Inspection on 19/10/09 for Knights Templar Court

This is the latest available inspection report for this service, carried out on 19th October 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Knights Templar Court 22/10/07

Similar services:

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Poldhu

Queensmount

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Knights Templar Court Throop Road Templecombe Somerset BA8 0HR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: David Smith     Date: 1 9 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Knights Templar Court Throop Road Templecombe Somerset BA8 0HR 01963370317 01963370759 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Greenview Care Limited care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 20. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Knights Templar Court is registered to provide personal care for up to 20 older people; the registered manager is Mrs Lorraine Hill. It is situated in the village of Templecombe that has local amenities such as a shop and pub. There is a railway station in the village which accesses the London Waterloo line. The home is set in large wooded grounds; the countryside views from the lounges and some bedrooms are far reaching. There are car parking spaces available for visitors. The home is not purpose built and has accommodation arranged over two floors; there is a stair lift, but no shaft lift. On the ground floor there are a number bedrooms, a Care Homes for Older People Page 4 of 34 Over 65 20 0 2 2 1 0 2 0 0 8 Brief description of the care home hairdressing room, two offices, the laundry, kitchen, a large communal lounge and two samller separate lounge areas; the dining area is next to the main lounge. The bathroom on this floor is now back in use. On the first floor there are a number of bedrooms and a bathroom. Between 7.30am and 9.30pm there are two members of staff on duty; overnight there are two members of waking night staff. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last Key Inspection of this service was completed on 22/10/08. This was an unannounced visit to the home to enable us to complete a Key Inspection of this service. We spent approximately eight hours in the home on the day of our visit. The inspection was carried out by one inspector, but the term we is used in this report. This is because the report, and the judgements within it, are on behalf of the Care Quality Commission. The pre-inspection planning involved reviewing the report of the last Key Inspection completed in October 2008. We looked at latest Annual Quality Assurance Assessment (AQAA) that was sent to us by the home; this is a self-assessment that focuses on how well outcomes are being met for people living at Knights Templar Court. It also gave us some numerical information about the service. We also looked at the service history, Care Homes for Older People Page 6 of 34 which details all other contact with, or about, the home. We sent surveys to the people who live in the home, to staff members and social and health care professionals who support the home as part of this Key Inspection. Nine surveys were completed and returned; five from people who live in the home, two from staff members and two were completed by a relative. The views of each person who wrote to us have been included in this report. We spent time speaking with people who are living in the home at different times of the day and we informally observed staff supporting people in communal areas of the home. We gathered additional information for this report by speaking with the homes Manager, the Area Manager and the members of staff who were working on the day of our visit. We looked at a number of records within the home such as individuals care records, risk assessments, daily records, activity records, medication administration, staff records, complaints and compliments and some health and safety procedures. We viewed all communal areas of the home, part of the grounds, rooms not currently occupied and some of the bedrooms used by the people who live here. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The Registered Person must complete the development and improvement of each persons care plan. This would ensure staff have clear and accurate information relating to each persons care needs. The Registered Person must ensure the way risks to people are assessed, and plans to reduce them, are improved. This would promote the welfare and safety of people who live in the home. Care Homes for Older People Page 8 of 34 The Registered Person must ensure the planned development and refurbishment of the home is completed. This would ensure the people who live at Knights Templar Court are provided with a comfortable and homely environment. The Registered Person must ensure each member of staff is supervised regularly; they should also consider revising the form used to record supervision sessions with staff. This would ensure staff are being given the support they need to provide good quality care to people who live in the home. The Registered Person must ensure that the improvements required following the recent health and safety inspection are carried out. This would ensure the home is safe for people to live in. The Registered Person must ensure that they know which staff have taken part in each fire drill. This would ensure that each person who works in the home would know what to do in the event of a fire and help to keep themselves, and others, safe. The Registered Person must ensure sufficient checks are carried out on new staff; they should also consider updating the homes application form to request a full employment history of staff who are applying to work in the home. This may help to make the recruitment process more thorough and promote the safety of the people who live in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given the information they need about the home to enable them to make an informed choice about whether they wish to live here. People are confident the home can support them as their needs are thoroughly assessed and they are encouraged to visit before they are given the opportunity to move in. Evidence: The home has an up to date Statement of Purpose and people have a guide to the service; we saw people had copies of these documents in their own rooms. The people living in the home we spoke with, and those who wrote to us, said they did have enough information to decide if it was the right place for them to live. To ensure the home is able to meet the needs of new people, thorough assessments are carried out on anyone wishing to move in. We looked at the records for two people Care Homes for Older People Page 11 of 34 Evidence: who have moved into the home since our last visit; these showed that an assessment was carried out and if other information was available, such as reports or assessments from other professionals, copies were also obtained to ensure the home was able to meet each persons needs. People are encouraged to visit the home before they decide to move in; this allows them to have a look around the home, to meet people who already live here and to speak with the Manager and care staff. One person told us I came for a look around with my daughter; I went home and thought about it and then came for another visit before I decided to move in. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health, personal and social care needs are usually met. People do not have a detailed plan of care that they, and people close to them, have been involved in making. Peoples right to privacy is respected and they are supported with their medicines in a safe way. Evidence: Each person who lives in the home has a care plan; we looked at four of these in detail. Following our last visit we said that care plans needed to be improved to ensure they contain enough information about each persons needs to ensure that staff are able to support people appropriately. The care plans currently in use have been added to since we last visited, although they still need to be improved further. They contain limited information, all seem to focus solely on peoples health care; there is no current information in care plans which relates to social care needs. One persons care plan explains that pressure area care is very important to them and that Care Homes for Older People Page 13 of 34 Evidence: monthly monitoring and reviews are to be carried out; there was no evidence that this was being done. The Manager confirmed this information was missing from the plan during our visit. In another persons plan the only areas covered in detail are falls and personal hygiene. Both the Manager and Area Manager agreed with our comments and showed a genuine commitment to improving each persons plan and adding much more detail to make them person centred; we spent time with them discussing care planning, offering advice and sharing good practice, to support the improvements which are needed. Risks to people are identified using assessments; the assessments we looked at covered areas such as the risk of pressure areas developing, nutrition, the use of hoists and the risk of a person falling. Many of these assessments have been put in place this year in an effort to improve care plans. However, the most recent risk assessments we looked at make no mention of the level of risk and how the measures in place reduce the risk. It is therefore not possible to see if they are effective in any way. Again we spent time with the Manager and Area Manager discussing this issue; they agreed these assessments need to be improved and understood what information they should contain. The home is now encouraging people, and those close to them, to be involved in planning and reviewing their care. Two peoples plans we looked at contain a statement that confirms they have been involved in their care plan and care arrangements. People who live in the home we spoke with, and those who wrote to us, said they do generally receive the care and support they need and staff are usually available when they need them. Staff listen to them and act on what they say; each person felt their privacy is respected. We saw that people were able to choose to spend time in their own rooms or in communal areas; staff were friendly and polite, knew people well and always addressed them using their names. People told us they do see their GP when they need to; Community Nurses and a Chiropodist also support the home. One person we spoke with told us they were having problems with their teeth and staff were arranging for a Dentist to visit them in the home as they would prefer this to going out to the surgery. When asked what the home does well one person said they look after me very well, all the staff are wonderful. Other comments include the care and attention I have Care Homes for Older People Page 14 of 34 Evidence: received is first class, the care is very good and the home is warm enough and staff are usually pleasant. When asked they would like to be improved comments included: some staff are not able to put my hearing aid in correctly, sometimes my nails are left to become quite long, I dont always have my weekly bath as staff are too busy and staff should be more aware of when mental and physical states deteriorates and not be dependent on [a relative] telling them. The home uses a monitored dosage system of medication administration and this appears well managed. All medicines are stored securely in a medicine trolley; during our last visit we saw that peoples medication records were being stored on top of this trolley and we said that records should be stored where they cannot be accessed by passers-by. This was addressed during the last inspection, however we saw these records are again being stored on top of the medicine trolley and they should be moved. A medicine fridge is available and the temperature is checked each day. All medication is checked and signed in when it arrives at the home and is signed for when administered to an individual; the Deputy Manager carries out a weekly medication audit. To further ensure the safety of the administration system, photographs of each person have been added to these records, manufacturers notes on all prescribed medication are kept and good practice guidance from the Royal Pharmaceutical Society has been obtained. During our last visit we were concerned that the home did not have a comprehensive system of assessment and management of bed rails which were in use. The Manager told us that a review has now been carried out and bed rails are no longer in use within the home. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person is treated as an individual and they make choices about their lives. People have limited opportunities to follow personal interests or take part in activities: they are supported to keep in touch with family and friends. People have nutritious and attractive meals and snacks. Evidence: The people living at the home we spoke with, and those who wrote to us, said they are generally happy living at Knights Templar Court. They are able to choose how to spend their time and staff respect their wishes. We spoke with people who were in communal areas of the home and some of those who choose to spend time in their own rooms. The home is set in large, attractive grounds and people are free to spend time outside, usually when the weather is warmer, if they wish. During our visit we saw people watching TV, some people were reading and another was completing a puzzle with help from staff. One person went out for a short walk; they told us they enjoy doing this and generally go out two or three times a day. Another person who lives in the home owns a dog; they told us they are glad they still Care Homes for Older People Page 16 of 34 Evidence: have their dog and staff help them look after them. The record of activities we looked at shows that a hairdresser visits each week, a religious service is held every Sunday and that various in-house activities are offered including indoor bowls, picture dominoes, puzzles, sewing, reminiscing and watching films. These sessions remain limited; we looked closely at the records for the last two months. During August there were only seven days where activities were recorded as happening and during September seventeen. People we spoke with said they would like more activities and trips out of the home. Comments from people who live in the home included: we do have some things going on here but I would like to go out, I really miss that, nothing much really happens here except the odd rare event, they need to provide more activities, there appears little time for staff to converse with residents and stimulation should be offered instead of [just watching TV]. The Manager agreed that the home needs to improve this and is working hard to develop an improved activities programme and encouraging people to join in. They told us two members of staff are currently working towards a National Vocational Qualification (NVQ) as activity co-ordinators, local school children visit to sing hymns, an entertainer is now coming into the home every two weeks and staff are encouraged to continue in-house activities. With regard to trips out, the home plans to buy a horse and carriage, as some people who live in the home said they would like this form of transport. People are also being supported to complete Memories of My Life books; four have been completed so far. These ask people to describe their childhood, schooling, where they worked, their family life and their hobbies and interests. These would help in developing activities in the home, as they describe peoples interests and would also help in making care plans more person centred by using some of this information. At present 13 people live at the home; there are two care staff on duty in the morning and again in the afternoon. Staffing levels will be reviewed as the number of people who live at the home increases. People told us there are usually enough staff working in the home to meet their needs; they said they do not have to wait if they ask staff for help. One person said I call for staff when I need them, they are very good and another person told us I have a call bell; I dont have to wait too long for help. Care Homes for Older People Page 17 of 34 Evidence: Each person is supported to maintain contact with their families and friends. Visitors to the home are welcome and relatives are kept up to date about important issues. Several people had visitors at various times during our visit; people were able to meet with them in communal areas of the home or in their own room. The people we spoke with said they were happy with the meals and snacks provided in the home; a cook is employed who was working on the day we visited. There is a planned menu which shows that a wide range of nutritious meals are freshly cooked in the home; a main meal, and the alternative offered each day, is written on a notice board in one of the lounges, nearest the dining area. One person told us the food here is good, you usually have a good choice and others said the food is good although I cant remember what I am having and the choices are written on the notice board each day. People choose where they wish to eat their meals; most choose the dining area which overlooks the grounds. If people wish to eat their meals in their own rooms, this is respected; should people have visitors who wish to stay for a meal, this is arranged for them. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care they, or people close to them, know how to complain. Any concern would be looked into and action taken to put things right. People are safeguarded from abuse and neglect and action would be taken to follow up any allegations. Evidence: The home has policies and procedures on how to recognise and report abuse, making a complaint and whistle blowing, which staff can use in confidence to raise any issue or concern they have regarding poor practice. Our contact details should be updated when these documents are next reviewed as, in some, they are out of date. There is a complaints book and visitors comments book; these are both kept in the entrance hall. The last complaints were recorded as being made in 2007, although the homes AQAA states they have had one complaint in the last 12 months; it is not clear where this has been recorded. The comments book contains several recent compliments regarding the grounds and gardens, one relating to one persons care and one issue where a visitor was unhappy their relatives bed had not been made. The people who live in the home we spoke with, and those who wrote to us, said they know they are able to complain if they are unhappy about any aspect of the home. One person said the manager has asked me if I have any problems or concerns, but I Care Homes for Older People Page 19 of 34 Evidence: dont and another person told us I have no complaints. Checks are carried out on staff to ensure they are suitable to work in the home and to protect people from abuse. Following our last visit we said there were some gaps in recruitment records which could place people at risk. During this visit we saw that new staff are subject to enhanced Criminal Record Bureau disclosures (known as CRBs) and a further safety check (known as POVA First). We did note that new staff start work in the home before their CRB is returned; on one occasion a member of staff did not disclose a caution they had received and had already started work in the home when their CRB was issued confirming this. This practice should therefore be reviewed by the home, as this may continue to put people at risk. Other comments regarding recruitment practice are contained in the Staffing section of this report. The staff we spoke with and those who wrote to us know what to do if an individual, family member or a friend is concerned about any aspect of the care and support they provide. Most staff have completed training in how to recognise and report abuse (currently known as safeguarding vulnerable adults) and each has their own copy of the homes whistle blowing policy. The home maintains a record of each accident, incident or other significant event which occurs. The Manager carries out an audit of these reports each month and they are also reviewed during the monthly auditing visits carried out by the Area Manager. We are notified of significant events together with any other concerns regarding individuals who live in the home. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Knights Templar Court is being improved to ensure it provides a homely, clean and comfortable environment for people to live in. Evidence: Knights Templar Court provides care and support for up to 20 older people; it is situated in the village of Templecombe that has local amenities such as a shop and pub. There is a railway station in the village which accesses the London Waterloo line. The home is set in large wooded grounds; the countryside views from the lounges and some bedrooms are far reaching. There are car parking spaces available for visitors. The home is not purpose built and has accommodation arranged over two floors; there is a stair lift, but no shaft lift. On the ground floor there are a number bedrooms, a hairdressing room, two offices, the laundry, kitchen, a large communal lounge and two smaller separate lounge areas; the dining area is next to the main lounge. The bathroom on this floor is now back in use. This room contains a hot water cylinder which is currently exposed; the Manager will contact a company who can advise on how this may be covered or concealed safely. On the first floor there are a number of bedrooms and a bathroom. The people who live in the home are encouraged to bring in personal items, furniture, pictures and photographs to help make their rooms personal to them and more Care Homes for Older People Page 21 of 34 Evidence: homely. Some of the bedrooms (currently in use) we saw during our visit did have many personal items; they were tastefully decorated and well furnished. We did view all of the communal areas of the home and the bedrooms not currently occupied; the home is in the process of being refurbished in many areas, to improve the living and working environment. One person who wrote to us said the public areas are very dirty in places and other comments included they need cleaner public areas and I had to make a complaint to get my mothers room cleaned. One lounge is currently not in use; this has some recently delivered bedroom furniture stored in it and has been prepared for redecoration and for the flooring to be replaced. We saw that some of the carpets in the home are very dirty and worn, some bedrooms need to be redecorated and some windows need to be replaced as they are rotten. During our visit the Manager and Area Manager produced an action plan for improvements which notes the following: four bedroom are to be completely refurbished, two bedrooms are having new windows installed, carpets in all hallways are to be replaced, the main hallway is to be refurbished, the exterior of the home is to be repainted, an allotment area is to be added to the rear garden and the fish pond is to be refurbished. There are varying timescales for this work, but the planned completion for all work is by Spring or Summer next year. A member of staff is employed on a full time basis to ensure the home is well maintained. Some bedrooms have an en-suite bathroom; only one person who lives in the home uses their facility and in other rooms the bath taps have been removed. Other people who live here share the communal bathrooms. The Manager told us they hope to remove the baths which are not being used and install wet rooms where possible as these will meet peoples needs and provide them with their own showering facilities. This is not mentioned on the current action plan and therefore appears to be a longer term goal. Staff have access to personal protective clothing such as gloves and aprons and there are hand wash facilities available around the home; the homes AQAA confirms they have an action plan for prevention and control of infection and that staff have had appropriate training in this area. Care Homes for Older People Page 22 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have appropriate support; staff are generally provided with the training they need to ensure peoples needs continue to be met. More thorough checks should be carried out on new staff to ensure they are suitable to work in the home. Evidence: The home currently employs 22 members of staff; there are 18 members of the team who are classed as permanent care staff. Four staff members have attained a National Vocational Qualification (NVQ); additional staff are currently working towards their awards and are due to complete these by next August. Between 7.30am and 9.30pm there are two members of staff on duty; overnight there are two members of waking night staff. On the day we visited there were two members of care staff on duty together with the cook; the Manager was due to have a day off but very kindly came into the home and fully supported the inspection process. The staffing levels appear to be sufficient to meet the needs of the people who currently live at the home; the Manager told us that staffing levels would be kept under review to ensure that peoples needs would continue to be met when new people choose to move into the home. Care Homes for Older People Page 23 of 34 Evidence: The people who live in the home we spoke with, and those who wrote to us, said they are treated well by staff; they are usually available when they need them and they listen to them and act on what they say. Those staff we observed supporting and interacting with people who live in the home had a good understanding of peoples needs and how to communicate effectively with them. Staff had a good rapport with individuals; there was a relaxed, homely atmosphere. One person who lives in the home said the staff are lovely, they look after me very well. Other comments were staff are very good and the staff appear friendly. The staff we spoke with, and those who wrote to us, said they are generally happy working at Knights Templar Court. They said there are usually enough staff to meet peoples needs and the way information is shared, between care staff and the manager, generally works well. When asked what the home does well comments included: meeting the needs of residents and keeping them healthy and looking after residents well and providing nicely cooked meals. When asked what could be improved one person said having some more time to give entertainment; other comments were keeping the home looking presentable, sometimes having enough staff to cover shifts and better communication between staff. Staff are provided with a variety of training courses to enable them to provide care and support to the people who live in the home. The training records we looked at show that staff are provided with the following courses: first aid, food hygiene, health and safety, manual handling, safeguarding, infection control and fire safety. The Manager also told us they wish to develop staff training further to ensure staff had the knowledge and skills to meet peoples changing needs; the training they would now like to access includes pressure area care and palliative care. There is a reasonably safe system of staff recruitment in place, but the home should review part of its current practice. We have already written in this report new staff are starting work in the home before their CRB is returned and checked; where this has happened there was no evidence that a risk assessment had been completed describing the measures the home would take to ensure new staff are supervised until their employment checks were completed. Looking at other recruitment records for new staff we noted that one member of staff has not had a reference from their last employer, only two personal references. We also saw that the homes application form asks for full details of the last employer but Care Homes for Older People Page 24 of 34 Evidence: then only asks for dates and brief duties of previous jobs people may have had, rather than a thorough employment history; this should also be reviewed. Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People generally have confidence in Knights Templar Court as the home is managed appropriately. Staff members must be given regular supervision to enable them to meet peoples needs. People control their own money and choose how they spend it; the environment is generally safe for people and staff because health and safety practices are carried out. Evidence: Knights Templar Court is managed by Mrs Lorraine Hill who is well qualified and experienced to run the home. Mrs Hill told us that she has identified many areas where the home could improve and has worked hard to implement some improvements with others planned. It is clear from speaking with her, and the Area Manager, they know the home is not at the standard they wish it to be; we spent time with both of them during our visit sharing good practice and discussing various ways Care Homes for Older People Page 26 of 34 Evidence: of improving the home. The people who live in the home we spoke with said they like the Manager and that they felt able to speak to her about any issue. Mrs Hill was seen speaking with people or helping to support them at various times during our visit; she had a good rapport with them. Some people who wrote to us said they have concerns that standards in the home have fallen since the change of ownership. One person said my [relative] came to this home prior to the current owner. It was a homely caring attitude..the home seems to be becoming more run down as time goes by. Other comments were it was a small friendly place with a lovely atmosphere. Standards appear to have fallen and it is difficult to have any meaningful discussion with the owners and it used to have a lovely family atmosphere but the home has become shabby, outside particularly. Last April the home needed to increase in the level of fees it charges; this appears to have been an issue, particularly with some relatives. However, this is not the sole reason for dissatisfaction. We discussed this issue with the Manager during our visit; Mrs Hill told us she is aware of these issues as she feels she has a good relationship with most relatives and they do say if they are unhappy with any aspect of the care and support provided by the home. Mrs Hill is also happy that the corporate management of the home has now changed (the management company are no longer involved) and that the Managing Director is very supportive. The home have a system in place to ensure a Quality Assurance review is carried out; people are given questionnaires to complete so they may comment on the quality of the care and support provided by the staff team. We were shown a sample of completed questionnaires; people said they were happy with the service the home provides. The completed forms are sent to head office; the results will be analysed and a report produced, but it was not clear when this would be done. Peoples records are stored securely. The Manager told us they do not act as a financial appointee or power of attorney for anyone. The home has a number of policies and procedures, which are designed to ensure that both the people who live in the home and the staff team are safe, the service complies with the law and remains aware of best practice or new ways of working. Staff understand these policies as they are asked to read them and they sign to say they have done so. Care Homes for Older People Page 27 of 34 Evidence: The Registered Provider, Greenview Care Limited, entered into a Company Voluntary Arrangement in June 2009. The purpose of the arrangement is to allow the Company time to pay its creditors up to that date in an orderly fashion whilst allowing the Company to continue to trade. The ability of the Company to continue with its business is unaffected by the arrangement and it is hoped that the future success of the home will be improved as a result of this arrangement. We were not formally notified until 19/10/09. The home is visited each month by the Area Manager, who completes an audit of the service. During these visits both people who live in the home and staff members are spoken with to gain their views on the quality of care and support provided; written records are also looked at. A clear record of each audit is kept in the home. There are systems in place to ensure the health and safety of people living and working at the home. A general check of the home is carried out each month and the temperature of hot water is tested regularly. The AQAA confirms that appropriate safety checks are carried out on the electrical wiring in the home, portable electrical appliances, the stair lifts and other lifting equipment such as bath hoists and portable hoists. We looked at the homes fire log book; the member of staff employed to maintain the home is a qualified fire warden. There is a Fire Risk Assessment in place; this appears to have been last reviewed in September 2008, so it is not clear if this is up to date. Regular checks are carried out on the fire alarm system and other fire fighting equipment; staff are also provided with fire safety training. Fire drills are carried out each time the alarm is tested; tests are carried out either in the morning or afternoon. Names of staff involved in fire drills have not been recorded until the last test on 15/10/09 so it is not possible to see which staff have attended any of the other tests. The Manager told us that night staff are asked to come in during the day to take part in fire drills; no drills are carried out during the evening. The home had a health and safety inspection carried out on 06/10/09 by South Somerset District Council. Their report notes that the home must take action in respect of the control of Legionella, ensure hot water does not pose a scalding risk, amend their manual handling policy, attend to some flooring which could be hazardous and provide confirmation that an asbestos survey has been carried out. The home has been given 12 weeks to complete these improvements. The AQAA states that staff are supervised six times per year and have an annual Care Homes for Older People Page 28 of 34 Evidence: appraisal. The records we looked at show that staff are appraised each year, but supervisions are irregular. One member of staff only had one supervision recorded this year and three staff have only had two. Also the records of each meeting are simply based on eight care tasks where a rating is given; there is no record of any discussions that may take place. The Manager told us they wish to change the form used to record supervision and showed us a template which they are considering using which is certainly an improvement on the current form. They also agreed that supervisions had slipped and, following the annual appraisals which are now due, the frequency of supervision would be improved. Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The Registered Person must complete the development and improvement of each persons care plan. This would ensure staff have clear and accurate information relating to each persons care needs. 19/01/2010 2 8 13 The Registered Person must ensure the way risks to people are assessed, and plans to reduce them, are improved. This would promote the welfare and safety of people who live in the home. 19/01/2010 3 12 16 The Registered Person must ensure that an full activities programme is put in place. This would ensure that each person receives adequate social stimulation. 19/01/2010 Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 19 23 The Registered Person must ensure the planned development and refurbishment of the home is completed. This would ensure the people who live at Knights Templar Court are provided with a comfortable and homely environment. 19/04/2010 5 29 19 The Registered Person must ensure sufficient checks are carried out on new staff. This would help to make the recruitment process more thorough and promote the safety of the people who live in the home. 19/12/2009 6 36 18 The Registered Person must 19/01/2010 ensure each member of staff is supervised regularly. This would ensure staff are being given the support they need to provide good quality care to people who live in the home. 7 38 13 The Registered Person must ensure that the improvements required following the recent health and safety inspection are carried out. 06/01/2010 Care Homes for Older People Page 32 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This would ensure the home is safe for people to live in. 8 38 10 The Registered Person must 19/12/2009 ensure that they know which staff have taken part in each fire drill. This would ensure that each person who works in the home would know what to do in the event of a fire and help to keep themselves and others safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 29 The Registered Person should consider updating the homes application form to request a full employment history of staff who are applying to work in the home. This may help to make the recruitment process more thorough and promote the safety of the people who live in the home. 2 30 The Registered Person should consider arranging additional training for staff, including support them to attain an NVQ, to ensure they have the skills to meet peoples changing needs. The Registered Person should consider revising the form used to record supervision sessions with staff. This would help to ensure staff are being given the support they need to provide good quality care to people who live in the home. 3 36 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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