Templeton House Care Home Service

Templeton House Care Home Service Racecourse Road Ayr KA7 2UY Telephone: 01292 291232 Type of inspection: Unannounced Inspection completed on: 28 April 2017 Service provided by: Windyhall Care Home LLP Service provider number: SP2013012160 Care service number: CS2013320489

About the service Templeton House is a purpose-built care home located close to the amenities of Ayr town centre. The service has capacity for 69 older people and was registered in March 2015. Resident accommodation is over three floors. The garden level, the ground floor at street level, which includes the main entrance and first floor. The top floor areas are located in two separate sites at either end of the front of the home. One contains the catering department and the other the staff area and additional office space. The home has a large landscaped garden to the rear which is secure. There is parking, including disabled parking, to the front. Internally the home has two lifts and disabled access to all areas. Each of the service user areas has access to an outside space either the garden or furnished balconies. All bedrooms are very well presented and have an en suite shower room. Assisted bathing facilities are available to support individuals with mobility issues. There are a choice of lounges and dining areas throughout, a cinema room, library, piano bar, hairdressing and beauty salon. The care service was finished to a very high specification throughout. At the time of the inspection there were 43 service users occupying the garden and ground floor levels. The first floor remained unoccupied. The providers stated aims and objectives were as follows: "Our aim is to listen and learn from service users to afford us the opportunity to work together to meet the identified needs and aspirations of the individuals who have chosen to live in Templeton House". Objectives: - To recognise that when persons choose to live in a care home the potential exists for them to renounce a certain degree of their independence and to act on this to preserve and assist the service users to exercise their optimum level of this right - To support service users in maintaining their inherent standards, through choices, during their day-to-day life. - To endeavour, as far as is practicable, to ensure that the service users maintain their citizen's rights within society - To promote and assist service users in realising their personal aspirations and abilities - To welcome the diversity of people who have chosen to live in Templeton House - To foster feelings of safety by employing staff that are committed to maximizing service users' choices, control and participation - To strive to seek the opinion of the service users and applicable others to continuously provide the highest quality of care. page 2 of 16

What people told us Four service users completed care standard questionnaires. They all agreed that overall, they were happy with the quality of care. No additional comments were made. Three relatives/friends completed a care standard questionnaire. They indicated that overall they were happy with the quality of care their friend/relative received. The following additional comments were made. "Any issues or difficulties have been addressed by the staff. The carers are very patient and always polite in their dealings with my dad and all visitors. The manager is very responsive to the needs of my father". " This home is ideal for my friend and she is well looked after in all aspects even in times when she gets upset and needs to speak to me, they phone me which I think is wonderful that they care enough to do this. The activities are amazing and I enjoy joining in". A volunteer inspector took part in this inspection. They spoke with eight residents and two relatives and made general observations. Comments were mixed about the quality of food and the way the home was run. The following comments were made: Quality of care & support: "Very Happy" "Foods not good" "Pendant buzzer taken from me" "not enough activities, no outings, no entertainment" "its like a prison" "I read, TV" "its fine, mostly good food" "very happy" "its horrible here, food is always tough, I spit it out" "very good, the food is very good" Quality of the environment: "very nice" " I don't like my room" "facilities are excellent" " I like the garden, the place is clean and spacious, I like the surroundings, they are super" "the room is lovely, can't fault the surroundings" " I like my room" Quality of Staffing; "Good" "carers are too busy, I have to wait too long, the good staff have all gone" "Staff are good in the main, helpful, quick with the buzzer" "excellent" "very nice staff, I get a lovely bath in the morning" "staff are very nice, sometimes pushed to their limit" page 3 of 16

"very nice staff" Quality of Management: "Not very efficient" "I don't know the manager" "manager is excellent, very helpful. no issues, family is very happy" "hopeless - she will have to go, lack of attention to detail" The volunteer inspector noted that two of the residents were unaware of who the manager was. One resident disclosed information that we passed to the appropriate authorities for consideration. Self assessment The provider was not asked to submit a self assessment. The manager planned to produce a formal development plan for the service as a whole. Feedback from service users, relatives and staff and information from quality audits was to be used to inform this. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 3 - Adequate 6 - Excellent 3 - Adequate 4 - Good Quality of care and support Findings from the inspection During this inspection we continued to follow-up on a number of outstanding recommendations and requirements. We found that some progress had been made. However, a number of the requirements and recommendations were not fully met and were repeated. For further detail on the progress made please refer to the section of this report entitled outstanding requirements and recommendations. The service had worked hard to improve care plans. Progress was sufficient to meet a previous requirement. However, this is recognised as an area for on-going development within the service. We found that improvements were needed in how aspects of medications were managed. There had been medication errors and recording of topical creams and lotions was inconsistent. The manager planned to make improvements by offering additional training and conducting observed practice sessions. We have repeated a requirement about this. See requirement 1. There remained a high staff turnover, however, the manager was confident that improved stability within the staff team had been achieved and expected to see a reduction in agency staff use. This remains an on-going area for improvement as the services occupancy was expected to continue to increase. Staff changes had page 4 of 16

limited the development of a strong key working system. We have repeated a recommendation about this. See recommendation 1. There continued to be a mixed response about the quality of the food. The manager was aware of this and gave a commitment to continue to work with service users and catering staff to ensure that the food served met the needs and expectations of the residents. We repeated a requirement relating to monitoring and record keeping of service users nutrition and hydration. See requirement 2. There was an in-house activity programme and some outings had taken place. This was work in progress and should continue to be developed as we received a mixed response from the residents about this. We saw that residents continued to enjoy the hairdressing and beauty treatments available. The residents enjoyed regular coffee mornings and "happy hours" in the piano bar area. There were chickens and a rabbit within the grounds and a hamster had been recently purchased. The manager was recruiting a second activity coordinator to facilitate improvement in this area. The manager had implemented falls prevention documentation and a requirement about incident reporting to Care Inspectorate and other authorities was met. Requirements Number of requirements: 2 1. The service should operate a medication recording system in accordance with recommended best practice. To do this, the service should adhere to the following: - Prescribed medication must be administered in line with the prescriber's instructions - Maintain accurate records of all medications received, administered, refused/withheld and returned to pharmacy This is to comply with SSI 2011/210 Regulation 4 (1) (a) Welfare of users and SSI 2011/201 and SSI 2002/114 Regulation 19(30)(j) - a requirement to keep a record of medications kept on the premises for residents. The following National Care Standards have been taken into account in making this requirement. Timescale for compliance: to begin within 24 hours and be completed by 30 September 2017. 2. The provider must improve monitoring and record keeping in relation to service users nutrition and hydration. This is in order to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) regulations (SSI 2011/210). regulations 4 (1) (a) - Welfare of Users. Timescale for compliance: to begin within 24 hours and be completed by 30 September 2017 page 5 of 16

Recommendations Number of recommendations: 1 1. The named nurse/keyworker system should be developed to ensure that residents care plans are fully implemented and that staff have the time and support to discharge their responsibilities. National Care Standards, care homes for older people - standard 6: support arrangements. Grade: 3 - adequate Quality of environment Findings from the inspection Templeton House is a new purpose-built care provision. Overall, the standard of accommodation was excellent. It was evident that careful consideration had been given to the styling and presentation throughout. The overall impression was hotel like, clean, bright and welcoming. The accommodation was over three floors and accessed via two passenger lifts. All bedrooms were single with en suite wet floor shower facilities. Some ground floor rooms had direct access to the garden area via patio doors. All bedrooms were attractively presented and had a nurse call facility, television and telephone point. We saw that residents had been supported to personalise their own bedroom with personal items and furnishings. Residents on all floors were able to access attractive outside space on the patio, terrace or balcony. There were comfortable and well furnished lounge and dining areas. There was a schedule of equipment servicing and maintenance checks and the maintenance and domestic team ensured that the accommodation was presented and maintained to the highest standard inside and out. Some of the service users, mainly on the lower floor, live with dementia. Some signage was in place to support orientation around the building. This remained a work in progress. We directed the manager to an environmental audit tool to assess how dementia friendly the building was. The manager was aware of the need to continue to make the required adaptations to the building in accordance with the needs and expressed preferences of the growing resident group within Templeton House. We will continue to monitor this as the occupancy within the care home increases. The volunteer inspector noted inappropriate storage of equipment within fire escape stairway and unattended cleaning materials. This was reported to the management who took immediate action to resolve the issue. Requirements Number of requirements: 0 page 6 of 16

Recommendations Number of recommendations: 0 Grade: 6 - excellent Quality of staffing Findings from the inspection Since the last inspection the service had experienced a significant turnover of staff. The manager had continued to recruit registered nurses and care staff to reduce the use of agency staff. This had limited progress in establishing a regular schedule of one to one supervision sessions where staff could discuss training, practice and development issues with their line manager. We have repeated a recommendation about this. See recommendation 1. The company employed a designated trainer to deliver moving and handling training, induction training and coordinate mandatory training within two designated care homes. We have repeated a recommendation as there remained gaps in staff training. This included the 'Promoting Excellence Framework' dementia training developed by Scottish Social Services Council and NHS Scotland as part of the Scottish Government's Dementia Strategy, Palliative Care and Adult Support & Protection. There was an ongoing training programme to support to staff to attain the required SVQ qualifications to register with the Scottish Social Services Council. See recommendation 2 The manager acknowledged the limitations of the current training matrix as this gave no training history prior to 2017. We heard that a new system of electronic training was about to be implemented. The manager believed that this would improve the recording of staff training. There was evidence that nurse meetings and meetings with support staff had been scheduled. The manager discussed poor attendance at staff meetings. Alternative means of communicating with the staff were being considered. This included a staff bulletin. Information was shared at shift handover meetings and in daily diaries. The manager had introduced a morning meeting where all departments were represented. This helped to promote communication across the service. The provider employed safe recruitment procedures and had a system to monitor staff registration status with their regulatory bodies. Aspects of the induction training programme for new staff should be developed. This should include Adult Support & Protection training, specific arrangements to shadow more experienced staff and a formal assessment of the individuals competency to complete key tasks of the role. See recommendation 3. An on call system was in place to ensure that support and advice was always available to the staff team from the management. We found the staff were attentive and interacted well with the residents. Requirements Number of requirements: 0 page 7 of 16

Recommendations Number of recommendations: 3 1. The provider should ensure that staff receive appropriate support, via ongoing one-to-one supervision with their line manager, to equip them to perform their caring role. National Care Standards, care homes for older people - standard 5: management and staffing arrangements. 2. The provider should ensure that care staff receive appropriate training, including, protecting vulnerable adults, dementia and palliative care. The training and development plan should also take account of specific health care and support needs of the current resident group. National Care Standards, care homes for older people - standard 5: management and staffing arrangements. 3. The provider should develop the staff induction process. This should include Adult Support & Protection training and evidence formal assessment of an individuals competency to complete key tasks of their job role. National Care Standards, care homes for older people - standard 5: management and staffing arrangements. Grade: 3 - adequate Quality of management and leadership Findings from the inspection Resident numbers had increased in recent months and the management team had worked hard towards achieving a full complement of staff. Significant management resources had been directed to managing the high staff turnover. There was a management structure in place. This included an external consultant who fulfilled an area management role. We saw that the management team had continued to challenge areas where practice fell below expected standards. We saw that some quality assurance work had been completed to monitor standards within the service. This included audits of care plans, weights, skin care, wound management and medication. The manager discussed that quality assurance had not been developed as planned. Other priorities had limited progress in this area. We have repeated a requirement about quality assurance and a recommendation about monitoring medication practice as this had not yet been implemented. See requirement 1 and recommendation 1. Consideration should be given to formalising a development plan to support the continued programme of improvement required within the care service. This should be shared with service users, relatives and staff to demonstrate the strong commitment to securing ongoing improvement at Templeton House. There was a system to manage service user's finances. However, we noted that service users had no access to their money outwith office hours. The manager agreed to review this immediately. page 8 of 16

One staff member completed a care standard questionnaire. They noted a "huge" improvement in the care home in the last 6/7 months and found the manager "approachable and always listens". Any issues raised were dealt with. Requirements Number of requirements: 1 1. The provider must ensure that the system of quality audits are improved to ensure that deficits in practice and record keeping highlighted in this report are identified and systems and practices improved to effect continued improvement. This is to comply with Social Care and Social Work Improvement Scotland (Requirement for Care Services) Regulation 2011 SSI 2011/210, Regulation 4 (1) (a) provider must make proper provision for the health, welfare and safety of service users. Timescale for compliance: to be completed by 31 December 2017. Recommendations Number of recommendations: 1 1. The service provider should take action to ensure that staff who are authorised to administer medication have the necessary skills and knowledge to do this safely and in accordance with best practice guidance. Medication procedures should be subject to regular audit and staff skills, knowledge and ability to safely administer medication assessed on a regular basis. National Care Standards, care homes for older people - standard 15: keeping well - medication. Grade: 4 - good What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 Care plans must be implemented to offer care staff clear direction in meeting each person's assessed care and support needs. The content should be person-centred and reflect the goals and wishes of residents in order to meet their needs, with regular review to ensure appropriate support delivery. Staff must adhere to the stated frequency of monitoring aspects of health care identified within care plans. page 9 of 16

This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) regulations (SSI 2011/210). regulations 4 (1) (a) - Welfare of Users, 5(1) - personal plans. Timescale for implementation: one month from the publication of this report. This requirement was made on 6 December 2016. Action taken on previous requirement We sampled care plans and found that improvements noted at the last inspection had been sustained. We found health assessments had been completed and care plans reviewed monthly. We saw that input from external heath professionals had been sought to support individual support plans. Met - within timescales Requirement 2 The provider must improve monitoring and record keeping in relation to service users nutrition and hydration. This is in order to comply with Social Care and Social Work Improvement Scotland (Requirements for Care Services) regulations (SSI 2011/210). regulations 4 (1) (a) - Welfare of Users. This requirement was made on 6 December 2016. Action taken on previous requirement We found that there was a general improvement to the approach to nutritional care. Nutritional risk assessments were completed monthly. Weights were recorded and monitored by registered nurses and the service manager. Where required individuals had been refereed to the dietician for specialist input. We found that further improvement could be made when recording individual food and fluid intake. In particular, records should reflect how individual's meals are fortified with additional energy dense products, additional snacks outwith meal times and prescribed dietary supplements taken. It was agreed that this requirement would be repeated. Not met Requirement 3 The service should operate a medication recording system in accordance with recommended best practice. To do this, the service should adhere to the following: - Prescribed medication must be administered in line with the prescriber's instructions - Maintain accurate records of all medications received, administered, refused/withheld and returned to pharmacy - Handwritten entries/amendments on medication administration records must be accurately transcribed. Entries should be checked and double signed page 10 of 16

- Medication should be securely stored. This is to comply with SSI 2011/210 Regulation 4 (1) (a) Welfare of users and SSI 2011/201 and SSI 2002/114 Regulation 19(30)(j) - a requirement to keep a record of medications kept on the premises for residents. The following National Care Standards have been taken into account in making this requirement. Timescale for compliance: to begin within 24 hours and be completed by 30 April 2016. This requirement was made on 6 December 2016. Action taken on previous requirement Overall, we found improvements had been made. Our selected sample of medication administration records showed that medications were available for administration and had been administered in accordance with the prescribers instruction. We continued to find records relating to creams and lotions should be improved. We wish to acknowledge the improvements made. However, the services quality assurance checks had detected occasions where medication was not administered in accordance with the prescribers instruction. The service notified us of these instances and took other appropriate action. The manager planned further training for the staff team and observed practice sessions to promote compliance with best practice guidance and positive outcomes for the service users. Not met Requirement 4 The provider must ensure that the system of quality audits are improved to ensure that deficits in practice and record keeping highlighted in this report are identified and systems and practices improved to effect continued improvement. This is to comply with Social Care and Social work Improvement Scotland (Requirement for Care Services) Regulation 2011 SSI 2011/210, Regulation 4 (1) (a) provider must make proper provision for the health, welfare and safety of service users. Timescale for compliance: to begin within 24 hours and be completed by 30 May 2016. This requirement was made on 6 December 2016. Action taken on previous requirement The provider had introduced "It's my day". This was an approach to reviewing individuals needs and care plans on a specific day each month. We also noted that audits of care plans, accidents and incidents and medication continued. The manager had an overview of skin care and nutritional needs. An audit had been completed by the supplying pharmacist. The manager was aware of the need to continue to develop quality assurance processes to inform positive change and improved outcomes within the service. The manager planned to establish regular one to one supervision to support practice development. page 11 of 16

The manager acknowledged that staff changes had limited progress in this area. This requirement is repeated. Not met Requirement 5 The provider must ensure that notifications are made to the Care Inspectorate as detailed in the Guidance Document 'Records you must keep (except childminders) and Notifications you must make, (Care Inspectorate 2015). Notifications must be made within the timescales stated in this document and in the guidance provided in each notification form. This is in order to comply with SSI 2011/210 Regulation 4 (1)(a) - a requirement to make proper provision for the health and welfare of people. Timescale: with immediate effect. This requirement was made on 6 December 2016. Action taken on previous requirement We found incidents had been reported appropriately to the management or other relevant authority. Met - within timescales What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The named nurse/keyworker system should be developed to ensure that residents' care plans are fully implemented and that staff have the time and support to discharge their responsibilities. National Care Standards, care homes for older people - standard 6: support arrangements. This recommendation was made on 6 December 2016. Action taken on previous recommendation There were ongoing changes within the staff team. The manager continued to recruit to fill vacant posts and reduce reliance of agency staff. Ongoing work was required to fully implement a competent keyworker system. The manager was receptive to the suggestion we made about involving keyworkers more actively in supporting service users in social activities and outings of their choice. This recommendation is: not met and is repeated in theme 1 of this report. page 12 of 16

Recommendation 2 The provider should ensure that staff receive appropriate support, via ongoing one-to-one supervision with their line manager, to equip them to perform their caring role. National Care Standards, care homes for older people - standard 5: management and staffing arrangements. This recommendation was made on 10 August 2016. Action taken on previous recommendation This recommendation is: not met and is repeated in theme 3 of this report. Recommendation 3 The provider should ensure that care staff receive appropriate training, including, protecting vulnerable adults, dementia and palliative care. The training and development plan should also take account of specific health care and support needs of the current resident's group. National Care Standards, care homes for older people - standard 5: management and staffing arrangements. This recommendation was made on 10 August 2016. Action taken on previous recommendation Overall, we found training records difficult to interpret. However, we saw that there remained some gaps in training. The manager was confident that an electronic learning package being introduced by the company would facilitate improvement in this area. This recommendation is repeated in the staffing theme of this report. Recommendation 4 The service provider should take action to ensure that staff who are authorised to administer medication have the necessary skills and knowledge to do this safely and in accordance with best practice guidance. Medication procedures should be subject to regular audit and staff skills, knowledge and ability to safely administer medication assessed on a regular basis. National Care Standards, care homes for older people - standard 15: keeping well - medication. This recommendation was made on 10 August 2016. Action taken on previous recommendation We found that medication audits were completed. This took account of daily medication counts and a wider audit of medication processes monthly. The supplying pharmacist had also audited medication systems. Audit processes allowed the management to quickly detect any discrepancies. We saw that medication errors or recording errors were followed up appropriately. The manager was aware of the need to eliminate further errors and had requested additional training for the staff team. The manager also planned to implement formal observations of practice. The practice where medication was returned to the pharmacy had been reviewed to reduce wastage. page 13 of 16

This recommendation is: not met and repeated in theme 4. Recommendation 5 The service should improve their approach to falls management. Record keeping relating to the action taken to reduce further instances of falls should be improved. National Care Standards, care homes for older people - standard 6: support arrangements. This recommendation was made on 6 December 2016. Action taken on previous recommendation We found that improvements had been made. The management had implemented appropriate falls management documentation. Risk Assessments were being reviewed following a fall which showed that consideration was being given to how further falls may be prevented. This is Met. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 4 Nov 2016 Unannounced Care and support 3 - Adequate Environment 6 - Excellent Staffing 4 - Good Management and leadership 3 - Adequate 22 Jun 2016 Unannounced Care and support 2 - Weak Environment 6 - Excellent Staffing 4 - Good Management and leadership 2 - Weak page 14 of 16

Date Type Gradings 25 Feb 2016 Unannounced Care and support 2 - Weak Environment 6 - Excellent Staffing 4 - Good Management and leadership 2 - Weak page 15 of 16

To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 16 of 16