Archived: Cool Runnings Too

Cool Runnings Too is a care home which is registered to provide care and accommodation for up to 12 older people. At this inspection there were 10 people living at the home, one person was in hospital and the provider had one vacancy. The home has access to a garden area. There are two floors with communal spaces such as lounges and dining rooms on the ground floor. At this inspection everyone had their own individual bedroom. The provider has some people completing periods of respite.

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

Quality monitoring systems were not effective, the provider had not identified shortfalls through their governance system. Specifically, with regards to medicine management.

Risk and safety were not always comprehensive or up to date. The provider had not ensured people living at the home had a Personal Emergency Evacuation Plan (PEEP). A PEEP sets out the specific physical and communication requirements that each person had to ensure that they could be safely evacuated in the event of an emergency. We have recommended that the provider considers current guidance on managing risk in care homes and takes action to update their practice.

Since 2016 onwards all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard [AIS]. The standard was introduced to make sure people are given information in a way they can understand. The registered manager was aware of the AIS but had not fully ensured information was shared in an accessible way. We have recommended that the provider considers current guidance on accessible information standards and takes action to update their practice.

People were supported by staff that were caring and treated them with dignity and respect. Staff understood the needs of the people they supported well and knew them as a person. All the feedback we received from people and their relatives was positive.

People were supported by staff who had the skills and knowledge to meet their needs. Staff felt supported by the registered manager. Staff understood their role and received appropriate training that supported them in their roles.

Staff worked together with a range of healthcare professionals to achieve positive outcomes for people. Staff supported people to maintain important relationships and continue personal hobbies and interests.

People's concerns and complaints were listened and responded to. Accidents and incidents were reviewed. People and their relatives commented positively about the registered manager and the quality of care their family member received.

The registered manager had ensured all relevant legal requirements, including registration and safety obligations, and the submission of notifications, had been complied with. The registered manager felt staff had a clear understanding of their roles and responsibilities. This was evident to us throughout the inspection. Staff worked with people within the principles of the MCA, and DoLS.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection (and update) The last rating for this service was good (published 14 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to medicines management and made three recommendations in relation to, risk management, accessible information and communication and quality assurance including medicines management.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cool Runnings Too is a care home which is registered to provide care and accommodation for up to 12 older people. At this inspection there were 12 people living at the home with one of these people returned from hospital during the inspection and another went to hospital. There were people with various stages of dementia living in the home during the inspection. Some had limited verbal communication skills. The home had a number of people who wished to live a more independent lifestyle within the safety and security of the care home.

The building is a large home with access to a garden area. There are two floors with communal spaces such as lounges and dining rooms on the ground floor. At this inspection everyone had their own individual bedroom. The provider has some people completing periods of respite.

There is a registered manager in post who is also the provider. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Some concerns were found at the previous inspection which resulted in us making recommendations. At this inspection we found there had been improvements to staff levels around meal times and their training in relation to moving and handling. Special equipment to help people with transfers had been purchased. However, people were not always kept safe because staff did not have all the guidance required to support specific people. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. There were occasions when the risk assessments lacked important details.

Staff had the skills and knowledge required to effectively support people. New staff had received a thorough induction. They were supported by the management to deliver high quality care. Staff told us they had been through a recruitment procedure. However, some staff had gaps in their employment history and references were not always from previous care employers.

The home was well led. People told us the management was supportive. The registered manager had systems to monitor the quality of the service and made improvements in accordance with people’s changing needs. The management strove to develop positive relationships with people and their relatives.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. When they lacked capacity the correct procedures had been followed. People’s medicines were managed safely and stored appropriately including those requiring additional security. People who required special diets had their needs met. People told us their healthcare needs were met and staff supported them to see other healthcare professionals in a timely manner.

People and their relatives told us, and we observed that staff were kind and patient. People’s privacy and dignity was respected by staff. People, or their representatives, were involved in decisions about the care and support they received. People who had specific end of life wishes had their preferences respected by staff to help provide a dignified death.

Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. Activities were in place to provide a range of opportunities. People were encouraged to suggest activities which would respect their hobbies and interests. The provider had received no recent complaints.

We made a recommendation about the recruitment of staff.

Whilst the home provided kind and responsive care to people some improvements were required to ensure the safety and the effectiveness of their care. This is a small, homely home that suited some people very well. They were able to live in a way that pleased them and were well known by staff. However the equipment and staffing levels in the home meant that people requiring more complex care during the day and night were not having their needs fully met. We have made a recommendation about improvements to the manual handling of people in the home.

During the day two care staff undertook catering and housekeeping duties in addition to caring for people. An activities person was employed two afternoon’s per week. People living in the home and their relatives said there were sufficient numbers of staff on duty. However we have made a recommendation about the deployment of staff during meal times.

There is a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. At Cool Runnings Too the registered manager is also the registered provider. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations

about how the service is run.

The last inspection was carried out on 29 June 2015. Some concerns were identified in relation to safeguarding arrangements and the effectiveness of one person’s care. During this inspection we found the actions had been completed and sufficient improvements had been made.

People living in the home and their relatives liked the atmosphere of the service. One relative said “It is a nice sized home.” They told us “[Their relative] would not like a big home. They would feel lost and worried no one would know them. Here each person is very well known.” Another relative said “I cannot fault the care. There is never any rudeness or unkindness. Quite the opposite.”

The service provides personal care in a residential environment. The manager was clear people’s health and clinical needs were met by community nurses or other healthcare professionals. Community nurses visited the home daily to provide healthcare.

People told us they had access to healthcare professionals according to their individual needs.

People’s records showed they were visited by doctors, chiropodists and opticians. Relatives told us of occasions when they had been kept informed if the doctor had visited or there had been a change in their family member’s health.

People and staff told us the registered manager was friendly and approachable. They told us they would be able to make a complaint or raise any worries or concerns with them and be sure they would receive a helpful response. People were able to share their views informally with the care staff and manager.

People told us the quality of the food was “good” and there were “no complaints.” People also said they were able to have drinks and snacks at any time of the day or night. Activities were organised in the home two afternoons each week. In addition people went out of the home with their families and socialised with each other.

Staff had access to training to ensure they had the skills to meet most people’s needs. Further training was needed in relation to the care of two people.

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Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us that they felt safe. A relative told us that they had no worries about the care their parent received. Another told us that they had never had any complaints.

The home was clean and safe. We saw that equipment was well maintained and in good working order.

Staff said that if they had any concerns about people's safety they would report them to a more senior member of staff. However, when asked about safeguarding and abuse they did not did not know enough about it to ensure that people would be kept safe at all times.

Risk assessments in people's care plans did not always reflect their changing needs. Some risk assessments were not in place, although care plans showed that the person should have one. This meant that people might be at increased risk of harm.

Records were not always kept up-to-date or stored securely.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to monitoring safety, accurate recording, secure storage, and staff training in safeguarding.

Is the service effective?

People told us that the service was meeting their needs. A relative said, 'I love it, and [my relative] loves it. I've no worries.' Another relative told us that their parent was a lot better in their general well-being since coming to live in the home.

People's health and care needs were assessed, and dietary, mobility and equipment needs were identified. Not all of the care plans we saw were signed by the person, although they had been assessed as having capacity to make daily living decisions. We could not be sure that the service had identified all their needs and was effective in meeting them. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and involving them in planning their care.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff spoke respectfully to people, asking what they wanted to do, listening, and giving them time to respond. A person told us that the staff were very caring, saying, 'We have some fun with them. It's lovely ' I can't find fault.'

Is the service responsive?

People told us that they had never needed to complain about the care they received. They told us that staff asked them what they wanted to do, and listened. One person said that they saw the doctor regularly. They said, 'If there's something wrong, they get it sorted.' As we looked around the home we saw that a call bell was answered promptly.

People received visits from community health care professionals such as nurses and chiropodists.

People had asked for a day trip, and one was in the process of being arranged, in response to their requests.

Is the service well-led?

The provider monitored some aspects of care for quality and safety. They included medicines management and checking care plans. However the manager told us that much of the monitoring was done on an informal basis, and not recorded. This included obtaining feedback from people, and regular review of daily care records and risk assessments. Maintenance records for portable electrical items were not up-to-date.

We have asked the provider to tell us what improvements they will make to meet the requirements of the law in relation to quality monitoring and record keeping.

Everyone who spoke with us said something positive about the care staff. We heard that they were always kind and polite. We saw during the inspection that they spoke to people who lived in the home respectfully.

At the inspection on 12 November 2012 we found that people were asked for their consent prior to receiving care or treatment. We asked the provider to improve the ways in which people were supported to make decisions. At this inspection when we looked at care plans people's mental capacity had been assessed and suitable arrangements were in place to support the decisions they made effectively.

At the last inspection on 12 November 2012 we found that the home did have recruitment procedures but these were not complete. At this inspection we saw all staff had photographs for identification in their files and there was no evidence of an interview for a new member of staff.

During this inspection people told us that they had no complaints or concerns and that the home was "very good."

People were involved in activities. Throughout the day we observed people listening to music, reading the paper and watching the television. We also reviewed the activities diary which demonstrated that a number of activities had been undertaken in the previous two weeks including a video afternoon, reminiscing, a birthday party and scrabble.

People told us that the food was 'excellent'.

Care plans were updated as required and reflected the needs of people. However there were no mental capacity assessments in people's records.

Some staff had not had effective recruitment procedures. Staff received supervision and appraisals and had opportunities to learn and develop.

There were systems in place to monitor people's care.