CARE HOMES FOR OLDER PEOPLE
Templecroft 42 Scartho Road Grimsby DN33 2AD Lead Inspector
Bev Hill Unannounced 9 August 2005
th 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 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. Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Templecroft Address 42 Scartho Road, Grimsby, DN33 2AD Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01472 752684 Dryband One Ltd Ann Elizabeth Martin CRH 40 Category(ies) of OP 40 registration, with number of places Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 17.11.04 Brief Description of the Service: Templecroft Care Home is situated in the town of Grimsby on a regular bus route and within walking distance of the main shopping areas. The home provides accommodation and care for up to forty people over the age of sixtyfive and in no other category. District nurses provide any element of nursing care that may be required. There are two floors with a passenger lift and stair access. There are three lounge areas and a large dining room with individual tables set out. Patio doors open from the dining room onto a paved courtyard that has a raised pond and an area for tables and chairs. The home has seven shared bedrooms and twenty-six single rooms, eight of which have en-suite facilities. The home has two bathrooms with parker baths, a shower room for more able service users and an unassisted bathroom that is rarely used. All these rooms have toilets in them. The home has further single toilets throughout, near the lounge and dining areas. There is a good-sized car park at the front of the building. The environment is homely, clean and well presented. There are four or five care staff on duty throughout the day as well as the registered manager and three waking night staff. The home also has a good complement of domestic, laundry, cooks and kitchen assistants.
Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day. The Inspector spoke to the manager and three care staff that were on duty at the time of the inspection. Throughout the day the Inspector spoke to eight people who lived at Templecroft and one relative and received feedback cards from a further four relatives. The inspector looked at a range of paperwork in relation to staff recruitment, rotas, quality assurance, care plans, accidents, risk assessments, the servicing of equipment, fire prevention management, policies and procedures and complaints. The Inspector also checked that people who lived in the home had the opportunity to suggest changes and were listened to. The Inspector completed a tour of the building and checked that all the things that needed to be done from the last inspection had been done. What the service does well:
The care that people required was written down in care plans. It was clear from looking at them, that the manager and staff team had worked very hard to make sure that the care plans were detailed and included everything that was needed. They made sure that any changes in people’s care needs were included and they checked them monthly to make sure they were still all right. People spoken to say that they were looked after very well. People who lived at the home stated they liked the meals. They said they had plenty of choice and if they did not like the main course at lunchtime they could always have something else. One person particularly liked the large selection of cereals and muesli at breakfast time and another commented on the three-course meal they received for lunch. The home was very clean and tidy and homely in appearance. People spoken to liked their home and thought the domestic staff worked very hard. Some staff had worked at the home for a long time and knew the people who lived there well. People spoken to said the staff team were pleasant and kind, friendly with each other and would do anything to help them. One or two people said staff members looked particularly busy at the moment. The staff spoken to state they had a good relationship with the proprietors who visited the home two to three times a week and spoke to residents, visitors and staff.
Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 6 Everyone spoken to say that visitors were made to feel very welcome, could come at any time and were offered refreshments. What has improved since the last inspection?
Nearly all of the things the home was required to do from the last inspection had been done. The manager had made some progress with assessments to see what activities people were able to participate in and had started making sure staff supervision was held and recorded. People spoken to say that more activities were on offer and a staff member was employed during the day specifically to encourage and provide activities. The care that people required was written in care plans and everyone’s had been updated using a new style. Medication was signed when it came into the home and was labelled correctly. A new air conditioning unit and medication fridge had been installed in the medication room. The room now remained at the correct temperature for storing medication. All bedrooms now have lockable storage facilities so people can keep safe their money or special items. Some bedroom doors have locks but not all. However the proprietor ensured that those people who requested a lock had one placed on their door. Some new easy chairs, footstools and coffee tables had been purchased for the lounges, and some dining chairs for the dining room. A kitchen window and guttering had been replaced and four bedrooms had been re-carpeted. The manager had made sure that the policy for the care of the dying had been updated. She had also produced a new care plan for use when people were dying to make sure all their needs were met in their last few days should they choose to remain at the home. Staff members spoken to thought this had worked well and reminded them to cover all the special needs people have at this time. The home now had questionnaires for all the professional visitors to the home such as doctors, social workers and district nurses and separate ones for residents, relatives and staff. This meant that everyone’s views were obtained to make sure they all had a say in how the home was run. The proprietor visited the home and produced a report on what they find. They have to visit the home to make sure they check up on how it is managed. They speak to the manager, residents, relatives present on the day and some staff members. The report is then sent to the Commission for Social Care Inspection for examination.
Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 7 The manager is now making sure that all incidents in the home that have to be reported to The Commission are done so. What they could do better: 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. Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 5 Service users had their needs assessed prior to admission and had the opportunity to visit and have a trial stay before a final decision on permanent residency. EVIDENCE: The manager completed in-house assessments and there was evidence that assessments completed by Care Management were obtained by the home prior to admission. The assessments were important as they provided vital information for the care planning stage. The homes assessment documentation covered all the required points highlighted in the standard. People spoken to stated that the manager had, in the past, visited them in hospital or their own home to complete the assessment. The manager formally wrote to service users or their representatives following assessment stating the homes capacity to meet needs. Staff members and people who lived at the home stated that people had the opportunity to visit Templecroft before they decided on permanent residency. The home also offered a respite service, which gave people the opportunity of
Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 10 short stays at the home and introduced them to other service users and staff. Most people spoken to said that family members chose the home for them, or they had known other people who had lived there. The manager confirmed that the first four to six weeks of residency was a trial basis and this could be extended as required. Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 11 Service users ongoing health care needs and those when they were dying were met in the home. Care plans were not consistently dated and signed, which made the start date difficult to audit and agreement of service users or their representatives was not always obtained. EVIDENCE: Four care files were examined. The care plans formulated were pre-printed sheets for each identified need and then individualised for each service user. There was evidence that staff had included needs identified at the assessment stage. Staff spoken to stated the care plans were clearer in the tasks they had to complete to meet service users needs. Care plans had been updated and were evaluated monthly. The home had produced a condensed care plan to use for service users admitted for short stays. Again this was pre-printed sheets and individualised as required. There was some evidence that service users or their representatives signed agreement to the care plans but not all. However the date and signature of the person individualising the pre-printed care plan was not always in evidence.
Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 12 There was use of risk identification tools for nutrition, skills and moving and handling needs. However it was noted that a relative had signed a risk assessment form agreeing to bed rails but the assessment section had not actually been completed. Bed rails were in place though. Similarly a risk assessment for self-medication had been partially completed for one service user but needed the service users name on the form and their signature of agreement. Daily recording of the care people received did not always follow through issues to the next shift and it was not always clear exactly what care had been provided. People spoken to stated that their health care needs were met. The home completed monthly weights and there was evidence that the dietician and district nurse had been involved in the care of one service user who had lost weight as she deteriorated. A log was maintained of professional visitors and instructions to staff. The home had produced a care plan to use when a person is dying. This included all the care they required when nursed in bed during their final days. It covered personal care, pressure area care, nutrition, oral hygiene, pain control, communication, spiritual needs, and support for the family and friends. The home demonstrated their ability to care for people who were dying. They contacted the GP and district nursing services for advice and support and ensured that the person could be nursed at home. The homes medication management will be assessed at the next inspection, however the requirements made at the last inspection had been met. Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 The home provided service users with an environment that met their social and nutritional needs. EVIDENCE: There had been an improvement in the activities available to people. Service users spoken to described a range of entertainments that they had participated in such as, a film quiz, jigsaws, trips out, play your cards right, dominoes, sing a longs, bingo, Salvation Army singers, exercises to music, manicures, Cleethorpes Parade, ball games and entertainers. Some people had formed small groups and chatted to each other. Some people chose not to join in at all. People stated that routines were flexible and staff members respected their wishes. Eight service users were spoken to and all stated the meals were very good. Some people commented on the range of breakfast cereals and others commented on the three course main meal at lunchtime. All stated that alternatives were available and some people said that there was too much to eat. Bowls of fresh fruit were available in each of the lounges and hot and cold drinks available throughout the day.
Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 14 People spoken to said that the most flexible meal was breakfast which can be served any time up to 10am. On the day of the inspection one or two people who had preferred to stay in bed came to have breakfast at this later time. Menus were written over four weeks and were subjected to seasonal changes or at service users requests. The menus were held in the kitchen and it was suggested that these be made available to service users. Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home provides an atmosphere whereby people feel able to make complaints and feel confident they will be resolved. EVIDENCE: The homes complaint procedure was clear and displayed in the entrance. It had appropriate timescales for resolution and included contact details of other agencies. The home had a complaint form, which included aspects of the complaint and what action was taken to resolve the issue. The home also had a suggestions/niggles book for people to complete if they did not wish to formalise a complaint. Service users spoken to felt able to make any complaints they may have either to the manager, staff members or their families. Complaints received since the last inspection had been resolved. Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24 and 26 The home provided a very clean and tidy environment for service users, however they could be put at risk from unguarded radiators in the lounges and an uneven driveway. EVIDENCE: Templecroft provided a homely environment with furniture and décor of a good standard. The home had recently purchased more lounge and dining room chairs, coffee tables and footstools. All the radiators in bedrooms and corridors had been covered. Some radiators in the lounge areas remained unguarded and although these were inaccessible to service users, as chairs had been placed in front of them, they still required covers. This would ensure that no service user was placed at risk of burns when the radiators were on full use during colder weather. The home was generally well maintained inside and out. However the driveway had potholes that had been filled with small stones. This had been effective to varying degrees but some areas of the drive were very uneven. This could place service users and visitors to the home at risk of falls. The courtyard area
Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 17 was safe and contained a raised pond and garden furniture. The home was suitable for its intended purpose. Service users spoken to were happy with the home and their bedrooms. People were able to furnish their bedrooms with their own personal furniture and belongings and some people have installed their own telephone. Shared bedrooms had screens for privacy. All bedrooms had lockable facilities and three of the bedrooms had privacy locks to the doors. Service users signed to state whether they preferred a privacy lock and one person spoken to felt comforted by her door lock and used her own key. The home was free from unpleasant odours and was very clean and tidy without losing its homely feel. Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The home provided sufficient numbers of staff on each shift to meet the care needs of service users. The homes recruitment practices were not sufficiently robust to safeguard service users living at the home. EVIDENCE: Staff rotas were examined and showed that there were four care staff members on duty throughout the day with an extra person between the hours of 11am and 4pm. There were three waking staff at night. The manager was supernumerary, although 10 of her hours were on standby for care hours. There appeared to be sufficient domestic and catering staff. People spoken to were very complimentary about the staff team. The manager confirmed that there were seven day shifts, three night shifts and four 11am-4pm shifts currently vacant. On some days these posts were filled by existing staff at present, however people spoken to state that staff were very busy especially in the mornings, which impacted on response times to call bells. The manager was actively recruiting these vacancies. The home had recruitment policies and procedures, however these were not always followed. The recruitment records of the five newest staff members were examined. All the files had correct documents in place apart from references. Two of the five files had the required two references, two had only one reference and one had no references on file although the manager was
Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 19 able to evidence that they had tried on two occasions to obtain them. References were an important part of the recruitment process and to ensure that service users were not put at risk, staff members must not commence employment until all recruitment documentation is in place. Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 36, 37 and 38 The home has made a good start with monitoring the quality of service provided to people living in the home. This will result in people having a say about the way the home is managed. The insufficient content and inconsistent frequency of staff supervision could result in care practices not being monitored. EVIDENCE: The homes method of monitoring the quality of the service it provides consisted of audits completed by staff, for example on hygiene, health and safety, medication, accidents and maintenance records. There were also questionnaires sent to service users and relatives twice a year and to staff and visiting professionals annually. This year was the first year of this system so the home had not completed a full cycle of quality monitoring. Action plans were to be completed to address issues in questionnaires and a report will be sent to CSCI.
Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 21 The manager conducted supervision sessions with senior care staff and the seniors in turn supervised carers. Domestic and catering staff members were supervised on a day-to-day basis. Supervision identified training needs, which the manager collated each month, however it did not address how care staff were monitored in fulfilling their role. Supervision sessions were inconsistent in their frequency and all care staff did not receive the required six sessions per year. Supervision of staff was important as a means of checking that staff members were competent in meeting the needs of service users. Records were stored appropriately and the proprietor completed visits to the home in line with regulation 26 of the Care Homes Regulations. He speaks to service users, staff and any relatives in the home. This gave people the opportunity to tell the proprietor if they were unhappy with the way the home was managed. Reports of these visits were forwarded to the CSCI. Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 2 x x x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 2 x x 2 3 x Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 23 YES Are there any outstanding requirements from the last inspection? 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 36 Regulation 18(2) Timescale for action The registered person must 30th Sep ensure that all care staff receives 2005 a minimum of six formal supervision sessions per year. (previous timescale of 31.3.05 not met) The registered person must 30th Sep ensure that care plans are 2005 signed and dated on completion and by the service user or their representative on agreement. The registered person must From date ensure that daily records are of clear about the care provided inspection and follow through to the next 9th Aug shift. 2005 The registered person must 30th Sep ensure that identified risks have 2005 risk assessments completed and signed by the service user or their representative. The registered person must 30th Nov develop and implement a 2005 programme of covering the unguarded radiators in the lounge areas. The registered person must 30th Sep ensure the driveway is even and 2005 safe to walk on. The registered person must From date ensure that all recruitment of
Version 1.40 Page 24 Requirement 2. 7 12(1)(a) 3. 7 13(4) 4. 7 15 5. 19 13(4) 6. 7. 19 29 23(2)(b) 19(1)(b) Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc 8. 33 24 documentation is in place prior to staff commencing employment. The registered person must continue the quality assurance programme, publish results of surveys and forward a copy to the CSCI inspection 9th Aug 2005 31st Dec 2005 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. Refer to Standard 24 15 Good Practice Recommendations The registered person should fit privacy locks to bedroom doors as standard when bedrooms are vacated. The registered person should ensure that daily/weekly menus are available for service users to see. Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© 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 Templecroft J54 2894 Templecroft V244285 9 August 2005 Stage 4.doc Version 1.40 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
