Inspection on 15/05/08 for Cool Runnings Too

This inspection was carried out on 15th May 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cool Runnings Too 13/11/08

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Cool Runnings 58/63 The Park Yeovil Somerset BA20 1DF Lead Inspector Sally Murphy Unannounced Inspection 10:00 15th May 2008 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cool Runnings Address 58/63 The Park Yeovil Somerset BA20 1DF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01935 414611 Cool Runnings Residential Home Ltd Mrs Maria Adele Hallett Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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 lady, under 65 years, as named in application date 28/05/06. To accommodate one gentleman, under 65 years, as named in application dated 16/05/06. Date of last inspection Brief Description of the Service: 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 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. Bedrooms are provided on both ground and first floors. 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 £390 to £410 per week. Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This key inspection was unannounced, and was completed over one day by Sally Murphy and Gail Richardson, Regulation Inspectors. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘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. Since the last key inspection, three random inspections have been completed. These have focussed upon the administration of medication, and the random inspection reports are available on request. A statutory requirement notice was issued on 22nd February 2008 regarding the administration of medication. At the visit completed on 19th March 2008 it was found that appropriate action had been taken to comply with the notice. On the day of this inspection there were 18 people residing at the home. During the course of the inspection we (CSCI) met with people living at the home and their relatives. Care and medication records were examined. Discussions were held with the Registered Manager and staff members. Staff recruitment and training files were examined. A tour of the building was completed and health and safety documentation was reviewed. Prior to this inspection surveys were sent to people living at the home, relatives, staff and health care professionals and feedback received from these have also been included within this report. The Registered Manager also completed the Annual Quality Assurance Assessment (AQAA) that provides information regarding the service. Information from this has also been included within the report. We would like to thank the people living at the home, and staff members for their assistance during the inspection. What the service does well: People living at the home were pleased with the care provided. Within a survey one person wrote that ‘Cool Runnings is like home from home’ and another that ‘nothing is too much trouble for the staff and management. Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 6 People said that they had enjoyed the recent visit made by an entertainer to the home. Within the surveys received staff members wrote that ‘we provide a clean, friendly small home’ and that ‘all staff are friendly’. Positive feedback was received regarding the meals provided. One person spoken with during the inspection stated that ‘the food is superb’. People were aware that an alternative was available, and staff demonstrated a good knowledge of peoples dietary needs and preferences. All rooms are single occupancy and have en suite toilet facilities. Bedrooms had been personalised to reflect people’s individual tastes. Staffing levels are appropriate to meet the needs of people living at the home. The Registered Manager advised that when agency staff are required, that they try to use the same people whenever possible to ensure consistency of care. 7 out of the 12 care staff employed have completed the NVQ level 2 qualification. What has improved since the last inspection? What they could do better: A written contract of terms and conditions should be provided to each person residing at the home, so that they are aware of what will be provided within the weekly fee. When completing the assessment for a prospective service user the Registered Manager must obtain comprehensive information regarding their care needs, and give consideration to the staffing levels, staff training, registration and environment within the home. Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 7 Care records require further information to ensure that staff have the necessary guidance to fully meet people’s needs. This includes information on diabetes, catheter care, mental health, nutritional and pressure area needs. Care plans must be regularly reviewed and updated to ensure that they reflect people’s current needs. Care records must include information regarding visits from health care professionals and the outcome from their visit. A staff signature must be recorded for hand written entries. Each person who self medicates must be provided with secure storage facilities within their room. The home must review the timing of midday medication to ensure that people are able to enjoy meals fully. People with increased level of physical or mental health needs must be provided with appropriate opportunities to engage in social activities. The complaints procedure must be reviewed and a copy provided to each person or displayed within the home. The home must obtain a copy of the updated guidance on Safeguarding Adults produced by Somerset County Council and ensure that the policy on Dealing with Abuse is updated accordingly. Staff must be made aware of the revised policy. The whistle blowing policy must be updated. On the day of the inspection immediate requirements were issued stating that risk assessments must be completed in relation to unrestricted window openings on upper floors, wardrobes and other heavy items of furniture that have not been fixed to the wall and hot water outlet temperatures that exceed recommended levels and any appropriate action taken. Following the inspection the Registered Manager provided written confirmation that these matters had been addressed. Further action must be taken to address maintenance issues and regular quality audits completed to ensure that home provides a safe, comfortable and hygienic environment for people. The Registered Manager must ensure that evidence is obtained of the CRB, POVA First and references relating to any agency worker. All agency staff must be provided with induction training by the home and an appropriate record maintained. A health declaration must be obtained for each staff member. The Registered Manager must undertake regular review of the standards of care provided to ensure that it continues to comply with the regulations, and any identify areas for improvement. The Registered Manager must review the system for recording and storing information relating to people living at the home to ensure that it complies with Data Protection legislation. Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 8 All hazardous substances must be stored securely and not be accessible to people living at the home. An immediate requirement was issued at the time of the inspection, and the Registered Manager has provided written confirmation that this matter has been addressed. The registered persons must review the provision of equipment available to ensure that staff are able to meet the needs of people living at the home. An appropriately competent person must carry out maintenance and servicing of gas and electrical equipment. This must include: portable appliances, electrical hardwiring, stair lifts, fire system and nurse call system. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3, & 5. (Standard 6 does not apply). Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People have not been provided with appropriate information regarding the conditions of residency at the home. The Registered Manager has not fully considered staffing levels, staff training, the conditions of registration or environment within pre-admission assessments, leading to inappropriate admissions being made to the home. EVIDENCE: The Statement of Purpose and Service User Guide were not reviewed as part of this inspection. Within the surveys received from people living at the home, two people stated that they had received a contract and two that they had not. All of the Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 11 respondents stated that they had received sufficient information regarding the home. A copy of the contract was provided. This does not give details of which room is to be occupied or include information on what is and is not included in the weekly fee. The Office of Fair Trading provides further guidance regarding contracts for people within care homes. Each person living at the home should be provided with a written contract of terms and conditions so that they are aware of what services and facilities are included. Within the AQAA it states that people are encouraged to visit before moving into the home. The pre-admission assessment was seen for one person who had recently moved in. An assessment of need had been obtained from the placing authority. This states that the person has ‘significant cognitive impairment’ and has been assessed as ‘not having the mental capacity to make future decisions about their future care’. A pre-admission assessment was also completed by the Registered Manager. This was very brief and states that the person has ‘confusion’. When completing the assessment for a prospective service user the Registered Manager must obtain comprehensive information regarding their care needs, and give consideration to the staffing levels, staff training, registration and environment within the home. Cool Runnings is not currently registered to provide dementia care and therefore through admission of this person has breached the conditions of registration for the home. This was discussed with the Registered Manager / Provider during inspection. Should the home wish to vary the conditions of registration an application would need to be submitted to CSCI and appropriate changes made to staffing levels, staff training and the environment within the home. Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care records require further information to ensure that staff have the necessary guidance to fully meet people’s needs. The management of medication is generally safe, however further consideration must be given to the secure storage of medication and times of administration to promote people’s independence and choice. EVIDENCE: Care plans were examined for people living at both Cool Runnings and Cool Runnings Too. It was found that the level of guidance available to staff varied considerably throughout the records seen. Some included detailed information such as plans relating to communication, hearing, eyesight, foot care and peoples specific health needs, whilst others provided a list of needs, rather than the plans in place to meet these. Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 13 For one person who has diabetes the care plan should be further developed to include information on signs and symptoms, the normal blood sugar (BM) range for that individual and guidance to staff on the actions they should take. Another person at the home has a catheter. Similarly their care records should be provide further guidance to staff and should also include information on the recommended daily fluid intake for this person. The care records for a further person stated that they had continence needs but there was no plan in place to guide staff on how they should manage or improve continence for this person. It was noted that some people living at the home have dementia care or mental health needs however care plans did not include information on individuals psychological needs. Care plans for some people do not reflect that they suffer confusion or have dementia care needs. One person leaves the home for periods of time, but there was no plan or risk assessment in place to guide staff regarding when their should contact this person’s Social Worker or the Police. Some people living at the home can display challenging behaviour but there were no plans in place regarding the actions to be taken. The care records for one person state that they are at risk of sacral pressure sores and that they use a pressure cushion but a pressure risk assessment had not been completed. Records evidenced that this person now had a greatly reduced diet but there was not an appropriate plan in place to address this. The care records for this person were not reflective of their current needs and had not been updated appropriately. Care plans for some people had been updated following a change in their health or following a fall. Some care plans had been signed by the person and evidenced that they had been consulted in developing the care plan. This is good practice. Care records did not include information on professional visits, or the outcome from these. The current system of recording information is complicated with information being written in several places. This raises the potential for important information to be missed. It is recommended that the home review the current system of storing information within separate daily records, handover books, care plans, Managers records, weight records and risk assessments so that all of the information relating each person may be easily accessed and thoroughly reviewed. The home should review the use of abbreviations within care records to ensure that they can be easily understood. Medication records were examined. It was found that these had generally been well maintained. There was one occasion when a hand written entry had no signature recorded, and a further entry that had only one signature. Most prescribed creams seen in bedrooms did not have an opening or expiry date recorded. This included one cream that had been prescribed in 2002. Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 14 Risk assessments had been completed in relation to those people who selfmedicate. The home must ensure that any one who wishes to self medicate is provided with appropriate storage within their room. Staff spoken with during the inspection confirmed that there is no lockable storage for people who self medicate within their bedrooms. A quantity of approximately 100 prescribed paracetamol were found in one persons room. The expiry date for these tablets was 2006 and these had not been stored securely. During observation of the mealtime, it was observed that a pot containing liquid medication was placed on the table for one person next to their food. Another person was interrupted from eating their meal to be given their medication. Following this the person did not continue with their meal. The timing of midday medication should be reviewed to ensure that people are able to enjoy their meals fully. People spoken with during the inspection confirmed that they are treated with dignity. Within the surveys received three people stated that they ‘always’ receive the care and support they need and one person that this was ‘usually’ the case. Surveys were received from two health care professionals who provided positive feedback on the service provided. Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are able to participate in some activities; however further support is required for those people who have increased dependency needs. People provided positive feedback on the meals provided. Staff are aware of peoples dietary needs and preferences. EVIDENCE: Within the AQAA it states that ‘we encourage residents to take part in activities, i.e. bingo, games afternoon, gardening, sing-along etc. We always have time to chat with residents and know their individual interests so we are able to converse appropriately’. People at the home spoke about a recent visit from an entertainer, which they enjoyed. Daily records evidenced that some people were able to go out independently or spent time engaging in activities such knitting. Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 16 Some people spoken with stated that there is ‘not a lot to do’. Within the surveys received from people living at the home two people stated that there is ‘usually’, one that there is ‘always’ and one that there is ‘sometimes’ activities to participate in. During the course of the inspection, people with increased dependency needs were observed to either sleeping or disengaged for periods of time. There were no activities taking place to engage with them or provide mental stimulation. Within the AQAA the Registered Manager stated that ‘we treat out residents as part of our own family and uphold all their rights as individuals’. Within the surveys received relatives stated that they are usually kept up to date, and confirmed that people always receive the support needed to live the life they choose. One person living at the home wrote that ‘nothing is too much trouble for the staff and management’. One person spoken with during the inspection stated that ‘the food is superb’. The meal was liver and bacon on the day of inspection. People who didn’t like this were aware of what was being provided as an alternative. There were stocks of fresh fruit and vegetables available. People gave positive feedback regarding the meals provided. Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Policies and procedures do not contain appropriate guidance and may put people at risk. EVIDENCE: The home has a complaints policy. This must be updated to include the contact details of CSCI, and to state that CSCI may be contacted at any stage. People spoken with during the inspection stated that they were not aware of the complaints policy but would raise any issues of concern with the registered manager. They were not aware of who else they may be able to contact. Within the surveys received from people living at the home, all of the respondents stated that staff do listen and act on what they say. The home has an Abuse policy. This states that ‘the home will have made a preliminary assessment of all allegations of abuse’, and states that the home will interview the alleged abuser. This contrary to the guidance provided within the Safeguarding Adults procedures. The home must obtain a copy of the updated guidance on safeguarding adults produced by Somerset County Council and that the policy is updated accordingly. The Registered Manager advised that newly appointed staff are required to read the policies and Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 18 procedures regarding abuse therefore it is important that this policy is updated and that staff are made aware of the revised procedures. The whistle blowing policy must be updated to make it clear that staff may raise concerns directly with an external agency. All staff spoken with stated that they would raise any issues of concern with the Registered Manager. One staff member stated that would report any concerns to the Police, whilst other staff were not aware that they could also contact other agencies. Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21, 23,24,25 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has appropriate communal and bathing facilities to meet people’s needs. Further action must be taken to address maintenance issues and regular quality audits completed to ensure that home provides a safe, comfortable and hygienic environment for people . EVIDENCE: The home consists of two separate buildings that are located on opposite sides of a quiet residential road. The units are staff separately and each has a kitchen, lounge, dining room and assisted bathrooms. A call system is available. Since the last inspection a stair lift was installed in the second Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 20 property. The home has decorated and furnished to an adequate standard. There are sufficient communal areas and bathing facilities to meet people’s needs. Bedrooms are situated on the ground and first floors. All rooms are single occupancy and have en suite toilet facilities. Bedrooms had been personalised to reflect service users individual tastes. During a tour of the premises it was noted that some window openings on upper floors had not been restricted and some wardrobes and heavy items of furniture had not been fixed to the wall. An immediate requirement was issued to state that appropriate action must be taken to prevent risk of injury to people living at the home. There is an assisted bathroom in each property. It was observed that in one communal bathroom the bath panel was damaged and within the other it had been covered with carpet. This would make both areas difficult to keep clean. Toiletries were found in both bathrooms. In one bathroom there were over twenty bottles of toiletries, two unclean hairbrushes, several tablets of soap and a pot of Conotrane. These pose a risk of cross infection. Toiletries must be for use by individual people and must not be available within communal areas. Hot water outlets for baths were tested and were found to be within appropriate limits. Hot water from hand basins was found to be very hot and exceeded 50 C. An immediate requirement was issued that risk assessments must be completed in relation to these hot water outlets and any necessary action taken. During a tour of the premises it was noted that hand washing facilities consisting of liquid soap, paper towels and a foot operated flip top bin had not been provided in all bathrooms, toilets, the laundry or en suite bathrooms where staff provide assistance with personal care. Some commodes had not been thoroughly cleaned. A number of maintenance issues were identified including: sealant requiring replacement around the bath and some en suite hand basins, broken handles on the wardrobe in room 7, and a broken window ledge within one toilet. Some carpets within bedrooms were stained and require through cleaning or replacement. The flooring in some en suite bathrooms does not meet the base of the toilet and within the utility area the waterproof flooring does not meet the edge of the wall. The paintwork around the hand basin in the kitchen requires renewal to ensure it can be thoroughly cleaned. Within the surveys received from people living at the home, all respondents stated that the home is always clean and fresh. Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are appropriate to meet the needs of people living at the home. Generally staff have been provided with the training required to undertake their role. The Registered Manager has not obtained appropriate information or provided induction training to all agency staff working at the home. EVIDENCE: Duty rotas are maintained. There are two staff on duty throughout the day at each unit. There is one waking member of staff and one sleeping in member of staff. Duty rotas state that the Registered Manager provides the sleep in cover every night between 9pm and 8am. The Registered Manager advised that another staff member sometimes covers this duty, but this had not been recorded. Some people spoken with during the inspection confirmed that there were sufficient numbers of staff on duty throughout the day and night, whilst others said that there is ‘not enough’. People stated that they were pleased with the Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 22 care that they receive. Within the surveys received from staff members all of the respondents stated that there were sufficient staff on duty each day to meet people’s needs. Agency staff also work at the home. The Registered Manager advised that they try to use the same staff whenever possible to provide consistency for people receiving care. On the duty rotas seen one agency member of staff was working approximately five shifts each week. The home did not have evidence of the CRB, POVA First check or references being seen for the agency worker and there was no record of this staff member having received induction training at the home. One staff member is aged under 18years. They confirmed that they did not participate in moving and handling or personal care, and that a senior member of staff is always available. The Registered Manager has confirmed that an appropriate risk assessment has been completed. Recruitment records were examined for three staff members. An enhanced CRB, POVA First check and two references had been obtained for each staff member. None of the files seen included a health declaration, and there was no record of mandatory training for one person. It is recommended that the Registered Manager maintain an interview record. Induction records were seen. The Common Induction Standards were discussed during the inspection. Within the surveys received from staff, all stated that the induction provided them with the necessary training to undertake their role and that they are provided with regular training. Within the AQAA it states that 7 out of the 12 care staff employed have completed the NVQ level 2 qualification. Staff training files included evidence of training being provided on food hygiene, first aid and manual handling. Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37 & 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Registered Manager has not established a system for regularly auditing and improving the service provided. The Registered Manager has failed to take appropriate actions, through routine maintenance of equipment and staff training to ensure the health and safety of people living and working at the home. EVIDENCE: The Registered Manager and Provider is Maria Hallett. She has owned and managed Cool Runnings for a number of years. She is supported by a small staff team that includes a number of family members. Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 24 Mrs Hallett advised that due to the size of the home, there are no formal systems for obtaining feedback, and that instead she tries to speak with people living at the home, their relatives and visiting professionals on a regular basis. There are regular staff meetings at the home. People spoken with during the inspection stated that they would feel able to raise any issues of concern with her. Within a survey received one staff member wrote ‘The manager is very supportive with all aspects of my work’ The home was given Quality Rating by Somerset Social Services on 1/1/06. The Registered Manager has not undertaken regular review of the standards of care provided to ensure that it continues to comply with the regulations, and to identify areas for improvement. This was discussed during the inspection. Within the AQAA the home is required to identify plans for improvement for the next 12 months. For most outcome groups ‘N/A’ has been recorded. The Registered Manager may wish to undertake reviews of the environment, care plans and medication practice to ensure that these meet the required standards and that the service continues to improve. As previously stated within Staffing, the Registered Manager has not obtained evidence of the CRB, POVA First check or references being seen for the agency worker, therefore potentially placing people at risk from unsuitable staff working at the home. The home will keep money securely for those that wish them to. Receipts had been obtained to support most transactions and signed for by one or two people. It was recommended that receipts be also obtained from the hairdresser so that there is a clear audit trail for all transactions. Records are audited on a monthly basis. Staff are provided with supervision. These records were examined. It was found that supervision was task-centred and did not cover the topics covered within the National Minimum Standards of older People. These were discussed with the Registered Manager during the inspection. During the course of the inspection records relating to people at the home were examined. It was found that the content of the Handover book, and storage of daily records (kardex) did not comply with Data Protection legislation. The home uses the Safer Food Better Business system. Records seen had been appropriately maintained. Fire safety records examined. It was found that the system had been tested and serviced as required. Emergency lighting has been tested on a monthly Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 25 basis. A fire risk assessment has been completed for both properties. This should be expanded to include information on the electrical equipment used in each room, the ability of each person to use this, storage of rubbish and chemicals within both homes. The Registered Manager has confirmed that there is an evacuation procedure in place. The home has completed a risk assessment in relation to the front door being locked at one of the premises. The Inspectors were advised that fire training is completed at staff meetings, but there was no record of this seen on the minutes provided. Following the inspection the Registered Manager has confirmed that fire training was provided at the previous staff meeting and appropriate records maintained. During a tour of the premises it was observed that within one bathroom a cupboard housing cleaning solutions was not locked. This was found to contain several bottles of bleach and toilet cleaner. Cleaning solutions were also found within the laundry of the second property. This included a several bottles of toilet cleaner, including one that had the top removed, anti bacterial cleaner and oven cleaner. An immediate requirement was issued to state that all hazardous substances must be stored securely and not be accessible to people living at the home. Following the inspection, the Registered Manager has provided written confirmation that this has been completed. First Aid boxes must be reviewed as the expiry date had passed for some sterile products. The Registered Manager advised that there were no servicing records to evidence that servicing had taken place by a suitably competent person, for portable appliances, electrical hardwiring, stair lifts, fire system or nurse call system. The Registered Manager has confirmed that there is no hoist available at the home. The registered persons must review the range of equipment available to ensure that there is appropriate lifting equipment available to meet the needs of people living at the home. Accident records were examined. A number of accident records had been completed, however daily records evidenced that an accident had taken place for one person, but an accident record had not been maintained. Following the inspection the Registered Manager has advised that this had been completed and was located within filing tray at the time of the inspection. Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 1 1 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 3 3 X 3 2 2 1 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 1 X 2 2 1 1 Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 17 (2) & Sch 4. Requirement Each person must be provided with a written contract outlining the terms and conditions of residency. This must include information on what is and is not included within the weekly fee. The Registered Manager 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 people’s needs. Care records must be reviewed to ensure that appropriate plans are developed regarding the following areas of need: - diabetes - catheter care - mental health - dementia care Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 28 Timescale for action 04/07/08 2. OP3 14 (1) 13/06/08 3. OP7 & OP8 15 (1) 04/07/08 - continence promotion - challenging behaviour - missing persons - pressure area care - nutrition as appropriate to the needs of the individual person. 4. OP7 15 (1) Care plans must be regularly reviewed and updated to ensure that they reflect people’s current needs. Care records must include information regarding visits from health care professionals and the outcome from their visit. A staff signature must be recorded for hand written entries. Each person who self medicates must be provided with secure storage facilities within their room. The home must review the timing of midday medication to ensure that people are able to enjoy meals fully. 7. OP12 16 (2) [m] People with increased level of physical or mental health needs must be provided with appropriate opportunities to engage in social activities. The complaints procedure must be reviewed and a copy provided to each person or displayed within the home. The registered manager must DS0000068414.V362237.R01.S.doc 04/07/08 5. OP8 15 (1) 04/07/08 6. OP9 13 (2) 13/06/08 04/07/08 8.. OP16 22(6) 04/07/08 9. OP18 13 (6) 18/07/08 Page 29 Cool Runnings Version 5.2 undertake Protection Of Vulnerable Adults training and familiarise herself with the county procedure for the reporting any incidents. (Previous timescale of 21/01/08 not met). The home must obtain a copy of the updated guidance on Safeguarding Adults produced by Somerset County Council and ensure that the policy on Dealing with Abuse is updated accordingly. Staff must be made aware of the revised policy. The whistle blowing policy must be updated to state that staff may raise concerns directly with external agencies. 10. OP19 OP25 13 (4) Risk assessments must be completed in relation to: - unrestricted window openings on upper floors - wardrobes and other heavy items of furniture that have not been fixed to the wall. - hot water outlet temperatures that exceed recommended levels. And any appropriate action taken. Immediate requirement issued. (The Registered Manager provided written confirmation following the inspection that Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 30 16/05/08 these matters had been addressed). 11. OP19 23 (2) Appropriate action must be taken to address the maintenance issues identified within the report. 18/07/08 12. OP24 16 (2) [c[ Some carpets within bedrooms 18/07/08 were stained and require through cleaning or replacement. The Registered Manager must review infection control procedures throughout the home. This must include ensuring that: - toiletries and creams are not available in communal bathrooms - bath panels can be easily cleaned. - sealant surrounding the bath and hand basins is renewed as required - hand washing facilities consisting of liquid soap, paper towels and a foot operated flip top bin are provided in all bathrooms, toilets, the laundry or en suite bathrooms where staff provide assistance with personal care. - commodes are thoroughly cleaned. - paintwork around the hand basin in the kitchen is renewed to ensure it can be thoroughly cleaned. - within the utility area that action is taken to address the gap where the waterproof 04/07/08 13. OP26 13 (3) Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 31 flooring does not meet the edge of the wall. 14. OP29 19 & schedule 2 The Registered Manager must ensure that evidence is obtained of the CRB, POVA First and references being provided any agency worker. A health declaration must be obtained for each staff member. 15. OP30 18 (1)(c)[I] 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. 16. OP33 & OP31 24(1)(3) The Registered person shall establish and maintain a system for reviewing the quality of care provided at the care home. This system must be developed and evidence commitment to developing and improving the care service to meet the service users needs. (Previous timescale of 29/09/06 not met). 17. OP37 17 & 12 (3) [b] The Registered Manager must review the system for recording and storing information relating to people living at the home to ensure that it complies with Data Protection legislation. The fire risk assessment must be expanded to include information on the electrical equipment used in each room, the ability of each person to use this, storage of DS0000068414.V362237.R01.S.doc 13/06/08 04/07/08 04/07/08 04/07/08 18. OP38 23 (4) 04/07/08 Cool Runnings Version 5.2 Page 32 rubbish and chemicals within both homes. 19. OP38 13 (4) All hazardous substances must be stored securely and not be accessible to people living at the home. Immediate requirement issued. (The Registered Manager provided written confirmation following the inspection that these matters had been addressed). 20. OP38 12 (1) [a] The First aid kits within the home require review as the expiry date had passed for some sterile products. An appropriately competent person must carry out maintenance and servicing of gas and electrical equipment. Certificate of completion to be forwarded to CSCI. (Previous timescale of 05/12/07 not met). This must include: portable appliances, electrical hardwiring, stair lifts, fire system and nurse call system. 22. OP38 13 (5) The home must ensure that there is suitable lifting equipment available to assist people living at the home. 04/07/08 13/06/08 16/05/08 21. OP38 23 (2) & 13 (4) 04/07/08 Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations New admissions to No 63 The Park should be screened for their level of independence at night, frailty and any night time needs to ensure the person needs can be met without waking night staff attendance. It is recommended that the home review the current system of storing so that all of the information relating each person may be easily accessed and thoroughly reviewed. The home should review the use of abbreviations within care records to ensure that they can be easily understood. 3. OP9 It is recommended that all hand written entries on medication records are checked and signed by a second staff member. It is recommended that an opening or expiry date is recorded for prescribed creams. 4. OP27 All staff engaged in a care worker capacity that are aged less than 18 years should be registered on a certified training course. An interview record should be maintained. It is recommended that receipts be obtained from the hairdresser to support each transaction. Staff supervision should be provided and recorded up to six times per year for care staff. The Registered Manager should review the topics covered to ensure that they comply with those outlined in the National Minimum Standards for Older People. 2. OP7 5. 6. 7. OP29 OP35 OP36 Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cool Runnings DS0000068414.V362237.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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