CARE HOMES FOR OLDER PEOPLE
Templeman House Leedam Road Bournemouth Dorset BH10 6HP Lead Inspector
Rosie Brown Unannounced 27 October 2005 11:00 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. Templeman House D55 S3903 Templeman House V236408 271005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Templeman House Address Leedam Road, Bournemouth, Dorset, BH10 6HP 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) 01202 537812 01202 535022 Care South PC Care Home only 41 Category(ies) of MD(E) - 6 registration, with number OP - 41 of places DE(E) - 6 Templeman House D55 S3903 Templeman House V236408 271005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 41 in the Category OP (Old Age) including up to 6 in the Categories DE(E) and/or MD(E). Date of last inspection 02 December 2004 Brief Description of the Service: Templeman House was originally built as a residential home in the 1960’s by Dorset County Council and was refurbished about 7 years ago when the home was purchased by The Dorset Trust (now known as Care South). The home is situated in the residential area of Kinson – a suburb of Bournemouth, close to bus services, shops and local amenities.The home has off road parking for residents, visitors and staff and is set in mature grounds and gardens with a pond and patio area.The accommodation at Templeman House is arranged over three floors. A passenger lift and two staircases enable easy access to all floors.All bedrooms are for single use. Assisted bathing facilities are located on each floor.There are two lounges and a spacious separate dining room on the ground floor with two addition small quite rooms and dining rooms available on other floors.The home is part of Care South – a non-profit making company. The Registered Indivdual for the company is Roger Fulcher. The registered manager Mrs J Nickson is now employed to manage another Care South home therefore the home is being temporarily managed by Mr Ian Slack, who has recently made an application to the Commission to become the registered manager.Templeman House is registered to accommodate 41 people over the age of 65 and in need of personal care and a maximum of 6 people with a mental health disorder or dementia. Templeman House D55 S3903 Templeman House V236408 271005 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 27th October 2005 and was undertaken by inspector Rosie Brown: it was the first of two statutory unannounced inspections planned to take place this year. The inspection commenced at approximately 11.00am and was concluded by 5.30pm. This was the first time the inspector had visited this home and a favourable impression was gained. There were 36 residents living in the home and approximately half of them experience some mental confusion. Twelve members of staff were on duty at the time. The inspector assessed 14 of the National Minimum Standards and reviewed progress made with the requirements and recommendations set out in the report of the previous inspection. The communal areas and the majority of bedrooms were viewed: residents’ care records, staff recruitment records and some of the home’s policies and procedures were also examined. The inspector used observation skills to assess certain findings and spoke with the temporary manager, the deputy manager, the chef and four members of staff. Four residents spoke with the inspector during lunch and four others were talked with during the day. What the service does well:
The home has a statement of purpose, which is comprehensive document and provides detailed information about life in the home and the services available. Residents are supplied with a balanced diet and are provided with good variety of options to the main menu on offer and special dietary needs are catered for. The home has a number of communal lounges, which offer the opportunity for privacy when needed. The communal ground floor dining room is pleasantly decorated and attractively set out with plenty of space for residents to move around the home with mobility aids. The dining rooms on the first and second floor are small but allow for specific individual’s special needs to be met and this is a useful provision. The home is well maintained and is set in attractive mature grounds that provide a pleasant alternative place to sit and relax on warm sunny days. Residents confirmed that staff are respectful, caring, helpful and friendly. A friendly atmosphere is achieved within the home.
Templeman House D55 S3903 Templeman House V236408 271005 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
The statement of purpose should provide the details of undersized bedrooms in the home, e.g. how many and room numbers/situation. The residents care plans must be updated when there is a significant change, following an incident or fall or a change in the way a situation is being managed, e.g. the fitting of a keypad to the front door. Risk assessment s concerned with diabetic care the prevention of falls must be drawn up and referred to in the relevant person’s care plan. Care files should include information concerned with the identification and prevention of hypo/hyperglycaemia. A dietician should be consulted in respect of one resident with a specific diagnosis. The risk assessment regarding one resident who wanders should make reference to wandering into other people’s rooms and the action taken to prevent recurrence. A physical description sheet should be developed and held on file for each person likely to wander out of the home and go missing. The social care provision in the home must be developed to ensure that the home meets residents’ needs in this respect and be noted in each resident’s care plan. Care plans must detail each resident’s wishes/needs regarding care when critically ill, resuscitation, living will, dying and upon death.
Templeman House D55 S3903 Templeman House V236408 271005 Stage 4.doc Version 1.40 Page 7 The generic risk assessments concerning the home’s hot water supply and unprotected radiators must be kept up to date, e.g. when a resident leaves the home or when a new person is admitted. In addition individual riskassessments must be drawn up regarding vulnerability to the hot water supply to wash hand basins and unprotected radiators in communal areas. The bathroom that is out of order should be refurbished as planned. The home is seeking a solution to an odour problem in one bedroom and should consider providing an impermeable floor covering if other options fail. An action plan detailing how the recommendations referred to in the home’s recent quality assurance report must be included in the home’s business plan. It is understood that the temporary manager has already started to address the recommendation concerned with the development of social care provision. 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. Templeman House D55 S3903 Templeman House V236408 271005 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 Templeman House D55 S3903 Templeman House V236408 271005 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) 1, 3 and 6 The home’s statement of purpose and separate guide clearly describe the services available and the management/ staffing arrangements. This enables prospective residents’ and their representatives to make an informed choice about the home. The Deputy Manager undertakes a pre admission assessment of need with each prospective resident to ensure that the home can meet assessed needs. The home does not provide intermediate care. EVIDENCE: Since the previous inspection the home’s statement of purpose has been updated to reflect management changes within the home and a change in title of the company name from The Dorset Trust to Care South. The information provided should make reference to the number of bedrooms in the home that are undersized. The acting manager has compiled a simple guide in an attractive company wallet as an easy reference for residents and their representatives. Both
Templeman House D55 S3903 Templeman House V236408 271005 Stage 4.doc Version 1.40 Page 10 documents are displayed in corridor near to the main entrance and readily available to all interested persons. The pre-admission assessments for one recently accommodated resident and one prospective resident were examined. These reflected that the deputy manager had gathered relevant information and carried out an assessment of need. The care file for one resident demonstrated that an initial care plan was drawn up from the information gained and that the plan included guidance for staff so that identified care needs could be met. Templeman House D55 S3903 Templeman House V236408 271005 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 and 8 Each service user has a care plan that identifies the care being provided to meet identified needs but they are not routinely updated at times of significant change to ensure consistent care is provided. Service users’ health needs are monitored and support from community services is accessed when identified as necessary. EVIDENCE: The care records for three residents were examined. Individual care plans are in place and are signed as reviewed by the CTM on a monthly basis. However, one care plan did not reflect a history of falls for a diabetic resident and although this person had fallen there was no risk-assessment concerning the prevention of falls in place. The care plans for diabetic residents must include information about the recognition of hyper/hypoglycaemia and provide more detail of the food provided, e.g. when, how often, night time needs etc particularly if the condition is only diet/tablet controlled as this is not subject to regular monitoring from a community nurse. The care plan for a resident with communication and mental health needs who is prone to wandering had not been updated for six weeks even though there had been changes made to care provision, e.g. the home were no longer
Templeman House D55 S3903 Templeman House V236408 271005 Stage 4.doc Version 1.40 Page 12 keeping a record of the clothes worn each day by this person. It is recommended that a physical description sheet be drawn up and used for all residents who are likely to wander out of the building and get lost. Another care plan for a resident with cancer of the colon did not include sufficient dietary information about the management of this condition. Daily care records did not routinely provide enough detailed information and simply read ‘care as planned’: daily records made should include factual information to aid in the development of care planning. The care planning system has improved since the previous inspection and it was evident that senior staff have worked hard to implement this change with such a large care team. Templeman House D55 S3903 Templeman House V236408 271005 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 temporary manager is gradually developing the social care aspect of home. Residents confirmed that their visitors are always made welcome and that they enjoy activities and social events when they are arranged. Residents are supplied with wholesome home baked meals and food, special diets are catered for and a choice is always offered. EVIDENCE: The home’s statement of purpose and guide states that visitors are welcome at any time: visitors are also requested to sign the visitors’ book. Residents said that they enjoy visits from their relatives. It was noted that the home has a number of lounges and communal rooms where visitors can be seen in privacy, in addition to a resident’s bedroom. The temporary manager explained that he has been focusing on developing the social care provision in the home and has arranged Christmas entertainment and a shopping outing following a residents meeting where ideas for social care were discussed. The home is advertising to recruit a part-time activities coordinator and some time was spent considering why it is difficult to recruit to this post. In the meantime a care assistant has taken on some additional responsibilities and organises in house board and quiz games. Two residents said how much they enjoyed a recent ‘fish & chip’ supper with musical entertainment. One commented, ‘we really had a good sing song to the old tunes’.
Templeman House D55 S3903 Templeman House V236408 271005 Stage 4.doc Version 1.40 Page 14 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) 18 Care South has produced an Adult Protection policy, which provides staff guidance to ensure that residents are protected from abuse while in the home. EVIDENCE: There are robust policies and procedures in place concerned with the identification of adult abuse and the protection of vulnerable adults. A copy of the local ‘No Secrets’ and ‘POVA’ guidance is held for reference. Residents told the inspector they feel safe and well cared for in the home. Templeman House D55 S3903 Templeman House V236408 271005 Stage 4.doc Version 1.40 Page 15 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 and 26 Residents live in a comfortably furnished home which is pleasantly decorated. The hot water supply to wash basins is not governed and some central heating radiators are not guarded which means that some vulnerable residents’ may be at risk. Residents confirmed that the home is always clean and on the day the home was clean throughout. EVIDENCE: The home has 41 single bedrooms available over three floors. The main staircase and back stairs provide access to the first and second floors and a small passenger lift provides level access for those who are physically frail. Residents’ bedrooms are personalised with photographs, ornaments and other personal items. An odour was noted in one bedroom and this matter was discussed: alternative floor covering will need to be provided if other options prove inadequate. Templeman House D55 S3903 Templeman House V236408 271005 Stage 4.doc Version 1.40 Page 16 Each bedroom has a wash hand basin but the hot water to these is not controlled. The generic risk-assessment concerning the temperature of the hot water and residents needs must be updated, e.g. to include an up to date list of all service users. Individual risk-assessments concerning each resident’s vulnerability to the hot water must also be drawn up with remedial action taken where identified. There are five communal bathrooms and one communal shower room: separate toilets and bathing facilities are situated on each floor and are close to bedrooms and communal rooms. The home has six lounges and three dining rooms in the home. The four main lounges are situated on the ground floor, as is the main dining room. Smaller separate lounges are available on the first and second floors close to small but separate dining rooms. The communal rooms form a positive feature of the home and provide a variety of areas where residents can find privacy to relax. The home is centrally heated and most radiators are guarded in residents’ bedrooms but radiators in corridors, bathrooms, toilets and some communal rooms are not protected. The generic risk-assessment is out of date and no individual risk-assessments concerning each resident’s vulnerability to hot surface temperatures and burns are in place. The home’s laundry and sluice facilities are satisfactory and one the day of the inspection the home was clean throughout. Templeman House D55 S3903 Templeman House V236408 271005 Stage 4.doc Version 1.40 Page 17 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 is staffed by the acting manager, deputy manager, care team managers, care assistants, catering staff, domestic workers and an administrator to ensure that service users needs are met at all times. The home follows the Care South staff recruitment and employment procedures in order to protect residents living in the home. EVIDENCE: The temporary manager showed the inspector the duty rota. This confirmed that at the beginning of the inspection the acting manager was on duty with the deputy manager, one Care Team Managers (CTM), five care staff, the chef, assistant chef and kitchen assistant and two domestic assistants. The two weekly staff rota evidenced that in the afternoons one CTM and three care assistants form the care team: the number of care assistants rises to four at 5.30pm to ensure residents’ collective needs are met. The night staffing commences at 9.30pm when two wakeful care assistants are on duty with a CTM who sleeps in on call. Agency staff are used to cover shortfalls and vacancies an induction procedure has been instigated for new agency staff: they are also included in all staff information handovers at the end/beginning of each working shift. The recruitment records for two members of staff were examined: one person recruited in during the summer months and the other has yet to commence working in the home. The records detailed that all necessary checks and
Templeman House D55 S3903 Templeman House V236408 271005 Stage 4.doc Version 1.40 Page 18 information was obtained by following the Care South recruitment procedures. One record showed that a care worker commenced working in the home prior to a satisfactory CRB/POVA disclosure being received and without a POVAFirst check and the manager explained that the standard Care South induction and supervision arrangements were in place. Care South use a programme of induction training, which meets NTO specifications and integrates with NVQ training. Templeman House D55 S3903 Templeman House V236408 271005 Stage 4.doc Version 1.40 Page 19 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) 31 and 33 Care South has employed a temporary acting manager who is experienced in residential care to ensure that the home is effectively managed and that residents receive consistent care. The views of residents, their representatives and associated professionals were recently obtained by a quality assurance survey to help ensure the home is run in their best interests. EVIDENCE: Care South have employed temporary manager, Ian Slack to replace the previous registered manager. An application for Mr Slack to become registered has been received by the Commission and is currently being processed. He has relevant residential management experience and is currently participating in NVQ level 4 management training through the company’s staff training programme. Templeman House D55 S3903 Templeman House V236408 271005 Stage 4.doc Version 1.40 Page 20 The company had an independent quality assurance audit undertaken in May 2005 involving residents, family, staff, visitors, healthcare professionals etc. A copy of the published findings was shown to the inspector. The recommendations identified for improvement were that a regular programme of social and therapeutic activities should be made available and that the home should develop the extent to which residents pursue their personal interests and hobbies. Management should ensure that action is taken to address these recommendations and that they are included in the home’s annual business plan. Templeman House D55 S3903 Templeman House V236408 271005 Stage 4.doc Version 1.40 Page 21 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 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 2 x 2 x x x x x Templeman House D55 S3903 Templeman House V236408 271005 Stage 4.doc Version 1.40 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 14 &15 Requirement Timescale for action 30/11/05 2. OP8 13 (4) 3. 4. OP12 OP19 16 (2) (m) 13 (4) Care plans must be properly reviewed and updated at significant times of change. Care plans must include information about social care needs/ individual interests and make sufficient reference to residents’ needs regarding terminal care, dying, living wills, resuscitation and so on. Care related risk-assessments 30/11/05 must drawn up in relation to diabetic dietary needs and blood sugar level monitoring and the prevention of falls, as appropriate. The social care provision in the 31/12/05 home must continue to be developed. The generic risk assessments 30/11/05 concerning the home’s hot water supply and unprotected radiators must be kept up to date. Individual risk-assessments must be drawn up for residents regarding their vulnerability to the hot water supply to wash hand basins and unprotected radiators in communal areas: remedial action must be taken where identified as necessary.
Version 1.40 Templeman House D55 S3903 Templeman House V236408 271005 Stage 4.doc Page 23 5. OP33 24 An action plan must be developed to address the recommendations made in the recent quality assurance report. 30/11/05 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 OP1 OP7 Good Practice Recommendations The homes statement of purpose should provide information about the undersized bedrooms in the home. Risk assessments concerned with a person wandering should include wandering into another residents room. A physical description sheet should be developed and kept on file in relation to people who are prone to wandering or going.Daily care records should provide factual information so that when a residents care plan is reveiwed, important information is not lost. Care files should include information concerned with the identification and prevention of hypo/hyperglycaemia. A dietician should be consulted for advise in relation to residents with a specific colon diagnosis. An activities co-ordinator should be employed for a suitable number of hours in the home each week to ensure that the social care aspect of the home is fully developed. The out of order bathroom should be refurbished as planned to ensure residents specific needs are met. 3. OP8 4. 5. OP12 OP19 Templeman House D55 S3903 Templeman House V236408 271005 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Dorset BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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