Inspection on 21/11/08 for Sutton Manor Nursing Home

This inspection was carried out on 21st November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sutton Manor Nursing Home 23/11/06

Sutton Manor Nursing Home 25/01/06

Sutton Manor Nursing Home 09/05/05

Sutton Manor Nursing Home 21/02/05

Sutton Manor Nursing Home 21/07/04

Sutton Manor Nursing Home 15/01/04

Sutton Manor Nursing Home 31/07/03

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sutton Manor Nursing Home Stockbridge Road Sutton Scotney Winchester Hampshire SO21 3JX     The quality rating for this care home is:   zero star poor 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: Kima Sutherland-Dee     Date: 2 1 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (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 32 Information about the care home Name of care home: Address: Sutton Manor Nursing Home Stockbridge Road Sutton Scotney Winchester Hampshire SO21 3JX 01962760188 01962761185 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Linda Gillum-Webb Type of registration: Number of places registered: Mrs Evelyn Mary Cornelius-Reid care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Staffing must be at or above the following levels 1 qualified nurse and 5 care staff 8:00am to 2:00pm 1 qualified nurse and 3 care staff 2:00pm to 5:00pm 1 qualified nurse and 4 care staff 5:00pm to 8:30pm 1 qualified nurse and 2 care staff 8:30pm to 8:00am The home may accommodate a maximum of 20 service users who are in need of nursing care The home may accommodate a maximum of 38 service users who are in need of personal care only The management hours of the registered manager must be supernumerary to the minimum staffing levels. The qualified nurse must not offer a service to service users in accommodation outside of Sutton Manor whilst on duty at the home. Care Homes for Older People Page 4 of 32 Over 65 38 38 0 0 Date of last inspection Brief description of the care home Sutton Manor is one of three homes owned by Mrs Cornelius -Reid, two are in Hampshire and the other in Wiltshire. Sutton Manor is a care home that also provides nursing care. The home is registered to provide personal care for up to thirty-eight service users over the age of sixty five, in the categories of old age and physical disability, not falling within any other category, and nursing care may be provided for up to twenty of the residents. Sutton Manor is in Sutton Scotney and set within sixty acres of delightful parkland. The home has large and airy sitting rooms and dining room on the ground floor. All bedrooms have en suite facilities with the exception of one room, which has a private bathroom in an adjacent room. The current weekly fees are #662 - #787 per week. Extra services such as hairdressing and chiropody are usually billed monthly. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor 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: The quality rating for this service is 0 Star. This means the people who use this service experience poor quality outcomes. The inspection included a site visit to the home over a period of seven hours and forty five minutes on the 21st November 2008. During this time we spoke with the manager and the registered providers representative, the service users and staff. We also observed the interactions between staff and service users,sampled the records and documents, and saw parts of the home environment. Other information used to make judgments about the standard of care in the home included the surveys competed by the service users and a member of staff and any Care Homes for Older People Page 6 of 32 information we received about the home since the last key inspection. The fees for this service are between 3045.00 pounds per calender month and 3615.00 pounds per calender month. The contract also includes a required deposit payment when a room is secured this is currently 15,000 pounds for a single room and 25,000 pounds for a double room. 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 set out on page 4. Care Homes for Older People Page 8 of 32 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 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users do not have the written information they need to make and informed decision about this service, although they are able to visit the home. Prospective service users cannot be assured that the home will met their needs as pre admission assessments have not been completed and they have not received written confirmation that the home can accomodate them based on their needs. Evidence: The statement of purpose that gives information about the home and the services is out of date so prospective service users and their relatives do not have up to date information on which to decide whether the home is suitable. A sample of four contracts were seen these had been signed by the service users or their representatives. No written assessments were available for the three most recent admissions. The manager explained that the registered provider made the decision to admit these Care Homes for Older People Page 11 of 32 Evidence: service users prior to the manager starting in June 2008. The staff had had a verbal handover when they moved in. An immediate requirement was left at the home to state that no service users could move in without a full written assessment of their needs being completed prior to their being admitted to the home. The service does not write to new service users to confirm whether the service can meet their needs. Two service users said they had had the opportunity to visit the home prior to their move and a number of service users are admitted from the independent living homes on the same site, so they know the home well. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans are not detailed enough to give the staff the information they require to meet the service users care needs. The plans are not kept up to date and they do not record the information the trained staff need to monitor the service users health. The service users can be assured that they will have access to health professionals. The medication records are inaccurate and therefore it is not possible to assess whether medication is always given as it is prescibed. Evidence: A sample of the care plans were seen.These were very brief and often handwritten,they did not contain all of the information the staff need to care for the service users.The staff said they generally know the service users well,however the home is recruiting new staff and they will need to know how each service user preferes to be cared for and what their needs are.The care plans did include risk assessments regarding manual handling, wounds, falls and scalding.The manager said that due to the lack of trained staff they have not had time to review all of the care plans to make sure the staff are aware of any changes. A member of staff said that they do not Care Homes for Older People Page 13 of 32 Evidence: usually look at the care plans but they get information about the service users at the handover meeting when the staff change shifts. The service users said they were able to see a doctor whenever they needed to and that the staff were very good at looking after them when they were poorly. The care plans did record medical information and when the service users had been seen by health professionals. The records that are supposed to be used to monitor the service users general health such as blood pressure, temperature and weight checks were incomplete. The medication trolley was not securely stored at the site visit but the manager did lock it to the wall at the time of the visit. The medication records were seen and there were a number of gaps in the records. This would indicate that either staff are forgetting to sign the records or the medication had not been given.The manager said that it is more likely that the staff are not signing after the medicine had been given,and they would ensure that all trained staff are fully aware of the need to maintain the records accuratly. Other securely stored medication and the records for these items were checked and they were correct and accurate. The staff were observed caring for the service users, they were always kind and caring and they maintained the service users privacy. Two service users who share a double room are provided with a screen to allow for privacy during personal care. Care Homes for Older People Page 14 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users benefit from a range of activities in the home, however staffing levels do not allow for trips outside the home. The service users are able to maintain contact with their family and friends and to continue to practice their religion if they choose. The service users enjoy a well prepared and served diet that meets their nutritional needs in pleasant surroundings. Evidence: The service users said they enjoyed the activities that were organised in the home.These included Beauty and nail sessions,quizzes,reminiscence, and a visit from the hawk conservancy bringing their birds into the home. A member of staff has been appointed as an activities organiser and they help to organise activities on three to four afternoons a week, they have also started a shopping trolley service in the home several times each week which is proving popular. The activities organiser also said they had set up excercise sessions,games and christmas card making. Not all the service users choose to take part in the group activities and there are no records in the care plans to show that the service makes an effort to enable the service users to continue their interests or hobbies. Care Homes for Older People Page 15 of 32 Evidence: Two service users said that they are never offered the opportunity to go out unless this is organised by their relatives. The manager and the staff confirmed that due to staffing levels there are not enough staff to accompany the service users outside the home. A mobile library visits the home once a month. The service users can choose to attend a regular in house church service every fortnight and they can attend church if they are able to organise their own transport. Visitors are welcome in the home and a number of relatives or friends were sitting with the service users having lunch in the dining room. Nine service users were spoken with during lunch time, they all said the food was excellent and they were always offered a choice. There is a large main dining room where waiting staff serve the service users their main meals. The waiting staff were attentive and pleasant to the service users, they knew peoples names and what food they liked. The dining room was busy with up to twenty five extra service users from the surrounding independent living homes in the grounds joining the homes residents for meals. The service users said they didnt mind this as some of the independent service users are friends of the service users in the main home so they could sit together and talk. Care Homes for Older People Page 16 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users cannot be assured that their complaints will be taken seriously or responded to appropriately. The service has not followed their own procedures for protecting the service users from abuse but the service did report their concerns to the police and protect a service user from continued abuse on one occassion. Evidence: The service has a complaints policy that states that complaints must be responded to within twenty four hours and a written response within twenty eight days. A letter of complaint was seen in a service users file dating from January 2008. Apart from a handwritten note by the provider written across the letter no response had been given to the service user. The registered persons reresentative could not explain the long delay and said that they would deal with the complaint and respond in writting to the service user. A member of staff said they didnt know about the complaints procedure but they would act appropriately by reporting any concerns to the manager. A recent safeguarding issue relating to a member of staff financially abusing one service user had been investigated by the registered persons representative and the police. The police had contacted social services but the service had not followed their own procedures for safeguarding the service users. The registered persons representative stated that they would submit the evidence they had to the Protection Care Homes for Older People Page 17 of 32 Evidence: of Vulnarable Adults list for the member of staff who was involved in the incident. Care Homes for Older People Page 18 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience 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 clean, and comfortably furnished. The service users cannot be assured that the home will always be well maintained and that all of the facilities will meet their care needs. Evidence: The home is in a large listed building surrounded by well kept large gardens and other independent living homes within the ground. A complaint was made in january 2008 regarding two aspects of a service users room. The registered person did not respond and made handwritten notes across the complaint regarding the service user being responsible for the bills to put right the fixtures and fittings of the home. The service user did pay a bill and then requested that the registered person repay these costs as they were not the responsibility of the service user. The registered person failed to respond appropriately. This complaint was discussed with the providers representative who could not explain the failings and said they would deal with them and respond in writting to the service user. The regulations require that the home is kept in a good state of repair externally and internally and that the layout and design of the home meets the service users needs. The home was comfortably furnished and well decorated. The service users liked their rooms and they were able to bring in their own belongings. the service employs cleaning staff and the service users said the home was alweays clean and fresh. Staff have had training in infection control and Care Homes for Older People Page 19 of 32 Evidence: equipment is availble such as gloves and aprons and sluices. Care Homes for Older People Page 20 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users benefit from staff who are committed to offering a high standard of care and who have taken part in a range of training courses to develope their skills. The services recruitement practice is not robust and does not protect the service users. Evidence: The manager stated that the home had experienced staffing difficulties with only two trained staff including the manager had been availble until a new nurse started at the home the week of the site visit. The manager said they had to work as a nurse rather than managing the service for a large part of their working week. They said it was difficult to recruit staff in a rural area where housing was exoensive. The care staff said they had time to meet the service users needs and the service users were complementary about the carers. the service employs anxilliary staff such as cleaners, cooks and maintenence staff. A number of Staff have trained for National Vocational Qualifications but this does not meet the requirement for 50 percent of staff to have or be working towards these qualifications. A sample of five staff files were seen and four of them had unexplained gaps in the employment histories. This means that the employer could not be assured that the staff were suitable to employ. The manager explained that the registered provider had Care Homes for Older People Page 21 of 32 Evidence: offered a job to the newest trained nurse and their records were incomplete. The staff do undertake a period of induction at the start of their employment and the staff said that the training met their needs and they understood their roles and responsibilities. Care Homes for Older People Page 22 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has not had the time or the support to effectively manage the service, despite their personal commitmenet to providing a high standard of care. The lines of accountability between the role of the manager and the provider are not clear as the provider continues to make day to day management decisions. The service users cannot be assured that their views will be listened to and acted upon to imrpove the service. The service users are cared for by a committed staff team who are able to meet most of the service users needs despite not having the systems in place to guide them and support them. Evidence: The manager has been in post since June 2008 they have yet to submit an application to register as manager with the commission. The manager stated they have not had time to make as many positive changes to the home as they had hoped as they have spend many of their hours working as a nurse Care Homes for Older People Page 23 of 32 Evidence: in the home due to the lack of trained staff. They said that this has had an effect on their ability to supervise staff, to update and improve the care plans and to lead the staff team. The registered provider makes decisions about appointing staff without fully communicating with the manager this has lead to incomplete staff records. The manager explained that when they started their job in June2008 they had had a two hour handover from the previous manager who still works for the same organisation and that when they ask for advice and support they do not always get the response they need to effectively manage the home. They did say that the registered providers representative was often at the home and did answer their questions. The manager is committed to caring for the service users but their ability to effectively manage the service is compromised by their lack of induction training and lack of time. The service does not have an effective formal way of seeking the views of the service users or audidting the quality and making improvements to the service as a result of peoples comments. The last report mentioned this in 2006 and it is now being made a requirement. The manager said that they were aware staff supervisions were not up to date, and the records confirmed this. The housekeeping manager is working towards putting a system in place to ensure that staff are regularly supervised. The staff said they could go to the manager if they needed advice. One member of staff said that the manager had worked hard since they started to improve the service. The registered providers representative is responsible for the health and safety and maintenence of the home. The records were up to date and fire drills had been carried out. The staff had had training in fire safety. Care Homes for Older People Page 24 of 32 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 25 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person shall 12/12/2008 not provide accomodation to a service user unless the needs of the service user have been assessed by a suitably qualified person, the registered person has obtained a copy of the assessment, there has been consultation with the service user or their representative and the provider has confirmed in writting to the service user that following an assessment the service can meet their needs. The service cannot judge whether they can meet all of a service users needs until a full assessment of what those needs may be prior to deciding whether to offer them accomodation and care. The service user cannot decide if the service is suitable unless they have had written confirmation that their needs can be met. 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 1 4 The registered person compile a written statement of purpose which consists of 30/01/2009 Care Homes for Older People Page 26 of 32 the homes aims and objectives, a statement of facilities and services and all of the matters listed in schedule 1. This statement needs to be up to date and accurately reflect the current service and facilities. The service users and their representatives need to have up to date information on which to base their decision when choosing a care home. 2 7 15 The registered person shall 30/01/2009 in consultation with the service users or their representatives prepare a written plan as to how the service users needs in respect of their health and welfare are to be met. The plan must be kept under review. The staff need to have guidance and information about the needs of each service user and how the staff should meet those needs. The plan must be reviewed so that the staff have the most up to date information and are aware of any changes to the needs of the service users. 3 9 13 The registered person shall 30/12/2008 make arrangements for the recording,handling,safekeepi ng,safe administration and disposal of medication. Care Homes for Older People Page 27 of 32 The medication records must be completed accurately and they must relate to all medication administered to all service users, they need to demonstrate the medicine and the time it was administered to show that all medicines were administered as they are prespcribed. The medicine staorage must be secure and safe at all times and the trolley shopuld be fixed to the appropriate point when not in use. 4 12 16 The registered person shall 30/01/2009 provide facilities and services to the service users in accordance with the statement of prupose and the service users assessed needs. Part n states that the service users must be consulted about a programme of activities arranged by on on behalf of the care home and provide facilities for recreation, including having regard to the needs of the service users. The registered person must assess and record the recreational needs and preferences of the service users after consulting the service users. This may include providing facilities for the service users to go Care Homes for Older People Page 28 of 32 outside the home for recreation activities. 5 16 22 the registered person shall 31/12/2008 establish a procedure for considering complaints made to the registered person by a service user or a person acting on their behalf. The registered person shall ensure that any complaints made to them are fully investigated. The service user shall respond within 28 days and inform the complainant of any action. Every service user should be supplied with a copy of the complaints procedure. All complaints and concerns whether verbal or in writting must be responded to in writting within the stated timescale as stated in the services own complaints procedure. A record must be kept of all complaints, the response made to teh comaplinant and any action taken as a result of the complaint. 6 18 13 The registered person shall 31/12/2008 make arrangements to prevent the service users being harmed or suffering abuse or being placed at risk of harm or abuse. When the registered person or the staff suspect abuse they must respond as stated Care Homes for Older People Page 29 of 32 in the abuse procedures and all agencies should be notified within 24 hours. All actions should be recorded and the home should act on guidance from the relevant agencies. 7 19 23 The premises to be used as a care home are of sound construction and kept in good state of repair externally and internally. The registered person is responsible for the maintenence and safety of the fabric and fixtures in the care home and service users must not be in a position where they are responsible for arranging repairs or paying for those repairs. 8 21 23 The physical design and layout of the home meets the needs of the service users. The registered provider has assured a service user that the service can meet their needs therefore the facilities should be able to meet that persons needs. This may include bathing facilities. An assessment should be carried out and recorded that can identify what adaptations the service should provide to meet the service users needs. 9 33 24 The registered person shall establish and maintain a system for reviewing at 30/01/2009 30/12/2008 30/12/2008 Care Homes for Older People Page 30 of 32 appropriate intervals and improving the quality of the care provided at the home including the quality of nursing care. The service must develope a formal system of seeking the views of the service users and their representatives. The opinions of the service users must be recorded and analysed in order to make improvements to the service. 10 36 18 The registered person shall ensure that all persons working at the care home are appropriately supervised. All staff must have the opportunity to regularly meet with senior staff to discuss their roles and performance and training needs. The standards recommend meeting six times per year and this may include practical supervision, annual appraisal or one to one meetings with a supervisor, records of these meetings should be kept. 30/01/2009 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 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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. 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