Templefields

We found the following examples of good practice.

The registered manager had a system to monitor covid testing and test results efficiently.

People were supported to continue their interests during the national lockdown such as arts and crafts and music.

The registered manager and the provider were exploring ways to enable people to see their relatives over the upcoming festive period. People had previously been supported to see relatives outside during the summer months.

Cleaning schedules were in place which were supported by the whole staff team. High touch areas were cleaned regularly throughout the day. These measures helped to reduce the risk of transmission of coronavirus.

People had their temperatures taken throughout the day to monitor any changes. This helped to reduce the risk of transmission of coronavirus.

Templefields is a residential care home providing personal and nursing care to people with autism and/or learning disabilities and associated challenging behaviours. The service is registered to provide support to up to 14 people and there were 12 people using the service at the time of our inspection. People live in either the main house or coach house and the property is situated on the outskirts of Dewsbury.

People’s experience of using this service and what we found

There had been a lack of leadership and oversight at the service which had led to a deterioration in the quality of care and people’s experience of living in the home. The provider had access to a range of specialist support to support people to live fulfilling, although this help had not always been identified as required.

Restraint was used at the service as a last resort and when all other measures had been considered. Records did not adequately analyse incidents where restraint had been used. More detailed records of all behaviours that challenged were needed to ensure the effectiveness of and achieve positive outcomes for people and for staff.

We looked at how the service managed risks to people and found some improvements were required in how the service assessed and managed risk. Recorded risk reduction measures were often generalised and did not show the necessary control measures were in place.

Medicine management procedures were in place. There was no evidence to confirm all staff medication training was up to date and their competency levels checked. The provider identified this and addressed by their own processes. Some staff training was out of date and this impacted on the quality of care provided.

Staff understood people with capacity had the right to make their own decisions. Some mental capacity assessments were not decision specific and best interest decisions processes didn't follow best practice. We have made a recommendation the provider considers current guidance on Mental Capacity Act (MCA) and best interest decision making.

The service applied some of the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for some people did not fully reflect the principles and values of Registering the Right Support for the following reasons: not everyone had choice and control, and this was often limited through the actions of other people living there. Concerns had not been appropriately managed by management to ensure restrictions were limited.

Staff were very dedicated and committed to people at the service. Some said they spent more time at the home than with their own family and they genuinely cared about people. We saw some great rapport with people they supported during the onsite visit and how some staff talked about the people they cared for. However, lack of oversight had led to some areas of care becoming less personalised, but once recognised, the provider put in resources to address these issues. They implemented systems to support staff to ensure they provided the best of care to people and achieved positive outcomes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 6 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding service users from abuse and improper treatment, staffing and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. We met with the provider several times during this inspection to discuss our concerns. The provider has sent us an action plan and regular updates to demonstrate how they are actively making improvements at the service. If we receive any concerning information we may inspect sooner

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

People received support which was individual to their needs, and risks were minimised wherever possible. Staff received training and support which helped them be effective in their roles. People were supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible. The service provider’s policies and systems supported this practice. We observed a good atmosphere in the service, and saw people were free to decide how and where they spent their time. The registered manager ensured the quality of the service was monitored, and improvements were made when required.

Further information is in the detailed findings below.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with the deputy manager, staff members, people who used the service and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by staff.

There were some systems in place to ensure managers and staff learned from events such as accidents, incidents and concerns. This reduces the risks to people and helps the service to continually improve. However, we found issues with the timescales these systems were used in. We saw staff members had received training in all relevant areas to meet the needs of people who used the service.

The service was safe, clean and hygienic and equipment was well maintained. During our visit, we saw people had access to hand washing equipment in both communal areas and in each person's room.

Staff personnel files contained all relevant information, including Disclosure & Barring Service (DBS) checks and reference checks from previous employers.

Is the service effective?

People were cared for and supported in an appropriate way. Individual care plans were up to date and were reviewed (at least) 6 monthly.

Is the service caring?

People were supported by kind and attentive staff. We saw staff showed patience and gave encouragement when supporting people. We observed staff speaking to people in a kind and caring manner.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. For example, one care record we looked at said; 'I love buying new clothes and puzzle books. I enjoy reading, watching television and doing jigsaws'. The same record also stated; 'I don't like the smell of lavender.' This demonstrated support was personalised and records provided information to ensure care and support was person-centred.

Is the service responsive?

People completed a range of activities at the service. On the day of our visit we observed people watching television and interacting with staff members. There were a range of activities available, including jigsaws, puzzles, baking, sewing and pampering sessions. On the day of our inspection, some people who used the service had gone out for the day or were getting ready to go out on an activity.

One member of staff we spoke with told us; 'It's good here. We're only a small team but we all get on great. We're like a little family and we all actually want to be here'.

Is the service well-led?

The service worked well with other agencies and services to make sure people received the most suitable care. This included multi-agency work with doctors and other health professionals.

The service had some quality assurance systems in place and actions were identified. We saw audits of medication and health & safety.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service. This helped to ensure people received a good quality service.

We spoke with four people who used the service and each of them appeared comfortable and settled at the home. One person we spoke with described how they were happy at the home and they enjoyed spending time in the large garden at the back of the property. Another person said staff were nice and they too were happy at the home. All of the people we spoke with were positive about their experiences of living at the home.

People's needs were assessed and care and support was developed from an assessment of their needs. Risk assessments to help minimise identified risk and protect the person from unsafe care were in place. Staff had received appropriate training for their role and understood the importance of reporting suspected abuse.