CARE HOMES FOR OLDER PEOPLE
Knights Templar Court Throop Road Templecombe Somerset BA8 0HR Lead Inspector
Ms Sue Hale Unannounced Inspection 22nd October 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Knights Templar Court Address Throop Road Templecombe Somerset BA8 0HR Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01963 370317 01963 370759 Greenview Care Limited Mrs Lorraine Hill Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 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: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 20. New Service Date of last inspection Brief Description of the Service: Knights Templar Court is registered to provide personal care for up to 20 older people. The registered manager is Mrs Lorraine Hill. The home 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 has large gardens. The accommodation is arranged on two floors and there are a variety of communal areas for residents use. Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of this inspection was to assess relevant key standards under the Commission for Social Care Inspection ‘Inspecting for better lives 2 framework’. This focuses on outcomes for residents and measures the quality of the service under four general headings, excellent, good, adequate and poor. These judgement descriptors are given for the seven outcome groups in the report. The home completed an Annual Quality Assurance Assessment prior to the inspection. Surveys were sent to some residents, staff, relatives and other professionals who have contact with the home. Fifteen staff, three residents and five relatives returned surveys and their comments are incorporated into this report. All the residents described their ethnicity as white and British. There were sixteen people living in the home on the day of the inspection. The inspection was unannounced and took place over the course of one day in October 2007.It was undertaken by one inspector who was accompanied for part of the day by a volunteer ‘expert by experience’, whose comments are incorporated into the report. This is the first inspection since the change in ownership and also since the registered manager, Mrs Lorraine Hill started work at the home. The inspector undertook a tour of the home and looked at selected residents and staff files and other documentation including policies and procedures, the complaints log, statement of purpose and service user guide. The inspector spoke to the manager, some staff, a visitor and to some of the people living in the home. The current fees are from £393.30 to £450 although these details were not included in the joint statement of purpose/ service user guide. What the service does well:
All prospective residents and their relatives/representatives are given written information about the home before they move and an individual reference copy if they decide to live at the home. They are encouraged to visit the home and their needs are fully assessed by Mrs Hill before they move in to make sure the home can meet their needs. All residents are given details of the terms and conditions of residency that is clearly written in plain English. All residents have an individual care plan and relevant risk assessments that are clearly written and give staff guidance on how to meet assessed needs.
Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 6 Residents are asked to sign their agreement to the care provided. Medication practice was well organised and safe. Activities at the home have increased and monthly events are arranged such as a visiting entertainer, ladies day, and the forthcoming Halloween party. Residents rights to privacy and dignity is respected by staff and residents are satisfied with the care they receive and the way in which it is delivered by staff. Visitors to the home are encouraged and made welcome by staff and are now invited to attend events. All the people spoken to were very satisfied with the standard of the food served at the home. Individual preferences were known and catered for by care staff and the cook. Residents could choose to have their meals in the dining room or in their own rooms. The kitchen records were well kept and the kitchen clean and tidy. The resident’s had been consulted about the planned review due to be made to the menus The home has not received any complaints and has a clear complaints policy that residents and visitors are aware of. Policies and procedures are in place to protect residents from the risk of abuse, including staff training and robust recruitment policies. There is enough staff employed to meet resident’s needs and residents feel confident that the staff are providing a good service. All have access to appropriate training. All staff are formally supervised to make sure their practice is good and they receive structured support from the manager. The new management are addressing the issue of a lack of staff training and encouraging staff to attend courses to make sure they have the skills and knowledge to provide a good service for people who live in the home. It was clear from talking to Mrs Hill, residents, visitors and staff that great efforts are being made to further improve the standards at the home to benefit the people who live and work there. The home was clean, tidy and free from unpleasant odours. It is furnished and maintained to a good standard with a planned refurbishment programme in place. Residents are able to bring in furniture and personal belongings to personalise their private room Resident and staff meetings have been held and the views of those living and working in the home are being taken into account by Mrs Hill in relation to the planned changes and improvements made since the new owners took over. Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 7 All the relatives surveyed said the atmosphere at the home was warm, caring and friendly, people living there confirmed that they shared this view. Staff were observed to be courteous and appropriately friendly towards residents. One resident described staff as ‘supportive but not intrusive’. Residents are seen as individuals and the home tries hard to accommodate their individual needs and characters. One resident said that ‘nobody wants to be in a residential home but if you have to this is as good as it gets’. An ongoing refurbishment programme is in place to improve the environment for people living there. What has improved since the last inspection? What they could do better:
The service user guide/statement of purpose should include the name, address and telephone number of the Commission for Social Care Inspection, a copy of the complaints policy giving specific details of how complaints will be investigated, the timescales and who by, the views of residents, reference to the Commission for Social Care Inspection report and where this can be obtained by prospective residents and their families, a copy of the terms and conditions of residency and a standard form of contract. It should also include details of current fee levels. The terms and conditions of residency should make clear who is responsible for paying the fees, i.e. the resident or a funding authority. The advocacy policy should acknowledge that many residents may not be able to ‘self advocate’ and should include the contact details of local advocacy services and the Commission for Social Care Inspection. Regular monitoring of the temperature in the main lounge should be carried out and it should be checked if the size of the radiator is sufficient for the size of the room. Risk assessments should be undertaken in relation to the building, gardens and paths and any action necessary to reduce the risk to residents should be recorded. The staff application form should not include equal opportunities details; these should be gathered separately and anonymously to enable the manager to monitor the homes recruitment practices. Efforts must be made to increase the number of staff qualified to NVQ level 2 to make sure that staff have the skills and knowledge to provide a good standard of care. Checks on agency staff
Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 8 should include obtaining details of their qualifications and confirmation that they have current satisfactory POVA First and CRB checks. Water temperature checks should be made weekly and the results recorded, control measures should be put in place to reduce the risk of legionella. This should include checks of the temperature and storage of standing water and running the water in empty rooms at least weekly. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has developed a joint statement of purpose/service user guide, which sets out the aims and objectives of the home and includes basic information. Admissions to the home are not made until a full needs assessment has been undertaken by Mrs Hill or the deputy manager. The prospective residents and their families are fully involved in the assessment and are encouraged to visit the home before making a decision on residency. All residents are provided with a statement of terms and conditions of residency/contract that sets out in plain English what is included in the fee, the role and responsibility of the provider, and rights and obligations of the individual. EVIDENCE:
Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 11 The home produces a joint statement of purpose and service user guide that is readily available to prospective residents, their families and funding authorities. This is clearly written in plain English and a copy is given to all residents when they move into the home. The document includes the majority of the information that should be in a statement of purpose (except for the specific size of rooms in the home) but does not include all the information required or recommended to be included in a service user guide. All the relatives surveyed said that they had received enough information about the home. Some residents spoken said that they had looked around the home before they moved in but others had been unable to visit and their family had chosen the home. The home produces a terms and conditions of residency that includes details of the room to be occupied and what is included in the fee but should make clear who is responsible for paying the fees, i.e. The resident or a funding authority. The home has an equal opportunity policy relevant to people living there which acknowledges peoples rights to be seen as individuals and makes clear that the home will make all efforts to meet individuals needs and aspirations. The homes pre admission assessment covers all the topics recommended in the national minimum standards. The inspector looked at the personal files of two residents who had moved into the home since the last inspection. Both files clearly showed that the homes manager, Mrs Lorraine Hill, had undertaken a pre admission assessment, these are carried out at the prospective residents home, hospital or wherever they are staying. This gives the manager and prospective resident the opportunity to meet and make sure that the home can meet their assessed needs before they move. The home had also confirmed that they could meet the individual needs and confirmed this in writing when offering a place at Knights Templar. A copy of the funding authorities assessment had been obtained and kept with the care plan. Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plan is written in plain language and gives staff clear information about how individual’s needs are to be met. It is kept up to date and includes relevant risk assessments. Residents have access to medical and healthcare professionals and services as required. People have the aids and equipment they need to maintain their healthy and safety. The homes medication practice is good. Staff have completed an appropriate course and the manager has assessed all staff as competent. EVIDENCE: The inspector looked at selected residents care plans, these have been changed to a new system since the present owners took over. The care plans
Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 13 contained good detail of residents needs and gave clear instructions to staff on how such needs should be met. Daily records were completed and contained good detail of what care had been given and how the residents had been during that time. Information on one file checked was not consistent between the falls risk assessment, the assessment and information supplied by the funding authority. All files checked contained good records of contact with chiropodists, opticians and dentists. The records about contact with district nurses and G.P’s contained details of what advice had been sought and details of any treatment given. Medication reviews were recorded and any changes in medication were clearly recorded. However, there had been a drug error following a medication review. This had not been notified to the Commission for Social Care Inspection as required by the Care Home Regulations 2001. Pressure relieving equipment and assessments were in place to reduce the risk of pressure sores and none of the residents had any problems on the day of the inspection. Falls risk assessments were in place and falls were audited by Ms Hill to determine any common causes and enable her to take appropriate action. The files checked did not contain a nutritional assessment although the area manager told the inspector that the home used the MUST assessment tool, this was not evident on files checked. As the care plans and assessments had all been completed relatively recently following the introduction of a new care planning system, they had not been subject to review unless a change in circumstances or need had occurred. Ms Hill told the inspector that a monthly review system would be starting shortly. It was also planned to complete a life history for each resident with their and families involvement. Medication practice in the home was checked. All medication was labelled. Details of an allergy were seen on one residents care plan and this had been crosschecked with the MAR sheets. Records were well kept, with photographs of residents, sample signatures of staff and systems in place to audit medications and return unused items to the pharmacy. All staff that administers medication had undertaken appropriate training. The home does not keep homely remedies, but requests any treatment necessary from the residents G.P.Advice was given in relation to this and information produced by the Commission for Social Care Inspection pharmacy inspector was sent to the home after the visit. Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The routines of the home are as flexible as possible to meet the individual needs and preferences of people who live at the home. Visitors to the home are encouraged and made welcome. Activities within the home have increased but the range is limited and dependent on care staff having the time available to arrange things. There are no opportunities for residents to take part in community or local events outside the home. The menu is varied and residents are satisfied with the standard of food provided. Assistance, if required, is provided in a sensitive manner. EVIDENCE: Mrs Hill told the inspector that an entertainer now comes into the home monthly, tea parties are held monthly with an invitation extended to relatives
Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 15 and friends of residents. A teddy bears picnic and a ladies race day had been held. A Halloween party was due to take place the week after the inspection; this was advertised in the entrance hall. Whilst the statement of purpose says that the home will ‘provide a variety of meaningful actives for all residents both inside and outside the home environment’, all residents spoken to said that there was no support available to go out of the home and that they would welcome the opportunity to go out to the village and on outings to local attractions, One resident said that they would enjoy being able to go shopping so that ‘I can choose my own cards and presents to give to my family for their birthdays and Christmas’. No activities were taking place on the day of the inspection. Residents are supported to follow their religious faith if they want to and clergy visit the home on a regular basis, one member of staff also arranges regular hymn singing. All residents spoken to confirmed that they are able to see their visitors at any time and could see then in private or in the communal areas. A visitor spoken to said they were always made welcome by staff and felt able to visit at any time without notice. Residents said that their privacy was respected by staff that knocked on their door before entering and that staff were always friendly but polite and courteous. Residents also said that they were able to get up and go to bed at time to suit themselves. All the residents surveyed and spoken to said that the food at the home was ‘very good’ and confirmed that there were always choices available. Breakfast was seen to be available at times to suit resident’s individual choices. The main meal is served at lunchtime with a choice of two hot meals and salad available as a third alternative. It was observed on the day of the inspection that discreet assistance was available if needed and that staff were familiar with residents likes and dislikes. The cook sees all residents daily to find out what they would like to eat and she also confirmed that special diets were provided as necessary and that special occasions such as birthdays were celebrated with a birthday cake and special tea. The cook told the inspector that she and Mrs Hill were planning to review the menus and records confirmed that at a residents meeting held in August had discussed the menus and residents were asked to make suggestions as to what they would like to see included. Drinks and snacks were readily available throughout the day as required by residents. The inspector observed that there was good supply of good quality tinned, dried and fresh food available. The cook confirmed that they were able to order food in sufficient quantities and that the quality of the food purchased, particularly vegetables and meat had improved recently. Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,19 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints policy and residents and relatives understand how to make a complaint and are confident that they would be listened to and taken seriously. Corporate policies and procedures are in place to safeguard people who live at the home and staff are trained and confident in how to identify and manage such a situation. The home needs to obtain locally agreed multi agency guidance and procedures for the reporting and investigation of any allegations of abuse. Checks in relation to the use of agency staff are not robust and do not safeguard residents. EVIDENCE: The home, or the Commission for Social Care Inspection had not received any complaint since the last inspection. The homes complaints policy includes the timescales within which a complaint would be investigated, the address and contact number of the CSCI and makes clear that complainants can contact the Commission for Social Care Inspection at any time. All the residents spoken to
Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 17 during the inspection were clear that they could raise any concerns or complaints with Mrs Hill and were confident that they would listened to and taken seriously. Surveys from residents and relatives also confirmed this. Staff had attended training in adult protection issues in September 2007 and all 15 staff who returned survey forms said that they were clear about how to protect the people in their care and that they had access to relevant policies and procedures to help them do their jobs properly. The home has a corporate adult protection policy, this should make clear that no one in the home would undertake initial questioning of a resident making an allegation but would follow locally agreed multi agency procedures and refer to the appropriate agency. The home does not have a copy of the locally agreed multi agency policy on safeguarding vulnerable adults. Advice was given on how to obtain this. The home has an advocacy policy that promotes ‘self advocacy’ but doesn’t include any contact details for local advocacy agencies or the Commission for Social Care Inspection, for those residents and their families who may be unable to ‘self advocate’. However, the manager stated that some information is available in the home for residents about advocacy services. Appropriate checks took place before new staff started work to make sure residents were safeguarded from the risk of abuse. However, the home has used agency staff and checks in relation to them having a current satisfactory POVA First and CRB check were not in place. The homes gift policy makes it clear to staff they must not assist with or benefit from residents wills and must not accept gifts. The home has a whistleblowing policy for staff that includes the contact details of Public Concern at Work but not the contact details of the Commission for Social Care Inspection. A policy giving staff advice and information about how to manage physical and verbal aggression by residents was in place. Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides physical environment that is appropriate to the needs of people who live there. People are encouraged to personalise their rooms. The home is well lit, clean and smells fresh. The shared areas provide a choice of communal space with opportunities to relatives and friends in private. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of people who live there. Staff will all undertake training in infection control in the near future. EVIDENCE:
Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 19 The home provides bright and spacious accommodation for residents that is nicely decorated and well maintained. The home was clean and tidy on the day of the inspection and free from unpleasant odours. All residents surveyed said that the home was always or usually clean and fresh and people spoken to on the day of the inspection said that their personal rooms were always kept clean and tidy by staff. Individual rooms have been personalised by residents with them being encouraged to bring small items of furniture and other things with them when they moved into the home. The home was generally warm except the main lounge where residents told the inspector that it was rarely very warm in there. All the residents on the day of the inspection had a jumper and cardigan on and some people had blankets on their legs and/or around their shoulders to maintain a comfortable temperature. There are a number of communal areas, all comfortably furnished. There are large gardens around the home proving pleasant views and a number of level patios. Risk assessments in relation to the buildings, gardens and paths were not in place. There is a separate hairdressers room. Upstairs windows have restrictors fitted and radiators are covered to reduce the risk of scalds to residents. Communal bathrooms and toilets have appropriate aids, adaptations and equipment available to meet individual needs. Appropriate laundry facilities are provided. Laundry and cleaning solutions are stored safely in a locked cupboard. Protective clothing and gloves to reduce the risk of infection are supplied and all staff will undertake infection control training in January 2008. Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient staff employed at the home to meet individual’s needs and people who live in the home have confidence in the staff that look after them. The organisation has arranged appropriate training for all staff to make sure they have the right skills and experience to carry out their role although the numbers of staff with NVQ currently employed is only 35 . The service has a recruitment policy relating to permanent staff that safeguards people living at the home. Procedures when using agency staff are poor. EVIDENCE: The staff files of three members of staff were checked. Two contained a photograph, a record of interview, proof of identity, an application form and two references. POVA First and CRB checks had been undertaken. One file did not contain any references, Mrs Hill stated that they had been obtained and faxed them to the Commission for Social Care Inspection so that they could be verified .One file did not contain copies of qualifications claimed on the person
Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 21 application form. All staff are given their own copy of the General Social Care Council code of conduct. Three resident returned surveys and they all said that there was always or usually staff available when they needed assistance. The staff rota confirmed that there is three staff on duty all day and two staff awake at night. The rota did not record who was in charge of each shift or who the person qualified in first aid was on each shift. All staff are aged 18 or over and all senior staff are aged 21 or over. There are 20 staff with 35 qualified to NVQ level 2 or above with a further 6 person registered on an NVQ training course. The home has used agency staff during the summer period and the manger stated that a procedure was in place to record workers POVA First and CRB checks. However, examination of these records show that none of the agency staff used had current satisfactory POVA First and CRB checks. The home hadn’t obtained information about the agency staff’s level of qualifications. The home has an equal opportunity policy for staff and requests information relevant to this on the staff application form. All staff undertakes a Skills for Care induction programme. All the residents and visitors spoken to spoke highly about the staff and comments included that they ‘were very friendly and caring’ and that ‘the staff are very friendly which creates a very happy atmosphere at the home’. Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 22 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager, Mrs Hill, has the required qualifications and experience and is competent to run the home. Mrs Hill is working to improve the service and provide an increased quality of life for residents. The service has corporate policies and procedures which Mrs Hill and staff are aware of and follow to achieve a consistent quality of service. Staff are given support and appropriate supervision by the manager who fosters an open, approachable style of management for residents and staff alike. Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 23 The homes health and safety policy and practice is generally good with some improvements already identified by the manager as necessary and steps in place to rectify outstanding issues. EVIDENCE: Mrs Lorraine Hill has been the registered manager at the home since March 2007.Mrs Hill has achieved NVQ level 4 and the registered mangers award. She has several years experience in the care sector and has undertaken relevant training including, dementia care, protection of vulnerable adults, challenging behaviour and managing diversity in the workplace. All the staff and residents were very positive about Mrs Hill and comments included that she was ‘always available’, ‘approachable’ and ‘very nice’. Staff spoken to confirmed that there was always support available when needed and that Mrs Hill has held one residents and two staff meetings since taking over the home, with minutes kept of all meetings. It was clear that all people had been encouraged to be honest and open about their views of the home and that these would be taken into account with any planned changes. There has been very little change in the staff team since the new owners took over and this has been very positive in providing continuity of care for residents. The home follows corporate quality assurance systems and undertakes audits of residents and relatives, but not exterior stakeholders. Mrs Hill told the inspector that this had been undertaken in May 2007 but the collated results were not available on the day of the inspection. The home doesn’t manage resident’s personal finances. All items such as hairdressing, newspapers are invoiced with the monthly fees. Staff files checked showed that staff receive regular formal supervision from Ms Hill and all but one staff survey forms confirmed this. The majority of the staff surveyed said that there was always a senior member of staff to confer with and staff and residents spoken to were clear that Ms Hill was approachable and had an open door policy if anyone wished to speak to her. Staff spoken to on the day of the inspection also confirmed this. Records showed that all equipment in the home had been regularly serviced and well maintained, including the hard wiring and central heating system. Accident records were well kept with accidents being audited by Mrs Hill to enable preventative measures to be put in place where possible. Accidents had been entered in the daily records on all but one file checked. Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 24 Kitchen records were well maintained and the temperatures of fridges, freezers were kept. The cook has recently completed a food hygiene awareness course that had been ‘really useful’ and given them good practice advice. Weekly checks of the water temperatures were not undertaken and there were no control measures in place to reduce the risk of legionella. The emergency lighting system had not been checked, this was arranged for the week following and a new call system was planed to be introduced shortly. Ms Hill told the inspector that since she started in post she had audited the staffs training qualifications and not all staff have completed up to date mandatory training. Training had been arranged for training in health and safety, emergency first aid, moving and handling all of which would take place by the 7th December 2007. Infection control training was booked for January 2008 for all staff. Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No – new service STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation Schedule 1(16) 5(b-f) Requirement The registered manager must ensure that a statement of purpose and service user guide that includes all the information required is made available to existing and prospective residents. The registered manager must ensure that all people working at the home have a satisfactory and current POVA First and CRB check Timescale for action 31/12/07 2 OP29 OP18 Schedule 2 (7), 19(1)(b) (i), 4)(b)(i) 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP18 OP25 OP28 Good Practice Recommendations The manager should obtain a copy of the locally agreed multi agency procedures to safeguard vulnerable adults. Risk assessments should be undertaken in relation to the buildings, gardens and paths. Efforts must be made to increase the number of staff qualified to NVQ level 2 or above. The NVQ qualifications
DS0000069366.V353376.R01.S.doc Version 5.2 Page 27 Knights Templar Court 4 5 OP38 OP38 of agency staff should be obtained and recorded. Information should be obtained and control measures should be put in place to reduce the risk of legionella. Water outlets should tested regularly and the results recorded. Knights Templar Court DS0000069366.V353376.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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