Inspection on 13/11/08 for Cool Runnings Too

This inspection was carried out on 13th November 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cool Runnings Too 15/05/08

Cool Runnings Too 05/11/07

Cool Runnings Too 12/07/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cool Runnings 58/63 The Park Yeovil Somerset BA20 1DF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Gail Richardson     Date: 1 3 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Cool Runnings 58/63 The Park Yeovil Somerset BA20 1DF 01935414611 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: CoolRunnings Residential Home Ltd care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Both premises will be staffed by separate staffing rosters with not less than two staff on duty through the day/evening and one at night in each house. No more than 9 service users to be accommodated in No 58 The Park, and not more than 12 service users to be accommodated in No 63 The Park. To accommodate one gentleman, under 65 years, as named in application dated 16/05/06. To accommodate one lady, under 65 years, as named in application date 28/05/06. Date of last inspection Brief description of the care home Cool Runnings (No 58 The Park) and Cool Runnings Too (No 63 The Park) are residential care homes for older people. They are registered as one service with CSCI, named Cool Runnings Residential Home Ltd. The homes are located on opposite sides of a road in a quiet residential area of Yeovil, close to the town centre. The Registered Manager is Mrs Maria Hallett and the Registered Provider is Cool Runnings Ltd. Cool Runnings accommodates 9 residents in single bedrooms and has a lounge/dining room Care Homes for Older People Page 4 of 32 Over 65 21 0 Brief description of the care home and a conservatory. Cool Runnings Too accommodates 12 residents in single bedrooms and has a large lounge and dining room. Both homes are two-storey buildings and are staffed independently, Cool Runnings has waking night staff and Cool Runnings Too has one member of sleep in staff each night. Bedrooms are provided on both ground and first floors with access by stairlift. Both homes have gardens and ample parking. Day care is provided to a limited number of non-resident people and the home offers short break residential care when vacancies permit. The current fees range from 368 pounds to 410 pounds per week. Not included in the fees are chiropody, hairdressing and the purchasing of some personal items. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection, which took place over 5.5 hours on the 13th November 2008 by Regulation Inspectors Gail Richardson and Jane Poole. Whilst there were two inspectors throughout this report the term we will be used when referring the Commission. Cool Runnings is comprised of two homes, Cool Runnings and Cool Runnings Too. There are 6 people currently residing in Cool Runnings and 11 people living in Cool Runnings Too. All are receiving personal care. The home has provided CSCI with a completed AQAA (Annual Quality Assurance Audit), which was completed by the registered manager and gives details of all aspects of the Care Homes for Older People Page 6 of 32 home. As part of this inspection the inspector surveyed the opinions of a random selection of people using the service and Care Workers . The responses from these surveys are contained within the body of the report. Records relating to care including 4 care plans, 2 staff files and health and safety records were examined. We spoke with five staff and ten people using the service and their comments are included within this report. The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are, excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the care home does well: What has improved since the last inspection? All people using the service who are privately funded have been issues with a contract and those people who are funded by Social Services have a funding agreement in place. The contract is in place to clearly outline the terms and conditions of residency. Care plans have been reviewed and reorganised to provide a basic but clear outline of each persons assessed needs and a plan for staff to meet those needs. The information is stored in one file and is stored securely to ensure confidentiality. All hand transcribed medication records are now signed by two staff, midday medication times have been adjusted to ensure people can enjoy their meals and lockable storage has been provided to ensure safety of medication for people who self medicate. Activities are being provided should people want to participate and records are maintained of the people who participated and the level of enjoyment. The complaints procedure now contains all the correct contact information and is displayed in the home. The maintenance and environmental issues raised in the last report have mostly been met and the recording of maintenance has improved. Quality assurance systems are now in place in the form of monthly meetings at the Care Homes for Older People Page 8 of 32 home to review the quality of the service and develop and improve the service provided. The home has developed a fire risk assessment which the home appears to follow to promote the health and safety of people using the service. The first aid kits available have been updated to support people should an injury occur. What they could do better: The manager is recommended to include the room number on each persons contract of terms and conditions to ensure they are clear about the room they are paying for. The manager is required to ensure that care plans are regularly reviewed and the appropriate updates reflected in the care plan. This will ensure that care changes are monitored and changes in need are met. Risk assessments are recommended to be developed to promote the opportunities for people using the service whilst continuing to support their safety and well being. Medication systems have improved in some areas but the manager must ensure that all prescribed creams administered have a clear name in place and are dated when opened. The manager is further recommended to monitor stock levels to ensure that appropriate levels of stock are available for people using the service. Staff must be clear of the protocol to be used should medication not be taken at the time of administration. These requirements are made to promote safe practice in the home. The manager is recommended to provide a clearly visible means of displaying the days menu to ensure that all people using the service are aware of the menu choices available each day. The manager is also recommended to develop the provision of religious support for people using the service to ensure that people can access any religious contact they choose. Some staff training has been made available about safeguarding vulnerable adults and a partial copy of the safeguarding protocol has been obtained. The manager is recommended to download the remaining parts of the policy and ensure staff are aware of the content. The manager must ensure that all unguarded radiators have a risk assessment in place to ensure the safety of people using the service from the risk of injury. The use of cloth hand towels must be reviewed and a suitable alternative be put in place and the base of the toilet noted at inspection is to be repaired to ensure that the risk of cross infection is reduced. Cool Runnings has one waking staff on duty overnight and Cool Runnings Too has one sleeping staff on duty overnight. The manager has stated to the Commission that she takes this role 2 nights per week and another member of staff takes the role five nights per week. The manager is recommended to ensure that the off duty rota is reflective of which staff is working overnight in both homes and is recommended to record clearly the staff working overnight to include if they are waking or sleeping. She is further Care Homes for Older People Page 9 of 32 recommended to develop the supervision of staff to include all the areas identified in the Common Induction Standards. This is recommended to promote and develop good practice within the home. The manager is recommended to review and update her understanding of the scope of notification under regulation 37 of the Care Homes Regulations 2001. This is required to ensure that CSCI are informed of all areas of notification. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes Service User Guide, Statement of Purpose and contract of residency have been updated to ensure that prospective people can make an informed decision about the home. Evidence: The home has in place a Service User Guide and Statement of Purpose to enable prospective people using the service and their relatives/representatives to make an informed decision about the home. The home have re issued the Statement of Purpose and Service User Guide to each person using the service to ensure that all people are aware of the services provided. The manager has reviewed the contracts used,, which now contains details of the fees charged. The manager is again recommended to include the room number in the contract, the manager stated that this detail is included in the statement of purpose Care Homes for Older People Page 12 of 32 Evidence: but should also be included in the signed contract to enable people using the service to be clear about the room they are paying for. The manager has issued all privately funded people with a new contract and all funded people have contracts in place by the relevant Commissioning authority. Since the last inspection no new admissions have been made to the home, therefore we were not able to review pre admission procedures. The homes Annual Quality assurance Audit states. Assessments are made by the manager, the home liaises with social workers, receives assessments and organises visits to the home and the home has a four week trail period. This standard will be reviewed again at the next inspection, however some comments were received in the surveys from people using the service about this standard, which included. We were looking for a small comfortable residential home with a garden and Cool Runnings well suited our requirements and needs. Visited several this was the best home. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans have been updated to provide a clear guide for staff about the needs of people using the service and how those needs are to be met. Further development of reviews, updates and risk assessments are needed to ensure that people are supported safely. Staff were observed to treat people with dignity and respect at all times and people feel well cared for. Medication systems have improved and are mostly well managed but require further review in some areas to ensure the safety of people using the service. Evidence: Care plans were seen from both Cool Runnings and Cool Runnings Too. Following the last inspection considerable effort has been made to reorganise the care plans to ensure that all the required information to assist staff is held together to form a working document. The care plans seen were basic but clearly identified the areas of Care Homes for Older People Page 14 of 32 Evidence: assessed need and a plan was in place for staff to follow to meet that need. These needs included any specialist and dementia or mental health care needs. Some areas of care planning do require further development to ensure that monitoring of weight is actioned to meet any risks identified. A system of practice is needed to ensure that people are weighed at a similar time of day each time to promote consistent recording. Risk assessments are in place for some areas but the manager is recommended to ensure that all risks identified have appropriate actions to support people to maintain independence. This is with reference to people going out into the community. These people should have plans in place to ensure that they can be identified if needed and what action is appropriate for staff should they be late returning. A clear daily record is maintained for each person and the care plans had been signed by the person or their representative in most instances, some care plans had not been signed and dated on completion. There was a clear record of all visiting healthcare professionals visits and the outcome. Updated reviews were not available for all people and the manager is recommended to ensure that each person is reviewed at least monthly and that this review is documented and care plans updated as required. The inspectors spent time observing the care being given and noted that the members of staff treated people using the service with dignity and respect at all times. People using the service appeared relaxed in the company of the staff and the atmosphere was happy and calm. Survey comments received included. Staff are very caring always there to help and support, always ready to listen and act accordingly, staff available 24 hours a day. Staff are always on hand ready and willing to give any help and assistance required. On the day of the inspection people were very positive about living at the home and felt they were well cared for. The medication systems were mostly satisfactory. There were no gaps evident in the Medication Administration Records, there was evidence of variable doses being recorded and hand transcribed entries being signed by 2 staff. People using the service have the option to self medicate should they want to and risk assessments are in place to ensure safe practice is maintained. Lockable storage is available as required. There are currently no individual photographs on each medication chart or care plan. the manager is recommended to provide a clear photograh of each individual to ensure visual identity should it be needed. The management of prescribed creams requires review as some creams stored in peoples bedrooms did not have a clear name or date when the cream had been Care Homes for Older People Page 15 of 32 Evidence: opened for use. This may lead to incorrect administration. In two instances medications were observed to have been left unattended for people to take. This may pose a risk of accidental ingestion. This practice must be reviewed. The manager is also required to review the homes ordering systems to ensure that adequate stocks of medication are available at all times. This is with reference to a persons whose medication had run out 2 days previously and replacement stock had not been made available which may have left the person in some discomfort. The management of administration during mealtimes has now been altered to ensure that medications are administered after lunch to ensure that the meal could be enjoyed undisturbed. The safe disposal of medication is currently signed by one staff and is recommended to be signed by two staff or the collecting pharmacist to ensure a clear audit trail of medications returned for disposal. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides activities in various setting and people have the choice of partcipation.Contact with the comunity and is maintained and is being developed to meet any religious needs. The meals provided are enjoyed by the people using the service and a choice is available. Evidence: The home provides an ativity coordinator who also is a care worker. She provides activities for both group and individuals and maintains a record of who attended and the level they participated. People told us that they jpined in if they want to and they were happy with the level of activity provided. The home provides newspapers and people were seen to be listening to the radio or TV. Activity records indicated that a visiting entertainer had been to the home that week and people told us they had enjoyed this. On the day of inspection people were seen to entertain themselves during the morning, in the afternoon one staff instigated a cooking session. The homes AQAA states that the home encourages activities and records participation. They state they cannot improve due to limited funds. They change activities to suit residents and have no plans for improvements for the next 12 months. Care Homes for Older People Page 17 of 32 Evidence: Comments received included, There are activities in the afternoons, a good selection we neednt join in if we dont want too. Several activities are always being arranged in a most friendly manner by the staff. We follow the sport, reminisce, musical afternoons, bingo, quiz, its all there if we want to join in. The home does not currently have any access to church services or visiting clergy. the manager confirmed that they are exploring the possibility of multi denominational vists but as yet this has not taken place. The manager is recommended to review this provision to ensure that the preferences of the people using the service are met. The home has an equal opportunities policy that supports people of any race, gender, age and disability. Staff spoken with have a good understanding of this policy and its role to support people using the service. People told us that their relatives visited the home whenever they wanted to and that they were supported to leave the home on visits. As previously noted people who leave the home must have a risk assessment in place and appropriate information made available to staff to minimise any risks identified but continue to support both independence and contact with the community. The people using the service confirmed that they enjoyed the meals and that a choice is available. Breakfast is served in the persons bedroom or the dining room, lunch is the main meal of the day and a lighter evening meal is served around 5pm. The menu is planned by the manager with input of choices from people using the service following the monthly residents meeting. People using the service are asked the day before what their choice of main meal will be. Several people did not know what was for lunch and whilst a folder of menus is available the manager is recommended to provide a more visually accessible method of display to be considered. All meals are cooked by the care staff and lunch appeared pleasant and appetising. One person at inspection told us that The food is good. Comments received from surveys included Food just like home cooking, Ive put weight on. There is always a varied and wholesome menu with choices for alternatives if necessary Always nicely cooked. Care Homes for Older People Page 18 of 32 Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that they are listened to and their requests acted upon. Staff demonstrated good knowledge and understanding of their role to ensure that people using the service are protected from abuse. Evidence: The home has updated the complaints policy to include the correct contact details and is now displayed in the home to enable access to all. One person told us Any complaints speak to Maria or we can go to a member of staff if needed. Staff and people using the service who were asked, knew how to make a complaint and were confident that their concerns would be addressed. Two staff have undertaken external POVA (Protection of Vulnerable Adults) training and the home has an incomplete copy of the Safeguarding Adults in Somerset protocol (May 2007). The manager is recommended to download the complete version and ensure staff are familiar with its content. The policies of the home are generic policies and should be adjusted to reflect the current guidance. Staff training records confirm that all staff have received abuse awareness training and this is undertaken by the manager in the form of updates at staff meetings. The homes AQAA states staff receive training in POVA through induction and the policy manual. All four staff surveys received said that staff knew what to do if concerns were raised. Care Homes for Older People Page 20 of 32 Evidence: One staff survey commented People are able to speak freely to staff where any comments can be passed on and sorted out. There are also comment and complaint sheets they are able to fill in. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides residents with a clean and homely place to live, it is comfortable, clean and suited to the needs of the people who live there. Evidence: The home consists of two separate houses which are located on opposite sides of the road. Each unit is independent with adequate kitchen, dining room, bathrooms and living space to meet the needs of people who live there. Bedrooms are situated on the ground and upper floor with access in both cases by stair lift. Bedrooms are of an appropriate size with some rooms in Cool Runnings Too being of a very good size. The bedrooms were adequately decorated and some people had personalised the rooms with their own belongings. Since the previous inspection the upper floor windows have been restricted and the wardrobes and larger pieces of furniture secured to prevent the risk of injury. There are 2 bathrooms in each home. All now have appropriate fittings to reduce the risk of cross infection and lockable storage for toiletries. All hot water outlets are monitored to ensure they do not exceed 44 degrees and appropriate signage is in place to indicate where water may be delivered hot. The base of one toilet was stained brown and the manager is strongly recommended to review this area. Bathrooms Care Homes for Older People Page 22 of 32 Evidence: contained hand wash, paper towels and foot operated bins, however one toilet had a cloth hand towel. The manager is recommended to replace this with a suitable alternative to reduce the risk of cross infection. The issues relating to the maintenance of the environment identified at the previous inspection have been addressed. Staff undertake all cleaning and the home appeared clean with the malodours noted being addressed. Staff felt there was sufficient time to attend to cleaning duties and people using the service told us that. Home cleaned every day. Always very clean and comfortable, always cleaners in attendance. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home employs enough staff to meet the needs of the people using the service and to ensure the safety, comfort and maintenance of the premises. People benefit from having experienced staff who have a good understanding of their needs. Evidence: For the current number of people living at the home there are two staff on duty at all times during the day. Cool Runnings has one waking staff on duty overnight and Cool Runnings Too has one sleeping staff on duty overnight. The manager has stated to the Commission that she takes this role 2 nights per week and another member of staff takes the role five nights per week.I The manager is recommended to ensure that the off duty rota is reflective of which staff is working overnight in both homes. Staff on duty and surveys received confirmed that they felt there was enough staff on duty at this time. Staff rotas seen show that these levels of staffing are maintained consistently. Agency staff employed at the home told us that they receive sufficient information and documents seen confirmed that all the agency working at the home provided confirmation of recruitment checks and training. Care Homes for Older People Page 24 of 32 Evidence: The home have not recruited any new staff since the previous inspection and so recruitment and induction will be revisited at the next inspection. The registered manager has implemented individual staff training matrix to ensure that staff training needs are identified and updated. These records indicate that staff have received mandatory training updates and that 50 of staff have achieved an NVQ in care. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is consistently managed, promotes residents involvement in the life of the home and protects them from the risk of harm. Evidence: The registered manager and provider is Maria Hallett. She has run the home for several years and is supported by a small consistent staff team which includes three family members. The home undertakes a monthly quality assurance review in the form of residents and relatives meetings. Minutes were seen and the content of discussion centred mainly around food and activities. The results of these meetings drives changes in the running of the home. Personal monies can be stored by the home and a record maintained of all deposits and withdrawals. These records were noted to be correct . Care Homes for Older People Page 26 of 32 Evidence: Records stored at the home are stored securely and in line with the Data Protection Act. Staff are aware of the need for security of confidential documentation and all records are maintained individually. Accident records are maintained for people using the service and staff. There appear to have been no accidents since the last inspection. The manager is recommended to review all accidents and audit monthly to identify trends and incidences to promote accident prevention. The manager confirmed that first aid kits have been updated so as not to include dressings which have passed their expiry date. Supervision of staff was noted to have taken place regularly but the content is limited to identification of training needs and achievements and appears to be task led. The manager is recommended to develop supervision to include the areas identified in the National Minimum Standards. During discussion with the manager it became apparent that she was not fully aware of the scope of notification under regulation 37 of the Care Homes Regulations 2001. The manager is required to ensure that she is fully aware of all areas which must be reported to CSCI. The records relating to health and safety were seen, all were up to date and had been reorganised to ensure that all checks were recorded. The home has had a recent visit from the fire officer and had updated the homes fire risk assessment. It was noted that 2 bedrooms did not have suitable radiator covers to prevent the risk of injury should somebody fall on them. The manager must ensure that all unguarded radiators have a risk assessment in place to ensure the safety of people using the service from the risk of injury. It was also discussed that the call bell system in each persons roon was not regularly checked and recorded. It is recommended that the checks are under taken monthly and the results recorded with appropriate action as required. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 3 14 (1) The Registered Manager 13/06/2008 must ensure that when assessments are completed of prospective service users, that appropriate consideration is given to the level of staffing, staff training and registration of the home to ensure that the home is fully able to meet peoples needs. Care plans must be regularly 04/07/2008 reviewed and updated to ensure that they reflect peoples current needs. New staff must receive induction in line with Skills for Care. Previous timescale of 5/12/07 not met. All agency staff must be provided with induction training by the home and an appropriate record maintained. 04/07/2008 2 7 15 (1) 3 30 18 (1)(c)I Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 The registered manager is required to ensure that all medications are recorded correctly and that medications which have been administered but not taken are recorded appropriately. This will ensure that there is a clear audit trail of medication administered and reduces the risk of medication being accidentally ingested. 18/12/2008 2 9 13 The registered manager is required to ensure that all prescribed creams are named and dated when opened. This is required to ensure that prescribed creams are safely administered within their opened expiry dates. 18/12/2008 3 37 37 The registered manager is required to review and update her understanding of 19/12/2008 Care Homes for Older People Page 29 of 32 the scope of notification under Regulation 37 of the care Homes Regulations. This is required to ensure that all areas for notification are recorded and forwarded to CSCI within the timescale. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 The registered manager is recommended to inlcude the room number or appropriate identification within the contract of residency to ensure that people using the service are clear as to the room contracted to. The manager is recommended to ensure that all care plans are signed and dated when agreed with the person recieving the care or their representitive and on the date of each subsequent review. The registered manager is recommended to review risk assessments to ensure that people are promoted to remain indpendant in their activities of choice whilst minimising safety risks. The registered manager is recommended to ensure that all medications returned to the pharmacy are signed by two people to enuse a clear audit trail of redications returned. The registered manager is recommended to provide a clear, individual picture of each person using the service to enable identigfication should it be needed. The registered manager is recommended to review the ordering procedures for medications to ensure consistent and adequate stock levels for th epeople using the service. The registered manager is recommended to review the provision of visiting clergy to ensure that the religious preferences of people using the service are met. The registered manager is recommended to implement an easily visible menu board to enable all people using the service to have a clear daily knowledge of the menu for the day. 2 7 3 7 4 9 5 9 6 9 7 12 8 14 Care Homes for Older People Page 30 of 32 9 17 The registered manager is strongly recommended to ensure that the home has a completed copy of the Safeguarding Vulnerable Adults in Somerset protocol (May 2007) and that staff kno what procedure to follow should an allegation of abuse be made. The registered manager is recommended to review the use of hand towels and ensure that a suitable replacement promotes good hand hygiene and prevents the risk of cross infection. The registered manager is recommended to ensure the repair of the base of the toilet discussed at inspection. The manager is recommended to further develop staff supervision to include all areas outlined in the National Minimum Standards The manager is strongly recommmended to risk assess all uncovered radiators and ensure appropriate action is taken to reduce any risks identified. The manager is recommended to ensure that the call bell system is checked regularly and recorded to ensure that all call bells are monitored for their effectivness. 10 26 11 12 26 36 13 38 14 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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