Care Home: Cool Runnings Too

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What the care home does well People living at the home were very pleased with the care provided. Comments included "staff are excellent. I can do what I want when I want to do it. Staff are very supportive." It was very clear from the evidence seen that people are regarded as individuals and that their individuality is respected by staff. Within the surveys received staff members wrote that "we are a small home with a stable staff team. Staff are friendly." Positive feedback was received regarding the meals provided. One person spoken with during the inspection stated that "the food is good". 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. The environment including communal areas provides a homely family feel. 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. 50% of the care staff employed have completed the NVQ level 2 qualification. What has improved since the last inspection? Following the last inspection the home has completed work to address some of the environmental shortfalls identified. Infection control measures are now in place What the care home could do better: The home provides good support and care to people with lower dependency needs. The care and support is not good as people become frailer or are ill. During this time staffing levels are not adequate particularly at night. The home does not provide equipment such as hoists (used to help people move) which may be required when people become frail or at risk of falling. Staff may not have the skills to meet peoples needs as they become frailer. Staff need additional training in medication, first aid and food hygiene. The management need to develop systems to review the care and support provided. This should include auditing of accidents and incidents, keeping staffing levels under review and developing staff supervision. The arrangements for keeping peoples money is not secure. 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 is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Justine Button     Date: 0 9 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 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 12 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 Care Homes for Older People Page 4 of 31 Over 65 12 0 1 3 1 1 2 0 0 8 Brief description of the care home 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, 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 31 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 key inspection was unannounced, and was completed over one day two Regulation Inspectors. The focus of this inspection visit was to inspect relevant key standards as detailed in the National Minimum standards. 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. On the day of this inspection there were 18 people residing at the home. During the course of the inspection we (CQC) 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. Care Homes for Older People Page 6 of 31 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. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 31 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 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 10 of 31 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. There is information available to assist people to make a choice before they come to the home. People have an assessment before they come to the home. People have a copy of the contract or terms and conditions of their stay Evidence: Information is available for people to help them make choices about coming to the home. Some people spoken to during the visit to the home had not had an opportunity to visit the home prior to coming to live there because they had been unwell. Two people talked about the role of their relatives in selecting a home. The surveys sent to people prior to the inspection asked did you receive enough information prior to moving into the home All people stated that they had. Care Homes for Older People Page 11 of 31 Evidence: The manager stated in the AQAA that she conducts an assessment visit prior to someone coming to live in the home. Completed assessments were seen in peoples files. Records were also seen that showed that people were reassessed by health professionals as their needs changed and in some cases more appropriate care settings were found. All but one person in the surveys received stated that they had received a copy of the terms and conditions. Care Homes for Older People Page 12 of 31 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. Staff need to ensure that care plans are consistently developed in all areas and for all individuals living at the home. The home needs to ensure that they are meeting the peoples health care needs particularly when people become frail or ill. Improvements in the management of medication have been seen. Staff training is this area is needed. Evidence: All people spoken to during the inspection said that they were well cared for. There was further in the surveys received that people found the care to be good or excellent. Each person at the home has a plan of care. The plans seen were not robust and did not detail all the care needs of the individual. The plans did not give sufficient guidance to staff on how they could support the individuals to meet these needs. Four plans were seen and reviewed in detail. One individual had been admitted to the Care Homes for Older People Page 13 of 31 Evidence: home in 2007. The notes from health care professionals prior to admission show that the individual had a long standing history of mental illness. Due to this the individual could sometimes become distressed and upset. There were no care plans in place which detailed the actions staff should take when this occurred. There was evidence that the individual had a history of falls. Despite this staff had not developed a risk assessment or care plan for this area of care. Increased confusion can often be caused by a urinary tract infection. There was clear evidence in the daily records that the individual had been seen by the GP and a urinary infection had been diagnosed. Staff had not developed a care plan for this aspect of the individuals needs. There was no evidence to suggest that staff had considered supporting the individual to drink more which helps relive the symptoms of a urinary infection. There was no evidence that staff were supporting the individual to access the toilet more regularly. Despite having a history of falls and a urinary infection there was no evidence available that consideration had been given to increasing staffing numbers at night to support the individual to access the toilet at night (see outcome area 6). In August 2009 the individual was admitted to hospital. It was clear from the notes from the local hospital that the individual had an on going health illness. There was no care plan developed by staff at the home either before or after admission to hospital detailing or giving guidance to staff with regard to this issue. It was also clear from the notes from the hospital that due to dementia and on going confusion that the individual was unable to give consent for investigations into this illness nor the capacity to decide on future care. Despite this staff at the home have not developed a care plan detailing how they would support the individual to make choice. The staff need to refer to the Mental capacity act for additional guidance in this area. As previously stated concerns had been raised to us with regard to the care and support afforded to one person living at the home. These concerns related to increased falls. A fall risk assessment had been completed on the 14/09/09. This assessment stated that the individual was unsteady due to infection. Ensure that x is monitored at all times when walking. Rely gets out of bed We reviewed the running records for this individual between the date of 21/09/09 and 09/10/09. It was clear from these records that the individual had an accident on the 21/09/09 was very confused, agitated and vomited. This resulted in a decrease in the persons ability to walk. The completed risk assessment was not updated following this fall. The GP visited and prescribed some medication for constipation and a urinary infection. It was clear from the running records that over the next few days the individual was poorly with reduced appetite and mobility. weights completed between June 2009 and September 2009 showed that the individual was loosing a small amount of weight each month. Due to this and decreased in mobility the individual developed a pressure ulcer also know as a bed sore. There is evidence that the district nurses provided on Care Homes for Older People Page 14 of 31 Evidence: going support via dressing changes and pressure reliving mattress to the home. Despite the evidence that the individual was becoming frailer and was not well risk assessments and associated care plans were not developed by staff. There were no care plans in place for the individual reduced appetite and actions staff should take to address this. There was no care plan for the pressure ulcer and as such no guidance to staff on a regular change of position or dressing to be used. Despite the GP diagnosing constipation and a urinary infection there was no care plan detailing the actions staff should take in response to this which should have included increased fluids,fibre in the diet and increased access to the toilet. Despite requiring increased support to access fluids, the toilet, a regular change of position and previous falls consideration was not given to increasing the night staffing arrangements (see outcome area 6) . A subsequent fall was experienced by the individual during the night of the 09/10/09. This fall resulted in a hospital admission. The care records for a third individual were seen. This person had been living at the home for over a week. When people are admitted to the care homes it would be expected that staff would complete baseline assessments and care plans with in a very short period. The information received from the local social services department prior to admission shows that the individual had diabetes which was not controlled, a history of falling at home due to low blood sugars, weight loss, dementia and that the individual need staff support to maintain personal hygiene. Despite these care needs being identified by social services only one care plan / assessment had been completed by the home. The care plan which had been developed gave staff guidance on what to do if the individual left the building. No other care plans had been developed in any other area. A weight chart was in place but no weights had been recorded. There was no evidence that blood sugars were being monitored (although it cannot be confirmed if staff have the skills to complete this) There was no guidance to staff on supporting the individual to maintain a diabetic diet nor how to stem the weight loss which had been experienced. During the inspection we spoke to people living at the home who all stated that the care and support they received from staff was good. One gentleman told us that he was not well with back pain. He told us that staff had been very attentive and that he had received regular pain killers. The records viewed confirmed that there are regular visits from health professionals, doctors and nurses to the home. There is support available from community Psychiatric Nurses when needed. There is evidence that people can access specialist care when needed. In care plans there are some records of visits from doctors, nurses, chiropodists and opticians. People can make their own arrangements and Care Homes for Older People Page 15 of 31 Evidence: continue to visit their own choice of professional services with family or home support. Medication records were viewed during the inspection visit. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). The staff member on duty then administers medicines. We observed the staff in one area administering the lunch time medication. This was completed safely. During the inspection we noted that some paracetamol had passed its expiry date. This should have been returned to the pharmacy. In addition we noted that one medication should have been stored in the fridge when opened. This was being stored in a none refrigerated draw. During the inspection we spoke to two staff with regard to the training that they had received with regard to medication. Both staff told us that they had not received formal medication training. They told us you watch the others do the medication round a couple of times and then you can do them. This is not sufficient. Staff need to ensure that they are aware of how to give medication safely, what medication they are giving and the side effects. Additional guidance can be found on the CQC Internet Training care workers to safely administer medicines in care homes 8 January 2009. Additional help and advise can be found www.skillsforcare.org.uk. Care Homes for Older People Page 16 of 31 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. Routines at the home are flexible and people are able to choose what to do. visitors are made welcome meal and mealtime arrangements are satisfactory Evidence: People living at the home were very complimentary about their daily lives. People stated that they were able to to choice what to do and and when to do it. Activities for October on offer included bingo, blanket making, arm chair aerobics, a walk to the park, knitting, games and watching the X- factor (people told us that they really enjoyed getting together to watch this and taking bets who was going out that week!). People told us that they watched the church service on television. One gentleman told us that he was very happy at the home. Staff are very nice and that he could do what he wanted. He told us that he was quite happy pottering about and staff respected this. Another lady told us that she was also happy at the home as she was able to bring in her cats. This person told us that she went out for lunch regularly with her sister. This person stated that the staff were excellent. This individual had a number of plants in her room which she stated she enjoyed looking after. Care Homes for Older People Page 17 of 31 Evidence: All the bedrooms seen were full of personal possessions such as photos, plants and small items of furniture. The communal areas were also very homely in decor which added to the family feel of the home. The lunch time meal was viewed on the day of the inspection. This consisted of chicken pie mashed potatoes and veg. This was cooked by staff in both areas of the home. A choice of meal is not routinly offered although everyone spoken to during the inspecton stated that staff were aware of what they liked and did not like and would always get you something else. Menus were on display in some areas of the home although people spoken to prior to linch were not always aware what the meal was. People told us that the evening meal was something lighter we were told sandwiches or something on taost, that sort of thing. The majority of people were observed to go to the table for lunch although meals can be served to the bedrooms. The atmosphere in th edining area at lunch time was very friendly with lots of banter and conversation between people at the home and staff. Care Homes for Older People Page 18 of 31 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. Complaints are dealt with in line with the homes policy and procedures. People living at the home are aware and comfortable in expressing any concerns. People living at the home are protected by the homes policies and procedures. Some staff have not received recent training in the prevention and recognition of abuse. Evidence: Feedback forms to people living at the home asked do you know who to speak to if you are not happy? Comments from relatives included A wonderful home no complaints. The Home has a complaints procedure that is clearly written and contains the contact details for CQC. A range complimentary letters were also held on the file. As discussed one concern has been recieved by us. This was investigated by Social Services. The policies and procedures regarding protection of residents are in place, which include complaints,recognising signs of abuse and whistleblowing. Abuse training is included in the new staff induction programme. The training matrix was viewed as part of the inspection process and this showed that not all staff had recived abuse training, although this is covered by staff who have completed an NVQ and during induction. Care Homes for Older People Page 19 of 31 Evidence: The completed AQAA stated that the manager has been proactive in welcoming complaints and suggestions about the service, using these positively and learning from them. Care Homes for Older People Page 20 of 31 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. People have their own possessions in their room. The home was clean and tidy. The home may not provide adequate equipment to meet the needs of people at the home particularly when they become more frail, following an accident or are ill. 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. A stair lift is available in the second property. The home has decorated and furnished to an adequate standard. There are sufficient communal areas and bathing facilities to meet peoples 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. People coming into residential care now have more healthcare needs than they previously did. This is due to the fact people are choosing and being supported to remain in their own homes for longer. The home does not currently have a hoist used Care Homes for Older People Page 21 of 31 Evidence: for supporting people to move. Staff told us that this is a residential home and therefore we do not need a hoist. This is not the case. The home should provide equipment necessary for the needs of the people living at the home. During the inspection we reviewed the accident records. These showed that following a fall the staff support people to get up from the floor manually. This could increase the risk of injury to both the staff member and the person living at the home. For these reasons the home needs to consider increasing the amount of equipment such as hoists used in moving and handling, pressure mats and scales for weighing people who cannot stand. Care Homes for Older People Page 22 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers are not adequate at night when people are ill or frail. Staff need additional training to ensure that they have the skills to meet the needs of people at all times. Staff recruitment procedures were adequate Evidence: During the inspection we reviewed the staff duty rotas. There are two staff on duty throughout the day at each unit. There is one waking member of staff in cool running and one sleeping in member of staff in cool runnings too. Part of the concerns raised to us involved a person falling at night during an acute illness. As a result of the lack of waking night staff there is evidence that this individual remained on the floor for a period of time. This is unacceptable in a care home environment. Other care records viewed showed evidence that other people at the home would require staff interventions at night including support to access the toilet and fluids. We discussed the incident and our on going concerns with the manager of the home at the end of the inspection. The manager told us that due to restricted finances they would be unable to provide waking night staff cover. A number of options were discussed to address this issue. This included contacting social services when people are ill to provide additional finances to enable the provision of waking night staff. Consideration Care Homes for Older People Page 23 of 31 Evidence: could be given that when people are ill the sleeping night staff member gets up periodically to check on people, offer the use of toilet and fluids. According to the duty rotas it is clear that one of the home owners sometimes provides sleeping night staff cover. It could not be confirmed that this individual had received training to complete this role. 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 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 peoples needs. Staff spoken to during the inspection said that they had received a good induction and were happy with the ongoing training opportunities. The training matrix was viewed as part of the inspection. This showed that some staff require additional training. As previously stated some staff require training to ensure that they administer medication safely. Care staff complete all the cooking and preparation of meals. It could not be confirmed that all staff have undertaken food hygiene training. On viewing the accident records it was clear that one person at the home had fallen. Staff supported the person to get up off the floor. Later it was confirmed that the individual had a broken hip. It could not be confirmed if staff have the skills to recongnise the signs and symptoms of such injuries as staff have not undertaken first aid training. According to the AQAA received prior to the inspection the home employs 10 permanent care staff. Five of these have an NVQ and an additional 3 staff are training towards this. We viewed the recruitment files of the three most recently employed members of staff. These gave evidence of a robust recruitment procedure that minimises the risks of abuse to the people living at the home. New members of staff had undergone an enhanced Criminal Records Bureau (CRB) check and written references had been obtained before the person began work in the home. All staff who completed a questionnaire answered YES to the question Did your employer carry out checks such as CRB and references? Care Homes for Older People Page 24 of 31 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 well managed taking although more emphasis should be placed on considering the views of people who use the service. Various systems are in place to maintain a safe environment. A system of staff supervision needs to be developed. personal monies need to be securley stored. 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. 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, Care Homes for Older People Page 25 of 31 Evidence: 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. 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 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. During the inspection we observed that peoples personal money was not kept securly. Currently the home stores the money in fliling cabinet in the staff office. This cabinets also used to store care records. Although there is a key pad to restrict access to the room the cabinet was not secure as staff require access to the care records. Some people had some signifcant amounts of money stored in this way. One person had a balance of £158.27. Receipts had been obtained to support most transactions and signed for by one or two people. During the inspection we spoke to staff. Staff spoken to were not aware of supervision and what this entailed. Staff however did state that they found the home owner supportive and approachable. The management must ensure that there is a system of supervision in place. This will ensure that staff have the oppertunity to raise any concerns and discuss any training requirements. All accidents are recorded. The management needs to audits these records to monitor the needs of individuals, and to establish if there are any implications for the service. The AQAA recieved prior to the inspection showed that servicing had taken place for portable appliances, electrical hardwiring, stair lifts, fire system or nurse call system. Care Homes for Older People Page 26 of 31 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 7 15 (1) Care plans must be regularly 04/07/2008 reviewed and updated to ensure that they reflect peoples current needs. The registered manager is 18/12/2008 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. 2 8 13 Care Homes for Older People Page 27 of 31 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 12 The home must ensure that the healthcare need so of individuals are met by ensuring a range of assessments are completed according to the individuals needs. This should include assessments for pressure ulcers, continence, falls and nutritional screening This will help to ensure that the health needs of people living at the home are met. 13/01/2010 2 9 13 The management must ensure that all staff who administer medication have recieved appropriate and accredited training To reduce the risk of drug errors and to ensure that medication is administered safely. 28/01/2010 Care Homes for Older People Page 28 of 31 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 3 27 18 The management must ensure that there are sufficient staff on duty at all times particularly at night when people are ill or frail. To ensure the needs of the people living at the home are met. 11/01/2010 4 30 18 The management must 11/01/2010 ensure that all staff have the training to meet the needs of the people at the home. This should include food hygiene, first aid, and medication training To ensure the needs of the people living at the home are met. 5 33 24 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. This should include the auditing of accident and incidents This will ensure that the home continues to develop and meet the needs of people at the home 11/01/2010 Care Homes for Older People Page 29 of 31 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 6 35 16 The management must 11/01/2010 ensure that personal monies are stored securely. to reduce the risk of theft. 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 22 The home must consider increasing the availability of specalist equipment such as hoists, pressure mats and scales. Staff supervision should be provided and recorded up to six times per year for care staff. 2 36 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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