Background to this inspection
Updated
29 October 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by three Inspectors.
Service and service type
Temple Court Care Home 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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the service registered and sought feedback from the clinical commissioning group and local authority who commission care from the provider. We also received feedback from community nursing staff who had been deployed to provide oversight of the clinical care provided to people in the home.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all of this information to plan our inspection.
During the inspection
During the inspection we spoke with four people who lived in the home and two people’s relatives. We spoke with seven members of staff, including care staff, senior care staff, nursing staff, the registered manager, operations manager and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with six of the community nursing staff who had been deployed to the home to oversee people’s care and monitor their safety.
We looked at multiple records about people’s care needs and medicine needs. We looked at other information related to the running of and the quality of the service. This included quality assurance audits, rotas and training information for staff.
After the inspection
We spoke on the telephone with six people’s relatives and two care staff.
Updated
29 October 2020
About the service
Temple Court Care Home is a nursing home for older people and people living with dementia. The service is registered to provide personal care to up to 54 people.
On the first day of our inspection, there were 21 people at the service, by the end of the second day of inspection all people had been supported to move to alternative care providers by care commissioners.
People’s experience of using this service and what we found
The provider failed to have sufficient managerial and clinical oversight to ensure people were cared for safely.
Since early April 2020, the registered manager and the senior care team had been absent from the service, the clinical lead was also on prolonged leave. In the absence of the registered manager, senior care team and clinical lead, the provider failed to ensure they had sufficient oversight of the service.
People’s risks had not always been assessed or updated regularly as people’s needs changed. People’s care plans did not always reflect people’s current needs. Staff did not have enough information about people’s current needs to provide safe care that met their needs.
The provider failed to deploy enough staff with the skills, competencies and supervision to carry out their roles safely. Staff had not received all the training they required, or had their competencies checked, to ensure they could meet people’s needs. New, agency and deployed staff did not receive an adequate induction or receive supervision which led to poor care.
People were not protected from the risks of abuse or poor care. Staff did not identify or report where people had come to harm, or report incidents, accidents and unexplained bruising. Following visits by commissioners a number of safeguarding referrals were made for people.
People’s health deteriorated and was at risk due to the lack of clinical and managerial oversight of their medicines, falls, mobility, wound care, pressure area care, clinical observations and infection prevention and control. Staff failed to take prompt action to seek medical care where people displayed signs of ill-health or failed to receive their medicines.
People were identified as being malnourished and dehydrated. People were at risk of malnutrition and dehydration as staff did not provide food and drink that met each person’s needs. The provider failed to ensure there was sufficient oversight and monitoring of what people ate and drank or monitor their weights. Staff failed to identify and refer people to health professionals where people lost weight.
The provider failed to ensure that people were involved in the planning of their care. People’s dignity and respect was not always maintained as people did not receive all their care and provision was not made for their mental and physical well-being.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not support this practice.
The provider failed to have adequate systems to identify failures in staffing and the quality and provision of safe care. Audits had not been completed and the provider failed to learn from incidents or complaints. They failed to have sufficient managerial or clinical oversight to identify where things went wrong or have processes to analyse the cause.
We have identified breaches in relation to the management of risks to people, meeting people’s eating and drinking needs, staffing deployment, staff training, people’s dignity and the governance of the service at this inspection.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 25 June 2019), the provider was in breach of regulations 12 and 17 and we placed conditions on their registration. Since this rating was awarded the registered the provider has altered its legal entity. We have used the previous rating and enforcement action taken to inform our planning and decisions about the rating at this inspection.
Why we inspected
We received concerns in relation to people’s nursing care needs, health needs, medicines, wound care and nutrition and hydration needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. Following the inspection and identified safeguarding concerns a criminal investigation is in progress.
The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Temple Court Care Home on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
Following this inspection we took urgent action to impose a condition to restrict admissions and readmissions to the service. We did not take further civil action as there was no one living at the service and the provider cancelled their registration.