Inspection on 09/12/08 for Birch Tree Manor

This inspection was carried out on 9th December 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Birch Tree Manor Wharf Street Port Sunlight Wirral CH62 4UZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anthony Cliffe     Date: 0 9 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Birch Tree Manor Wharf Street Port Sunlight Wirral CH62 4UZ 01516440777 01516440606 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Anne Elizabeth Lewis Type of registration: Number of places registered: Southern Cross OPCO 4 Limited care home 62 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 30) Dementia - Code DE (maximum number of places: 32) The maximum number of people who can be accommodated is: 62. Date of last inspection Brief description of the care home Birch Tree Manor is a purpose built care home built to national minimum standards. The building consists of ground and first floor accomodation and can accomodate sixty two people. The home is registered to accomodate older people whose health has deteriorated due to their physical health and memory problems. The home is situated at the heart of the historical village of Port Sunlight. The home is close to all local services, public amenities and local transport. The home has an internal passenger lift Care Homes for Older People Page 4 of 31 32 0 Over 65 0 30 Brief description of the care home and staircase to the first floor. All bedrooms are for single occupancy and have en suite facilities. Bedrooms contain connections for a television or telephone and have a call point. There are two lounge/dining areas on each floor as well as a quiet room. There are rear gardens and an enclosed rear garden to which people that use services have direct access. Both nursing and personal care are provided at the home. Fees for those funded through the local authority or Primary Care Trust are at a locally agreed rate and the standard weekly fee is Fees range from 418 pounds to 750 pounds per week and no additional top up fees. Information about Birch Tree manor can be obtained directly form the home or from the homes website. 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: two star good 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: References to we or us represent the Commission for Social care Inspection. This unannounced visit took place on the 9th December 2008 and lasted eight hours. One inspector carried out the visit. This visit was just one part of the inspection. Other information received was also looked at. Some weeks before the visit the manager was asked to complete a questionnaire called an Annual Quality Assurance Assessment (AQAA) telling us what they thought they did well, what they needed to do better and what they had improved upon since the last visit, to give up to date information about the service provided. This helps us to determine if the management of the home see the service they provide in Care Homes for Older People Page 6 of 31 the same way we do and if our judgements are consistent with home owners or managers. We provided questionnaires for people that use services, staff employed at the home and social and health care professionals involved in their care to find out their views about the service the home provides. During the visit various records and the premises were looked at. People that use services were spoken with and gave their views about the service. We also received questionnaires from staff that said the home had good recruitment procedures and staff received good support and training. What the care home does well: What has improved since the last inspection? What they could do better: The home needs to improve how the personalisation of the care of people that use services are reflected in their care plans so staff and others involved in their care understand how important peoples routines and decisions are to them and how these are transferred into how they receive care. Further training on how staff deal with difficult and angry situations between people Care Homes for Older People Page 8 of 31 that use services needs to be provided so staff are aware of their roles and responsibilities. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 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. Information is provided for people that use services so they can make an informed choice about using the service. Information is gathered about their needs and choices so they receive regular consistent care. Evidence: Information provided to people that use services was available in the foyer entrance to the home. The information displayed included a brochure which said the home was an Ashbourne Senior Living care home. The information provided to people that may choose to use the service also included information about the home and the facilities and services available called the service user guide so people that chose to use the service had information about the facilities and services available. Other information was available which told people that may choose to use the service about how the owners would arrange for their care to be provided. This gave Care Homes for Older People Page 11 of 31 Evidence: information about the needs of the people that could live at the home, how information would be gathered about their needs, the experience of the manager, the numbers and qualifications of staff and information about the building so people that chose to use the service could decide if the home could meet their needs. This was called the statement of purpose. There was also information on how the owners would support the different needs, beliefs, disabilities, sexual orientation and culture of people that chose to use the service. The manager had produced additional information on the home and its location. Information was also provided on how the owner monitored the standards within the home, details of the menu, activities available and how staff performance was monitored so people that use the service would know the standards expected of the staff employed so that people that chose to use the service would be confident they would be treated with dignity and respect. A copy of the contract for facilities and services could be provided and all the other information mentioned could be obtained directly from the home. Information could be provided in large print, easy read, audio and braille formats on request so people that chose to use the service had information provided to them in a format they could understand. The home had only offered accommodation to people that use services from August 2008 when it was ready for occupancy. We looked at the care files of two people that use services. The home is part of the Southern Cross Healthcare group and has standard documents and forms on which to record information on the needs of people that use services. The home use a document called a pre admission assessment on which to record information about people that use services before they move into the home so they can decide if they can meet the needs of people that want to live there. The two people whose records we looked at had both been seen by the home manager before they decided to move into the home to discuss their needs and care so they could ask questions about their care and get further information. The document allowed information to be gathered about people that use services inclusive of personal details, medical history,social contacts, religious beliefs, life history, wishes around death and dying, personal and health care needs inclusive of personal choices about their care and routines so important information was available to staff about their needs. A separate document to record information about the mental health needs of people Care Homes for Older People Page 12 of 31 Evidence: that use services was used so the home could obtain information on the mental health of people that chose to live there and provide appropriate care and support. The information gathered could be transferred into a care plan that people could see and sign to say they agreed to the information so they could agree their care. The documents also included information on how known risks to the health and safety of people using services were recognised so plans were in place to maintain their safety Care Homes for Older People Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use services receive their care with dignity and respect but information provided about their care needs to reflect more personal information about them so care staff can provide consistent care based on their decisions and routines. Administration and management of medicines was safe so people that use services were supported to take their medicines safely. Evidence: We examined the care records of two people that use services. The home demonstrated a strong commitment to involving people that use services in their daily lives. The records we examined had care plans relating to their health and personal needs. The care plans we looked at were revised monthly and demonstrated positive outcomes for people that use services. An example of this was that a person using the service that had moved into the home had pressure ulcers and these were healing. Another person that had a number of falls before moving into the home had only fallen Care Homes for Older People Page 14 of 31 Evidence: a few times without serious injury. Care plans could be improved by them reflecting more personal information about people that use services such as their level of independence to care for themselves, their preferred daily routines and how they make choices about when and how they receive personal care so they provide more details about the lifestyles and choices of people that use services. Reviews of care could also be improved by them recording how the health of people that use services are improving for example how risk assessments help to reduce the number of falls in the home. Staff had the right skills to recognise when people that use services need to be seen by their doctors or other health professionals such as a general practitioner, dietitian, optician or dentist so they had access to appropriate health care. An example of this was that before a person moved in the tissue viability nurse was asked to look at the care of a person that chose to live at the home. Another person using the service had been referred to the dietitian when concerns about their diet had been known before they also moved into the home. We could see by examining the records of two people that use services that their health care needs were met. The home had registered people that use services with a doctor so their health needs could be monitored. Visits from local doctors to look at the health of people that use services were requested and visits from health care professionals had taken place. Before the visit took place people that use services returned surveys to us and said their health care needs were always cared for. We looked at the arrangements for receipt storage administration and disposal of medication including controlled drugs. The arrangements were satisfactory and the recording of the administration of medicines was good with no missing signatures found so staff follow the policies and procedures of the home. The home had suitable storage arrangements for medicines on the ground and first floor. On the ground floor the storage facilities had a drugs fridge with the temperature of this monitored daily. The storage facilities contained specimen signatures of people responsible for the administration of medicines and the policies and procedures to be followed. Each month the manager did an audit of the medicines inclusive of expiry dates of medicines. We checked the arrangements for the receipt, storage, administration and disposal of controlled drugs and these were found to be correct. The home had the correct containers for the disposal of medicines including controlled drugs. As part of the controlled drugs audit staff have to keep a record of the administration of medicines that may be abused. Care Homes for Older People Page 15 of 31 Evidence: The policies, procedures, staff handbook and service user guide all contained information and guidance on the importance of treating people that use services with dignity and respect and maintaining privacy and dignity so staff know what standards are expected of them when they provide care and support for people that use services. The information provided to people that use services called the service user guide tells them how staff are supervised by the manager so they know the arrangements of how staff practise is monitored. 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. People that use services make decisions about their routines, take part in a range of activities and have a well balanced diet so have control over their lifestyle. Evidence: The home employs an activities coordinator to plan and assist with activities. At the time of the visit the activities coordinator was spending time talking to people that use services and asking them if there was anything they wanted to do apart form the planned activities. There were details of the weekly activities and events planned in the home displayed around the home so people had information about planned activities taking place. For example people that use services had been involved in watching films and making table decorations and in the afternoon a slide show took place on the history of the Wirral area. Activities were planned for the month ahead with regular assisted walks, film club, hairdresser, baking, coffee mornings, board games and quizzes arranged as well as additional Christmas festivities. Local choirs had been arranged as well as entertainers. The home has visits from the local clergy and library. The home holds weekly coffee morning for people that use services and relatives and members of the community are Care Homes for Older People Page 17 of 31 Evidence: welcome. The manager said she has been in contact with Age Concern and the Alzheimers Society to develop support for people that use services, their relatives and the local community and hoped to provide local support for these charities at the home. There were examples of the table decorations and art that people that use services had done. The home kept photographs of events held at the home and days out. The activities coordinator and staff spent time talking with people that use services and knew personal information about them, making reference to their families and life histories. The home keeps information of the life histories of people that use services and the manager said the information would be used to provide more individualised activities. The manager said despite the differing needs of people that use services the aim is that they can spend time in whichever area of the home that suits their needs or where they have friends. When domestic staff were vacuuming up a person that used the service chose not to go to the slide show and helped move armchairs for the domestic staff. A visitor said that the home was close to her and had been recommended by a social worker. She described the home as lovely, not what I expected, it was better. My husband has only been here three weeks and hes really settled in. The staff are friendly, really lovely. He does what he wants. Staff encourage him to do things for himself, and they know him well enough that he will do things when he wants to and they encourage him when he feels like it. This is an excellent place. Another visitor said, I always feel welcomed, staff are friendly and willing to tell me how my husband is. The dining areas were bright and airy. Fresh flowers were placed throughout the home and on dining tables. Tables were set for breakfast and lunch with table clothes, condiments, cutlery, napkins, cups and saucers and either juice or hot drinks that people that use services could serve themselves with. Menus were displayed on dining tables so that people that use services had information about the choices of meals available. The menu on the day of the visit was displayed on the tables. The menu gave a varied choice throughout the day. The chef prepared sufficient amounts of the meals should people that use services change their decision about the choice they had made. Breakfast was a choice of fruit juice, cereals. porridge, toast and marmalade or a cooked breakfast. Lunch was a choice of chicken casserole, lentil burgers, new Care Homes for Older People Page 18 of 31 Evidence: potatoes, peas and turnip. Sweet was semolina, fresh fruit, ice cream and a choice of juice, tea or coffee. In between meals there were mid morning and mid afternoon snacks. The evening meal was a choice of both hot and cold meals. The chef provided information about alternative meals and alternative meals could be ordered of a menu or the chef would prepare what people that use services requested . Staff were on hand to provide assistance to people that needed it. Staff encouraged people to eat their meals but helped when requested for example assisting someone to cut up their meal. Before the visit took place people that use services returned surveys to us. they said that had a variety of activities that they could join in and they chose how they spent their day. They said that staff listened to them and acted on their decisions. They said that the menu was varied, meals plentiful and always well presented, which people that use services said was something they really appreciated. One person commented in a survey that presentation of food was a good and a feature of why I like living here. A person that used the service said, Im really happy here, like I say not home but the next best thing Care Homes for Older People Page 19 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. Policies on promoting the welfare and safety of people that use services protect them from the risk of possible abuse, harm or injury but training could be improved so staff are aware of how to deal with difficult incidents. Evidence: We had not received any complaints about Birch Tree Manor and the home had not received any complaints. No complaints were referred to in the information sent to us by the home called the Annual Quality Assurance Assessment. The information given to people that use services by the home called the service user guide contained details of how to make complaints. Questionnaires returned to us by people that use services before the visit said they were aware of the complaints procedure and knew who they could talk to if the had concerns so could be confident their concerns and complaints would be acted upon. The manager said this could be made available to people that had problems with hearing or vision. The home had Information on the local councils safeguarding adults procedure. The safeguarding procedure is how the local council and other agencies involved respond to and manage allegations of abuse against vulnerable adults. Information on safeguarding from the local council was available. No safeguarding referrals had been made about the home. We looked at safeguarding training within the home and records for staff recorded that staff training was ongoing throughout 2008 with staff Care Homes for Older People Page 20 of 31 Evidence: receiving annual training on safeguarding adults during their induction. Staff on duty were aware of their responsibility in what they should do if they suspected a vulnerable adult was being neglected or abused so people that use services could be confident they would be protected. Staff said they knew how to manage situations where people that use services showed aggression to them and others. They were confident they could diffuse situations or distract the people involved but had not received training. They were unsure that if a person that used services went to hit another person that used services or staff a staff member they could physically prevent them from doing so, so were not suitably trained to deal with aggressive incidents. Care Homes for Older People Page 21 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. The home has been furnished and equipped to a very high standard so people that use services live in a comfortable homelike environment. Evidence: The could home accommodate 62 people in single rooms all with en suite facilities with 30 people on the ground floor and 32 on the first floor. There were two lounge dining rooms on each floor and a sitting room, which have comfortable furniture and dining furniture as well as plasma televisions so people that use services had the option of quieter facilities. There were two assisted bathrooms on both floors with additional corridor toilets. All the bedrooms had an electric profiling bed and air mattresses were provided for those that needed them so people that use services had the right equipment to meet their needs. A secure alarmed access linked to the call system leads to the enclosed gardens and the home aims to provide a landscaped sensory garden. Separate laundry and kitchen areas were provided and these were suitably equipped. The manager had introduced some good practise into the building to aid people with memory problems to recognise toilet and bathroom doors. This is to be extended to assist people that use services to find their way around the building and recognise their bedrooms. At the time of the visit the ground floor was being used to accommodate the people Care Homes for Older People Page 22 of 31 Evidence: that use services due to the home not being fully occupied since recently opening. The Ground floor has been called the Dorchester suite and the first floor the Grosvenor suite. People that used services had been offered a choice of bedrooms and as more people choose to live there people will move to the first floor. The people that will move to the first floor had already chosen their bedrooms so they could have a bedroom with the same location, layout and view. We looked at some bedrooms that were occupied and people that use services had brought in their own personal items to make them more homelike. The home was clean throughout and people that use services returned surveys before the visit and said the home was always clean. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate employment policies and procedures and training are in place so staff are recruited and trained and safe systems of care provided for people that use services. Evidence: At the time of the visit there were 21 people living in the home. There were sufficient staff on duty to meet the needs of people that lived at the home and this did not include the manager or activities coordinator so people that use services had appropriate care and support. We examined the training and recruitment records of staff employed at the home. The home employed ten full time care staff and six of these had an NVQ level two qualification a recognised qualification for staff employed in the care profession. We examined the training and recruitment records of three staff employed and theses confirmed that staff had completed or were completing the induction programme so staff had the time to familiarise themselves with the building and people that use services. The induction programme consisted of training on fire safety, fire drill, food hygiene, moving and handling, using hazardous materials, health and safety, safeguarding adults, infection control, nutrition and managing medicines. At the time of the visit a registered nurse was being supervised through the induction and said she had been doing this for a number of weeks and said, Ive not been rushed, had time Care Homes for Older People Page 24 of 31 Evidence: to learn the things I need to and feel I understand my job better having had the time to do so. We examined the files of three staff employed by the home and all the required employment checks had been carried out prior to employment. This included a Criminal Records Bureau (CRB) disclosure and where necessary a PoVA First check so people that use services could be confident they were protected from harm. Staff were provided with job descriptions and contracts of employment. so were aware of their responsibilities and accountability. The home had a clear commitment to staff training through induction and ongoing personal and professional development. The home employed permanent staff and aimed not to use agency staff. Lead staff for diabetes, continence and tissue viability were identified.The home operates an equal opportunities policy to recruit from diverse backgrounds. Staff were provided with job descriptions, handbook and contract of employment so were aware of their accountability and responsibility in their jobs. Staff received supervision so staff had the opportunity to talk about how they did their job and any training required. Staff had completed the Alzheimers Society yesterday, Today and Tomorrow training on dementia. Staff had also completed training as part of their induction programme so were equipped with the necessary skills to do their jobs. Staff questionnaires returned as part of the visit described training and supervision as excellent. Care Homes for Older People Page 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is active so that people that use services benefit from living in a home that is focused on promoting their independence, choice, health and welfare. Evidence: The manager holds the registered manager award which she achieved in May 2008. The manager demonstrated her competence and experience in the way in which the home had been furnished, staff recruited and management systems introduced into the home. The manager had previously managed services for older people and had knowledge skills and experience to manage the home. The manager said she had an open door policy and was seen to manage in a clear transparent and approachable manner so people had access to her when needed. One of the people that used the service said, I know the manager and I see her regularly shes a lovely lady who always has time to listen to you. Care Homes for Older People Page 26 of 31 Evidence: The manager maintains standards through monthly quality assurance audits. She encouraged staff to treat the home as if it is the home of people that use services. The home had a clear management structure with daily hand overs to senior staff so good communication was maintained. Monthly audits included the manager looking at how records of medicine administration and the care plans of people that use services are completed, accidents trends, complaints, recruitment and standard of the building so was aware of areas for improvement. The manager does the monthly audit and the operations manager checks the audit against the same information the manager had used to give the home a score of how it is operating against the companies operational standards. The home had regularly achieved high marks for quality assurance since it opened and received a nationally recognised award called ISO 9001. The home also have a health and safety committee that meets every two months to look at health and safety bulletins and discuss the companies policies and procedures. The home held a meeting for people that use services in October 2008 and discussed the menu, activities and staff. Their comments were recorded so they are listened to and can be acted upon. The food was described as good, very good, I eat everything, lots of choice. Staff were described as excellent staff who are very happy, when you ask for something to be done it gets done. A relatives meeting was held in October when the manager talked about the standards offered to people that use services, standards she expects from staff and how staff performance will be monitored. The company use regular surveys for relatives to complete and provide their view and comments on how the home is managed so they can contribute to how the home is managed. Surveys for people that use services were not being used at the time of the visit. Surveys had bee sent out form August 2008 and comments were received from relatives. Comments recorded were, My mother is extremely happy. She clearly loves the staff and believes they love and respect her. I am involved in decision making regarding my aunt, Birch Tree Manor is an excellent care home and we are very impressed with the level of the care provided. The staff are wonderful and My mothers health and welfare has improved greatly since she arrived at Birch Tree Manor. The home had robust financial procedures.The home holds but does not manage the finances of people that use services. People that use services are sent bills for any services not included in the contract for services they receive. The required maintenance and testing had been completed. Care Homes for Older People Page 27 of 31 Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 29 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 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 7 More information should be provided in care plans about how people choose and decide how their care is provided so staff and others involved in their care understand how important peoples routines and decisions are to them and how these are transferred into how they receive care. Further training on how staff deal with difficult and angry situations between people that use services should be provided so staff are aware of their roles and responsibilities. 2 18 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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