Templeman House is a residential care home for older people, the majority of whom were living with dementia. The home provides accommodation and personal care for up to 41 people on three floors; nursing care is not provided. The main communal areas are situated on the ground floor but on each of the other two floors there were lounge areas. At the time of this inspection there were 30 people accommodated.

At our last inspection we rated the service good. At this inspection we found the service remained Good. Progress was being made towards outstanding achievement. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The registered manager had worked at the service for many years. 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.

People were treated with kindness, respect and compassion, and their privacy and dignity was upheld.

People were protected from neglect and abuse. Risks were assessed and people were supported to stay safe with the least possible restriction on their freedom. Pre-employment checks were followed to ensure candidates were suitable to work in a care setting.

People’s physical, mental health and social needs were assessed holistically, and care and support was planned and delivered in a personalised way to meet those needs.

People, and where appropriate their families, were involved in decisions about their care and support. The registered manager and staff kept abreast of good practice through attending training and discussing developments in good practice at team meetings and during supervision. Staff had training in equality, diversity and human rights to help them challenge and avoid discrimination.

People's rights were protected because the staff acted in accordance with the Mental Capacity Act 2005. People and their relatives were encouraged to be involved in decisions about care.

Relatives and friends could visit when they wished without notice.

There were links with the local community.

People had access to meaningful activities and were encouraged to follow interests and hobbies.

People made choices about what they ate and drank. Mealtimes were relaxed and sociable occasions, with people receiving the support they needed to eat and drink at their own pace. Dietary needs were assessed and referrals made to dieticians or speech and language therapists as appropriate.

People were supported with their health care needs. They each had a ‘health passport’ to provide to hospital staff in the event they needed treatment there.

There were sufficient appropriately trained staff on duty to support people in a person-centred way. The service used regular agency staff, whom people knew, to fill any gaps in the rota.

Staff were supported through training, supervision and appraisal to perform their roles effectively.

Staff were valued, respected and supported to develop the service, through supervision, team meetings and ad hoc conversations with the management team. The service was open to the concerns of staff, whether through whistleblowing, supervision and staff meetings, or staff surveys.

Accidents, incidents or near misses were recorded and monitored for developing trends.

The premises were clean and well maintained. Individual bedrooms were furnished and decorated according to people’s preferences.

People were protected from the spread of infection.

Medicines were stored securely and managed safely.

The service sought to support people to have a comfortable and dignified death when ne

This unannounced comprehensive inspection took place on 2 and 3 March 2016. At the last inspection completed in March 2015 we found the provider had breached six regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. The provider sent us an action plan confirming what they would do to meet the legal requirements in regulation to the breaches. At this inspection we found the provider had made the necessary improvements and was meeting the regulations.

Templeman House is registered to provide personal care and accommodation for up to 41 people. These are mainly older people who are living with dementia. There were 29 people living in the home during our inspection.

Accommodation is arranged over three floors and there is a passenger lift to assist people to get to each floor.

At the time of this inspection the home had a registered manager. 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.

People and their relatives told us they were happy living at the home and felt safe there. Staff knew how to prevent, identify and report abuse and the provider had a system in place to protect people from the risk of harm.

People’s needs were assessed before they moved into the home and during their time there. Areas of risk were assessed such as, skin integrity, falls and mobility and nutrition. Regular reviews were completed to ensure people’s needs were continually assessed.

Staff appeared to know people well and gave good examples of how they preferred their care and support to be given.

People received their prescribed medicines when they needed them and appropriate arrangements were in place for the storage and disposal of medicines.

Equipment such as hoists, wheelchairs and pressure cushions were readily available, maintained correctly and used safely by staff in accordance with people’s care records.

Some areas of the provider's infection control processes required improvement, however the provider took immediate steps and provided an action plan which achieved this.

The provider was in the process of recruiting further staff. There was a system in place to ensure people were cared for, or supported by sufficient numbers of suitably qualified and experienced staff. The provider had good recruitment and selection procedures in place.

Staff spoke positively about the induction and training they received and told us they felt well supported to carry out their role.

The manager was aware of their responsibilities in regard to The Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty.

People were supported to make decisions and where people did not have the capacity, decisions were made in their best interest.

People’s care records were regularly reviewed and maintained and accurately reflected the care and support they required.

People knew how to make a complaint and felt confident they would be listened to if they needed to raise concerns or queries.

There were systems in place to monitor and improve the quality of the service provided.

We carried out this unannounced inspection as part of our schedule of inspections. During our inspection we pathway tracked four people who lived in the home. This meant we looked at their plan of care, spoke with them or observed the support they received, if the individual was not able to communicate well due to their condition. We also spoke with another person, one visitor, five members of staff, one visiting health professional, a tutor from a local educational college and four students who were on placements.

We found people's needs were assessed and a plan of care drawn up to meet these needs. Daily records showed that support had been provided to meet people's needs. One person who we were pathway tracking told us their lunchtime soup "tasted good" and we saw they interacted with staff by smiling and responding to questions about their lunch.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. One visitor told us they considered their relative was safe and "well cared for."

The provider had an effective system to regularly assess and monitor the quality of service that people receive. This included regular audits of the environment, care records and staff practice.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

We carried out our inspection to see if the records and documents the home held about people who used the service were complete, accurate and up to date. This was because at an inspection of Templeman House on 5 November 2012 we found that records had not been kept properly. This constituted a breach of the Health and Social Care Act (Regulated Activities) Regulations 2010.

Following the inspection on 5 November 2012 the home’s manager sent us an action plan. It set out how they intended to make sure that records were completed properly.

On this occasion we did not talk with anyone living at the home about their experiences of living at Templeman House. This was because our inspection was specifically about record keeping.

We saw a system had been put into place that ensured that documents were completed fully by staff members who were responsible for the task.

We examined a range of documents that described and recorded how people who lived at the home received the help and support they required.

On this occasion the sample of records that we looked at were all in good order.

During our inspection visit of Templeman House we spoke with six of the people living at the home and one visiting relative in order to obtain their views about the quality of the service the home provided.

We were unable to speak with most people living at the home because of their physical and mental frailty. We therefore also gathered evidence of people’s experiences by observing what was going on and staff working practices.

We saw that staff frequently checked the communal areas where people spent time during the day to ensure they were safe and their needs were being met. We saw that generally people's dignity was upheld.

People we spoke with told us they were “pleased” with the care and help they received. They said care staff were polite and kind. They told us their choices were respected. One person said, “The staff are nice, not grumpy or anything like that. You can please yourself when you get up and go to bed”.

People were positive about the food provided and said there was always enough to eat.

We saw that social activities were organised in which people could take part.

There were systems in place that ensured people’s medication was managed safely; equipment was maintained and serviced; new staff were recruited properly; and the quality of the service provided was monitored.

We found that records were not always completed properly and were not always accurate or up to date.

We carried out an inspection at Templeman House on Wednesday 2 November 2011. The purpose of our inspection was to follow up and assess what action had been taken about concerns we had identified at our last visit to the home on 17 May 2011.

We spoke with seven people who were living in the home, one visiting relative and six staff in order to obtain their views about the issues that we were following up.

The people living in Templeman House who we spoke with told us that they felt safe as they could lock their bedroom doors. A visiting relative told us that they had no concerns about the physical safety of their mother, even though they had heard people in the building shouting on occasions.

People told us that they thought the home was kept clean and hygienic. Individuals who were living in the home said that their bedrooms were cleaned every day. They also said that they saw staff regularly cleaning communal toilets and bathrooms.

The views expressed by people living in Templeman House and the visiting relative we spoke with about staff working in the home were all positive and complimentary. They told us that they thought that staff were well trained. They also said they thought that staff were well supported because there was always a member of the home’s management team available.

The staff that we spoke with told us that they received supervision from their immediate line managers. Some of them told us that they felt well supported by their managers. They also said that they attended staff meetings and they had a handover meeting at the start of every shift they worked.

We were only able to get comprehensive views and opinions of three people accommodated at Templeman House, because many of the people living there had enduring mental health problems such as dementia and were unable to communicate verbally. Consequently many of the experiences of people living in the home that we refer to in our report were based on our observations of the support that we saw staff providing for individuals.

We also noted the demeanour of many people which research about people with dementia indicates, can illustrate a person’s state of “well being”. During our visit we saw at different times several groups of people in the lounge areas having quite animated conversations. We also saw groups of people congregating in and around the home’s entrance hall listening to and clearly enjoying music being played on a compact disc player and engaging with each other and members of staff who frequently passed through the area. These observations suggested that the people we saw were content and happy.

We also obtained the views about the service from some relatives and care professionals who regularly visited Templeman House.

People living at Templeman House who were able to express their views and opinions told us, that staff were helpful and polite, and that their accommodation was comfortable, well maintained and afforded them privacy. They told us their views were sought about the service they received. They said, there was “little in the way of rules and restrictions”, the food was good and that they felt safe. They told us that, social activities were organised in which they could participate, that their medication was looked after for them and that the home promoted their healthcare.

Visiting relatives told us that the staff were “amazing”, “lovely to the residents that they believed that their relatives were in “safe hands”. They told us that lots of activities were organised and there was “always something going on”. They said that the home was well maintained and clean and tidy.

Healthcare professionals who regularly visited Templeman House told us that they had no concerns about the home and that the treatment people living there received, was “good”, and the home was “well organised” and “worked well” with them.

This was an unannounced comprehensive inspection carried out on 18 and 20 March 2015. Templeman House provides residential care for up to 41 people, some of whom may be living with dementia. There were 36 people living in the home during our inspection.

Accommodation is arranged over three floors and there is a passenger lift to assist people to get to each floor.

At the time of this inspection the home had a registered manager. 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.

We last inspected Templeman House in February 2014. At that inspection we found the service was meeting all the essential standards that we assessed.

At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The manager told us that 12 people at the home was subject to the Deprivation of Liberty Safeguards (DoLS). They also explained that they had applied for DoLS for all of the people who lived in the home. However, some staff lacked understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and were unable to tell us which person had been deprived of their liberty.

People were not fully protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines safely.

There were not always enough staff to meet people’s needs and staff did not receive support meetings in accordance with the provider’s policy.

Risks to people were not always assessed, monitored and planned for to make sure people were consistently safe from harm. People’s care plans and monitoring records were not consistently maintained and we could not be sure they accurately reflected the care and support people needed or that had been provided to people.

Some communal areas of the home were not clean and furnishings were worn and stained.

Staff were kind and caring but did not always respect people’s dignity and privacy.

The governance at the home was not always effective because record keeping was inconsistent and shortfalls identified in audits had not all been addressed to make sure the service continually improved. People, relatives and staff were not routinely consulted and did not have the opportunity to influence change at the home.

Staff were recruited safely and were provided with regular training so they had the skills and knowledge to be able to meet people’s needs.

People were supported to maintain their health and had access to healthcare professionals when required.