervision. Staffing levels were sufficient. Mental capacity assessments and applications for safeguards had improved. People were referred to health professionals when needed and were supported with food and drink.
However, the home was still not consistently safe, caring, responsive or well-led. Some people did not receive medicines exactly as prescribed. Risk assessments and care plans did not always give accurate, personalised guidance. Inspectors also saw some staff speaking or behaving disrespectfully towards people. The overall rating Requires Improvement means important improvements were still needed.
Staff training
Staff had completed essential and specialist training. Their competence was checked, and staff received regular supervision.
“Staff had completed a comprehensive training programme, all the staff had completed essential training, such as moving and handling, adult protection and mental capacity.” from the report
Enough staff
Inspectors found sufficient staff on duty to meet people's needs. Recruitment checks had also been completed safely.
“There were sufficient staff on duty to meet people's needs.” from the report
Health support
People's health was monitored and referrals were made when needed. Improvements had also been made in wound care records and specialist health guidance.
“People were referred to healthcare professionals when needed.” from the report
Improved consent processes
Mental capacity assessments were reviewed and applications for safeguards had been made when needed. Best interest decisions were recorded.
“When people were unable to make decisions for themselves, relatives, doctors and other specialists were involved in making decisions in their best interest.” from the report
Medicines were not always safe
seriousSome medicines were given at the wrong intervals, patches were not always changed on time, and required signatures were missing. This could have caused pain or discomfort.
“People were not receiving their medicines in line with the prescriber's instructions.” from the report
Risk guidance was incomplete
seriousSome risk assessments were contradictory or not personalised. Staff knew people well, but written guidance might not have kept people safe, especially for moving and skin care.
“However, there was not always clear guidance in the care plans for staff to follow to help keep people safe.” from the report
Some disrespectful interactions
needs fixingInspectors observed staff talking over a person and heard a person being spoken to disrespectfully. The provider said staff would be reminded how to treat and speak to people.
“People told us and we observed that some staff were not always respectful to people.” from the report
Care plans were out of date
needs fixingCare plans had been reviewed but did not always reflect changes in people's needs, equipment or agreed routines. This meant staff might not have had the right information when reading the records.
“Care plans had been reviewed but not updated to reflect the care given and people's changing needs.” from the report
Quality checks did not lead to lasting improvement
needs fixingAudits identified problems, but action was sometimes ineffective and the same shortfalls continued. Some audits also lacked enough detail to judge whether care was working.
“Action had not been taken to rectify the shortfalls or the action taken had not been effective.” from the report
- 01How are medicines now checked to make sure doses, timings, patches and required signatures are correct?
- 02How do you make sure risk assessments for moving people and protecting their skin are personalised and kept up to date?
- 03What action was taken after inspectors saw people being spoken to disrespectfully, and how is this monitored now?
- 04How are care plans updated when a person's needs, equipment or daily routine changes?
- 05How do your audits show that identified problems have been fixed and have not returned?
This was a comprehensive inspection of all five areas, carried out to check progress after an earlier inspection that found five breaches. This explanation was written from the published report of 8 December 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Temple Ewell Nursing Home
3 rated inspections over 2 years: the service has improved, from Requires improvement to Good.
- December 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- May 2017Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- August 2016
Registered with the Care Quality Commission on 1 August 2016.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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39 live-in carers within about an hour of Kent
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