Templeton Place Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this newly registered service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff understood how to report incidents. They told us they were encouraged to be open and honest when incidents occurred. One staff member said, “Absolutely, we are encouraged to report. Coming into this role you should know to raise the concerns anyway. The management chat to us in the daily meetings and ask if there are any concerns and we always go to them and say if there is anything we need to raise.”

Incidents and accidents were investigated and staff told us lessons learned were shared with them. We saw records of debriefs with staff following incidents and any group supervisions. A staff member said, “For example with [incident] we had lessons learned shared with us. [Clinical lead] will print a form out as to what the error was, and all staff must sign to confirm they have read and understood. The form goes through what to do, and what not to do.”

People’s relatives told us they were informed if their loved one had an accident, such as a fall. One person’s relative said, “[Name] had a fall about 2 months ago. [Name] was fine, but the staff phoned us up straightaway, told us what had happened and reassured us.”

We saw records which showed how incidents and accidents were analysed to identify trends. The management team told us how lessons learned were shared within the service and across the provider’s other services. The registered manager told us how they reviewed incidents, and identified further training needs, and competency assessments. For example, following some recently reported medicines incidents.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Staff regularly reviewed people’s care and support plans to ensure these were up to date and reflective of people’s needs. This meant staff were able to provide up to date information to healthcare partners when people’s needs changed. We saw staff update a visiting health professional about 1 person when they asked about their current health and medication.

We saw records that showed people were referred to other health professionals for advice when required. Staff told us when they had concerns about someone’s health, they would inform the GP and ask for a referral to be made. One person told us how staff had supported them during a recent return from hospital. They commented how helpful staff had been with what had been an “awful experience” in hospital. Another person’s relative said, “My [relative] is in hospital at the moment and is hoping to be discharged this week. The staff have been very good and informed me that they felt they were unwell and called for the ambulance and they were excellent at keeping me updated. I do not have any concerns, and the staff have assured me they will be able to accommodate my loved one when discharged.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe living at the service. One person told us, “I went to another care home before I came here, and I was very unhappy there. There were lots of people with dementia and another resident kept wandering into my room, even at night and nobody did anything about it. Here, I don’t worry about that.” One person’s relative said, “I feel [name] is safe as they have not had any falls since being in the home.” We observed staff using safe moving and handling techniques during the inspection.

Staff were trained in safeguarding and understood their responsibilities in reporting safeguarding concerns. One staff member said, “It’s important that we raise any concerns and make sure people are safe. If they’re not safe, we need to escalate it. [Safeguarding] is there to help people and keep them safe.”

The provider had safeguarding and whistleblowing procedures. The management team understood their responsibilities regarding any action needed to protect people from harm. The necessary internal documentation was completed, including accident and incident logs and body maps. The provider ensured referrals and notifications were made to the local authority and the Care Quality Commission in a timely manner.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People were assessed for risks such as skin damage, falls and choking. When risks were identified, care plans provided information for staff on how to reduce the risk of harm. Risks were regularly reassessed, and care plans updated when needed. For example, following a fall, we saw 1 person’s plan was updated to include measures to reduce the risk of further falls. The management team told us about exercise classes and walking groups to keep people mobile where able and improve strength and stability. Records showed the falls team were contacted for advice if needed, and people were involved in risk management. For example, 1 person had been actively involved in what type of falls monitoring equipment was used to keep them as safe as possible.

Records showed people were given enough to eat and drink. People’s weight was monitored, and their risk of malnutrition was regularly assessed. When people were assessed as at risk of choking, care plans provided clear guidance for staff on how to reduce the risks, and what to do if a choking episode occurred. Skin integrity plans informed staff how to reduce the risk of skin damage. Position change records showed people were supported to change position in line with care plan guidance.

Clinical governance meetings took place monthly, and reviews were held for people at risk of malnutrition, skin damage and choking for example. When actions were identified, records showed these were completed.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The environment was visibly clean and well maintained. Staff were able to report any maintenance requirements. Equipment that we looked at was fit for purpose. For example, wheelchairs and other moving and handling equipment were in good condition, clean and stored out of sight when not in use.

There was a well-maintained secure garden for people to use. This included some shaded areas to protect people from the sun. People living on the ground floor had direct access to the garden.

We reviewed records of checks carried out to ensure the premises were safe. This included gas, electrical and fire safety checks. Regular checks of equipment were carried out. Personal evacuation plans were in place. These were regularly reviewed to reflect people’s support needs in the event of needing to evacuate the building in an emergency. Regular fire drills were carried out.

In the main, the provider made sure there were qualified, skilled and experienced staff who received effective support, supervision and development. The service used a dependency tool to calculate staffing levels based on people’s care and support needs. The staff rota showed staffing levels were maintained and overall, people using the service told us they felt there were enough staff on duty. However, some people told us they occasionally had to wait for staff to support them. For example, 1 person said, “They [staff] are all fine. Sometimes they’re not as quick in the morning as I would like them to be, but they’re all fine.” We saw minutes of resident meetings which showed some people had said they had to wait sometimes for staff to support them. The management team had advised people to inform staff if they wanted to get up at a set time.

Some people commented that recent staff sickness had resulted in the use of agency staff, but they said this had since improved. For example, 1 person’s relative said, “There is always a lot of staff. We did receive a letter from the office stating they had staff shortages and were using agency staff, but things have improved, and they have since recruited and I have seen improvement with staffing levels and continuity of staff.”

Staff gave mixed feedback about staffing levels. Some staff felt there were enough of them whilst others felt more staff were needed. Those who felt there were not enough staff told us they felt frustrated not always being able to attend to people’s needs when they asked for help.

The service did not feel short staffed. Staff did not appear rushed, and call bells were answered in a timely manner. The service audited response times to call bell alerts to help ensure that appropriate numbers of staff were in place at key times of the day.

Safe recruitment processes were followed. Records showed staff had regular supervisions and were trained to carry out their roles. Training records showed staff had completed training. The management team told us additional training was available such as for senior care roles, NVQ qualifications and the provider’s ‘champion’ roles. They told us the provider was proactive in sharing good practise within their services and encouraged staff to be part of this. They told us, “We don’t have a falls champion in post here yet, but we plan to do this. The champions have training and then have monthly falls champion online meetings. It’s a good way of encouraging staff to share across homes.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There was a signing in system that asked visitors to confirm they had no symptoms of infection before entering the service. The home was visibly clean and well maintained. People told us they were happy with the cleanliness. One person said, “It’s all good. The other day, there was talcum powder spilt on the carpet, but it was all gone when I came back to the room later in the day.” One person’s relative said, “There are people allocated to each floor and I’ve seen them cleaning. I really like that it doesn’t have a horrible smell here like some homes do.”

Housekeeping staff were on duty 7 days a week. Cleaning chemicals were safely locked away when not in use by staff.

Staff were trained in infection prevention and control and knew when and how to apply and dispose of personal protective equipment (PPE). There was enough PPE available for staff to use.

Regular infection prevention control audits were carried out, including staff hand hygiene audits.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Staff responsible for managing medicines had completed training and had their competence assessed. Most of the staff we spoke with were confident and knowledgeable regarding the medicines they were administering, and we observed 1 staff member demonstrating a calm and skilled approach when supporting people with their medicines.

Medicine incidents were reported and investigated. One of the errors we looked at, had occurred twice, but no preventative measures were put in place. Staff told us they felt additional steps were needed to prevent a recurrence. We fed this back to the management team and on day 2 of the inspection, they assured us that action had been taken to address this.

People could choose to manage their own medicines if they wished. Records showed staff had assessed people’s understanding of their medicines and storage requirements, and weekly stock checks were carried out. People were provided with lockable storage for their medicines. However, we saw that 2 people’s medicines were in cupboards or drawers but were not locked away. This was not in line with the provider’s medicines policy. We fed this back to the management team, and on day 2 of the inspection, we were assured that people were formally reminded of the importance of keeping their medicines locked away.

Other medicines were stored, administered, and recorded safely.

Some people were prescribed medicines on an as required (PRN) basis. PRN protocols were in place and these guided staff to consider alternatives to medicines where possible. When PRN medicines were administered, staff recorded the reasons why and the outcome. This meant it was easy to assess the effectiveness and to identify any trends.

Regular medicine audits were carried out. When issues were identified, action plans were put in place. We saw actions were completed in a timely manner.