Inspection on 22/10/08 for Knights Templar Court

This inspection was carried out on 22nd October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 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:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives 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, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Shelagh Laver     Date: 2 2 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 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: Conditions of registration: Category(ies) : Greenview Care Limited care home 20 Number of places (if applicable): Under 65 Over 65 20 old age, not falling within any other category Additional conditions: 0 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. 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. The average fee is five hundred pounds per week depending on the room occupied. Care Homes for Older People Page 4 of 27 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 focus of the inspection was to assess key standards under the Commission for Social Care Inspection Inspecting for better lives framework. We (the Commission for Social Care Inspection) have requested an Annual Quality Assurance Assessment prior to the inspection however this has not been received and appropriate action has been taken. The inspection was unannounced and took place over one day by one inspector. The registered manager Mrs Lorraine Hill was available to answer all queries and to provide all requested information. Care Homes for Older People Page 5 of 27 A tour of the home enabled all people who live in the home to talk to us. Some were in the main sitting room, others were in their bedrooms. Documentation relating to the care of people and the selection and training of staff was reviewed. Further information regarding the corporate management of the home was requested and received following the visit. During the inspection people were assisted to complete questionnaires, others talked freely to the inspector. Two visitors to the home and five staff members talked to the inspector. What the care home does well: What has improved since the last inspection? What they could do better: The service has recently undergone a period of uncertainty with regard to the corporate management of the home. This has meant that when the manager was injured there was no robust system in place to support her and the home. People who lived in the home continued to be well cared for. There should be menus available so that people can make informed choices about their meals. People do have alternative meals such as salads but not all people knew what choices were possible. People wanted more activities and entertainment. Some people want the chance to go out on trips. The care plan system should be reviewed and up-dated. The current system contains repetition of some areas and omits important areas of care for some people. For people who have more complex needs care planning and staff training must be in place to Care Homes for Older People Page 7 of 27 ensure that people are not at risk of pressure damage. (The home currently does not have anyone with pressure damage.) There must be a system of assessing and checking the safety of bed rails in the home. during the inspection one bed rail was found to be very loose. This was addressed immediately but the manager must ensure that all other people in the home are protected from the risk of entrapment and that bed rails are fitted safely. There is a system of staff training and supervision in place . The manager should ensure that appraisals ans supervisions are up-to- date. There are systems in place to meet health and safety requirements however there should be a complete audit of all systems and consideration given to who is going to do the regular checks and maintenance in the future. The quality assurance system should be fully implemented. Peoples should have the opportunity to formally give their views on the home and there should be a management system in place that acts on the outcomes of these findings. The corporate management of the home should be sufficiently robust to support the manager. This will include providing structured support in the event of illness and injury. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 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 9 of 27 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. The home has information available for people who are considering coming to the home. People receive a full assessment before they come to the home to ensure that the home is able to meet their needs. Evidence: The home has produced a statement of purpose and service user guide that is readily available to people who might want to come to the home or their families. Three care documentation files were reviewed. Each contained an assessment document that was clear and indicated peoples needs. The home manager visits prospective in hospital or at home to confirm that the home Care Homes for Older People Page 10 of 27 Evidence: can meet their needs. People spoken to in the home were able to talk about the visit from the manager. People are not always able to visit the home prior to coming to stay. One person talked about the arrangements made by her family but was very satisfied by the home. People receive a letter offering them a place. Terms and conditions of occupancy are clearly set out. Care Homes for Older People Page 11 of 27 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. Care plans are written in plain language and give staff clear information about meeting peoples needs. The planning and implementation of care for people with more complex needs should be reviewed and up-dated. People have access to medical and health care professionals and services as required. The homes medication practise is basically sound but there is a need to improve some recording practise. Evidence: People said that they were pleased with the standard of personal care in the home. Three care plans were examined. The files were organised and written clearly. Two contained sufficient information to enable care to be delivered for people whose current needs were not complex. People confirmed that the doctor would visit when required. Community nurses visit Care Homes for Older People Page 12 of 27 Evidence: the home regularly when required and support people in the home with a range of nursing services including dressings and regular injections. The care plan for one person with more complex needs required improvement. This person was at risk of pressure damage and had been supplied with a high risk mattress. There were no clear records of the action being taken by home staff to prevent damage. There was no clear plan to ensure that nutrition and fluids were maintained or evidence of how continence had been managed. It was evident from reading the daily records that the nurses had visited and action had been taken but there was no clear evaluated plan. Other people had been supplied with lower risk equipment. Currently no one in the home has any pressure damage but staff should receive up-dated guidance and training. We spoke with one of the nurses who confirmed that the home would regularly refer people for GP or nurses treatment. A review of the medication records showed that although there is a basically safe system in place there were a small number of examples of incomplete or unclear recording. Staff in the home have been offered training and in some cases supervision. The Medical Administration Records are stored on top of the medicine trolley in a corridor. The records should be stored where it cannot be accessed by passers-by. This was addressed during the inspection. One bed rail was seen to be poorly fitting. This was addressed during the inspection but a comprehensive system of assessment and management must be implemented in the home to ensure the future safety of all people. Care Homes for Older People Page 13 of 27 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. People make choices about how they spend their days. People should be offered more social activities that they want to participate in. Food provided in the home is appetising and wholesome. menus should be in place and displayed to enable people to make informed choices about the meals they will eat. Evidence: People are able to chose how they spend their days at the home. During the inspection people were met in the communal lounge and in their rooms. At five to eleven eight people were waiting for their morning hot drink and biscuits. Some people were talking to each other or reading the papers. There was a relaxed friendly atmosphere. However all people spoken to agreed that they would like more activities in the home. One person said We would like trips out sometimes. Another person said Well really we just sit about here. Some people are able to go out with their families and some have very regular visitors. Care Homes for Older People Page 14 of 27 Evidence: One lady has a small dog. No one knew what lunch was but one lady said it will be lovely whatever it is. Other people were in their bedrooms. One person was reading, another was watching television. People have lovely views from most rooms. From one room someone was watching birds feeding from a range of feeders. She said I love watching the seasons change. The manager of the home said that there were plenty of games and activities available but people did not want to join in. People should be consulted and a programme of social events should be devised ad advertised. The home should devise a system of recording peoples interests that assists planning. There have been menus through the summer and the winter menus are in preparation. All people spoken to said that the food was good. Very eatable home cooking one person commented. Another said that choice was available and that meals were nicely presented. The inspector was offered a meal that was appetising and well cooked. Other people were seen enjoying a salad alternative meal. One person said that the home tried hard to ensure they enjoyed the meals. Two visitors were seen during the inspection. Both were pleased with the standard of care provided to their relatives. Care Homes for Older People Page 15 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures in place to safeguard people in the home. There is a complaints procedure in place that people would feel happy to access when required. Evidence: The home has a complaints policy. People spoken to during the inspection knew who to talk to if they needed to make a complaint. People said that small concerns would be quickly sorted out by the manager. The manager has accessed a copy of the local Protection of Vulnerable Adults policies and procedures. A training up-date is planned for all staff. There are recruitment procedures and policies in place to protect people from abuse although there were some gaps in the records examined at inspection. People in the home said they felt very safe and would feel quite happy raising any issues with staff. Care Homes for Older People Page 16 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a very attractive environment for people. The home is clean and comfortable. A review of the bathing facilities should be undertaken to ensure that people have sufficient choice and that facilities are available when needed. Evidence: The home is situated in a wooded garden. One relative said There is something special about this place. It could be the bird song. The countryside views from the sitting rooms and some bedrooms are far reaching and delightful. One person said I am happy just looking out of my window and watching the seasons change. There are some very pleasant bedrooms and overall the home is bright, clean and well decorated. The home is fortunate to have a large communal lounge and two smaller sitting areas. People who stay in their rooms because they do not like communal living could be made more aware of the smaller areas where they could access fresh air or a change of outlook. At the time of the inspection some work is planned to the bathing facilities. There is one bathroom where assisted bathing can be offered. Other rooms have traditional bathing facilities but these are not practical for people. Some of these baths have the Care Homes for Older People Page 17 of 27 Evidence: taps removed and consideration must be given to maintenance and water testing. A certificate of recent water tests was sent to the inspector. There was evidence of facilities for staff hand washing and infection control techniques. Care Homes for Older People Page 18 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures in place to ensure that staff recruitment is robust and protects people but there were some gaps in records. Staff training and supervision takes place but there must be more robust systems in place to ensure that all staff are trained and monitored appropriately. Evidence: Staff rotas indicated that there are usually sufficient staff on duty to meet peoples needs although people said at times staff could be rushed. The home does use agency staff at times to maintain numbers. Three staff files were seen. There is clearly a system of robust recruitment in place but there must be attention to detail. In one file two references and a Protection Of Vulnerable Adults check had been received before the member of staff started at home. The Criminal Record Bureau checks had arrived a month afterwards. It was not clear that the staff member had been supervised during induction. It was clear that they had received manual handling training and some induction. In the file of another new member of staff records indicated that a POVA check and Care Homes for Older People Page 19 of 27 Evidence: one reference arrived before the person started work. The second reference was not dated. There was evidence of supervision and appraisals but these needed to be up-dated particularly for established staff. There is evidence that staff receive mandatory training and that up-dates have either occurred or are planned. Staff have received training in infection control, first aid and manual handling. Staff were undertaking essential food hygiene training on the day of inspection. Care Homes for Older People Page 20 of 27 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. The manager of the home Mrs Hill has the required qualifications and experience to run the home. The homes health and safety policy and practise is generally good. The manager should audit the systems and ensure the plans are sound for future implementation of regular maintenance and servicing. The quality assurance systems including seeking the views of people who live in the home should be fully implemented. Evidence: The home has recently undergone a period of uncertainty and difficulty. The manager Lorraine Hill is well qualified and experienced to run the home. It was clear that systems had been implemented by Mrs Hill and that she is committed to the best interests of people in the home. Care Homes for Older People Page 21 of 27 Evidence: A period of injury has meant that whilst Mrs Hill has continued to try and work some areas of management now need attention. The management structure that should have supported Mrs Hill during her illness has also been changing and therefore appropriate help does not seem to have been available. People living in the home have continued to be well cared for and action has been taken to ensure that future management of the home is more robust. The inspector spoke with director of the home Lee Wilkins who confirmed that in future Mrs Hill would have the support of a qualified and experienced area manager. A system of independent audit and inspection has been implemented as part of the implementation of a quality assurance system. The reports of monthly visits will be sent to the Commission. We have not received a completed Annual Quality Assurance Assessment from this service as a result in the changes to management arrangements. This has been required. There are arrangements in place for key servicing in the home but it recommended that a complete audit of all health and safety systems in the home is completed and that there is an agreement regarding who will undertake regular maintenance, water checks and fire prevention tests. A formal system of quality assurance must be put in place to seek feedback from people who use the service so that the need for improvements can be identified and implemented. Care Homes for Older People Page 22 of 27 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 23 of 27 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 format and recording of 11/01/2009 care plans must be reviewed to ensure that they meet NMS guidelines. Care plans currently omit some key areas when people are in need of complex daily care. 2 7 13 A system of assessing and maintaining bed rails must be implemented in line with current clinical guidance. Action must be taken to avoid putting people who live in the home at risk of harm from ill fitting bed rails. 11/12/2008 3 12 16 The home must consult people about their social interests and make arrangements for them to have a programme of social activities and events. 20/12/2008 Care Homes for Older People Page 24 of 27 People in the home say that there is not enough to do. There is no activities programme displayed. 4 15 12 The home must ensure that 20/12/2008 there is a planned menu and that it is displayed making clear the choices that are offered to people. People do not know what is for lunch. The menus are currently not planned in advance. 5 29 19 The manager must ensure that the recruitment policies and procedures are always followed and that records reflect this has occurred. Staff files contained evidence of recruitment checks but there were some gaps. It was not clear from the files exactly when someone had commenced actual work. 11/12/2008 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 2 7 7 It should be clear from care plans that people have been involved in drawing up their care plans. The system of care planning should be reviewed to ensure it is meaningful and avoids repetition. A system of auditing care plans should be established to improve the effectiveness of plans. The review of bathing facilities should proceed as soon as possible to provide a choice of facilities to meet peoples Page 25 of 27 3 21 Care Homes for Older People needs. The recommended ratio of 1 assisted bath to 8 service users should be re-instated. 4 30 The manager should compile a training plan for the home that ensures all staff have appropriate training up-dates in the next year. The quality assurance systems should be fully implemented in the home. This will include a system of seeking peoples views and plans to improve the service. The manager should review the systems and practises that ensure health and safety in the home. There should be a system of planned maintenance. 5 33 6 38 Care Homes for Older People Page 26 of 27 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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