Care Home: Birtley House Nursing Home

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What the care home does well The service provides a comfortable environment for people to live in, which is situated in extensive grounds for people to access. Two people told us " The facilities and grounds are wonderful" and "The home provides very pleasant surroundings". Each person has a detailed care plan , which is regularly reviewed and the service has good links with a range of other health and social care professionals. A number of positive comments were received from people and their representatives about the care , support and the approach of staff including, "There is an extremely caring attitude at the home and the staff are always polite and considerate"; "The staff are so pleasant"; "The home provides competent and caring staff"; "I am very happy with the special care that my relative gets at Birtley House" and " The care staff are respectful, marvellous, approachable and very polite". The service provides a good range of activities and entertainment and people are provided with an entertainment programme . A person surveyed said, "The activities are innovative". People are provided with a varied and well balanced meals . Comments we received from people and their representatives included, "The service provides good and appropriate food"; "The menus are excellent" and "There is very good food". Staff are well trained and attend a variety of courses ensuring that they are able meet the needs of people living in the service. Regular consultation takes place with people to gain their views and feedback surveys are conducted. What has improved since the last inspection? The service has provided photographs of people with their medication administration record for identification. What the care home could do better: No requirements were made as an outcome of this visit .Three good practise recommendations were made The statement of purpose needs to include information about how the needs of any younger adults admitted to the service are to be met It is recommended as good practise that where medication is hand transcribed on to the medication administration record that these are checked and signed by two members of staff. Staffing levels at in the home should be kept under review. Key inspection report Care homes for older people Name: Address: Birtley House Nursing Home Birtley Road Bramley Guildford Surrey GU5 0LB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lisa Johnson     Date: 0 3 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Birtley House Nursing Home Birtley Road Bramley Guildford Surrey GU5 0LB 01483892055 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: jackie@birtleyhouse.co.uk Eyhurst Court Limited care home 47 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number oF service users to be accommodated is 47 The registered person may provide the following category of service : Care home with Nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Physical disability (PD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Birtley House has been providing care for over seventy years and is registered to provide nursing care for forty-seven service users. The home has remained with the same family over this time and is now run by the grandchildren of the first owner. The home is set in its own grounds and is surrounded by a range of gardens, e.g. rose garden, kitchen garden, walled garden and orchard. Adjacent to the house and within walking distance, is a large pond, which is a nature reserve. Care Homes for Older People Page 4 of 28 0 47 Over 65 47 0 Brief description of the care home The home has forty-five bedooms and thirty six of these are single occupancy . Nine bedrooms could be used as double or single rooms. Currently ownly three bedrooms are used as doubles occupied by married couples. The rooms are well decorated and a range of facilities is provided, e.g. telephone point, television. Most bedrooms have ensuite facilities The manager (matron) of the home oversees all the clinical practice of the home and day-to-day work. The owners/directors support her in this role and take direct responsibility for the administration and practical aspects of running of the home. The weekly fees range from £940 - £1, 200. Care Homes for Older People Page 5 of 28 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: three star excellent 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 last key inspection was carried out 4th September 2007. Since this inspection an annual service review was carried out on 4th September 2008. Information was provided to us by the service prior to this visit in the Annual Quality Assurance Assessment. (AQAA). This is a self-assessment that focuses on how well outcomes are being met for people using the service. We received the AQAA by the expected date , which was clear and detailed and gave us all of the information we asked for. Reference is made to this assessment throughout this report. As part of this key inspection we sent out ten surveys to people and/or their representatives using the service to gain their views and eight were returned to us. We received one survey from a health and social care professional and five were received from members of staff. Comments received are included in this report. Care Homes for Older People Page 6 of 28 During this visit we met with twelve people who live in the service and three relatives. We met with the Registered Manager and spoke with four members of staff During this visit we looked at staff recruitment, and training records, care plans, risk assessments, menus and observed the lunchtime meal, activities, quality assurance systems, complaint records, medication administration practises, health and safety records and policies and procedures were sampled. We also reviewed other information that we have received since our previous including notifications. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 28 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 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 28 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. Prospective people considering the service as a place to live are provided with the information they need to know to enable them to make an informed choice about the suitability of the home as a place to live. Peoples needs are assessed prior to admission. The service does not provide intermediate care. Evidence: The service has a dedicated web site, a comprehensive brochure, statement of purpose and service user guide, which provides detailed information about all aspects of the home and the services that it is able to provide. Eight people and/or their representatives surveyed said that they were given enough information to help them decide if this home was the right place for them to live. The home in the main supports older people, although where they provide support to a younger person this should be included in the statement of purpose detailing how their needs are to be met. Care Homes for Older People Page 11 of 28 Evidence: The service holds open days, welcomes telephone enquiries and prospective people and their families are provided with the opportunity to visit the home, stay for lunch and attend activities. Details are are provided of an external company who can provide independent advice on financial aspects for care home fees. A pre admission assessment is carried out by a registered nurse (usually the matron or deputy) to ensure that the service can meet the persons needs and to arrange and plan for appropriate support and expertise. A pre admission form is completed, which covers all aspects of peoples health, personal and emotional needs. This assessment is carried in peoples homes or in hospital, which enables people to gain further information about the service if they have been unable to visit. An assessment is obtained from the persons General Practitioner. During this visit we sampled the preadmission documentation for four people, which confirmed that this information is completed. The service does not provide intermediate care but short term or respite care is available. Care Homes for Older People Page 12 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are met and their preferences for support are respected. The home supports people with their medication in a safe way. Evidence: Each person has a care plan in place, which reflects their current health, personal, emotional , social, cultural and religious needs. During this visit we sampled four peoples care plans. We were informed that people and/or their families are consulted about their care plan, although gaps were observed in some care plans, where these had not been signed by people or their families to confirm their agreement. Each person has a named nurse who is responsible for ensuring that care plans are reviewed and updated monthly. The home has also implemented a night time care plan for each person. Two peoples representatives said that staff always keep them up to date of any changes. Care plans were based on assessment and information seen demonstrated that these are regularly reviewed. Information supplied in the AQAA states that people returning from any hospital admissions are re- assessed whilst still there and any changes to Care Homes for Older People Page 13 of 28 Evidence: their needs are recorded in their care plan. Peoples personal likes, dislikes and routines are recorded in their care plans, although these would benefit from being more detailed. Four peoples records sampled demonstrated that a range of assessments had been conducted including,dependency profiles, moving and handling, nutritional assessments using the MUST tool and tissue viability. Care plans contained information, which provides information to staff as to how people are to be supported, the number of staff and equipment required for moving and handling including, profiling beds and air pressure mattresses. Records were maintained of monitoring checks such as blood pressure, fluid intake and regular weight monitoring. Risk assessments were also in place for the use of bed rails. Eight People surveyed said that they always or usually receive the care and support that they need and their medical needs are met. A number of positive comments were received during this visit and from surveys returned to us about the care and support provided, including, There is an extremely caring attitude at the home and the staff are always polite and considerate; The staff are so pleasant; The home provides competent and caring staff; I am very happy with the special care that my relative gets at Birtley House and The care staff are respectful, marvellous, approachable and very polite A General Practitioner visits weekly, although people are able to keep their own GP if this their preference.If it is required the GP will make onward specialist referrals. A physiotherapist, who was seen attending the home during this visit, chiropodist, dentist continence, nurse, Parkinsons nurse, and multiple sclerosis nurse visit regularly according to peoples needs.The service also works in conjunction with speech and language therapists particularly for people who have had strokes. The service maintains doctors files and multi disciplinary team visit records. A health care professional surveyed stated that the peoples social and health care needs are always properly monitored, reviewed and met by the service and that the service always seeks advice and acts on it to meet peoples social and health care needs and improve their wellbeing Staff training records sampled indicated that staff receive specialist training , which enables them to meet the diverse needs of people living in the service. During this visit peoples privacy and dignity was observed to be respected.Staff were observed shutting doors when carrying out personal care and Do not disturb signs were available and being used on bedroom doors. Staff were observed to be Care Homes for Older People Page 14 of 28 Evidence: respectful, caring and attentive towards people throughout this visit. People spoken with during this visit said that staff knock on their doors before entering respecting their privacy, although one person said, Sometimes they forget Another person thought that communication could be better when their relative was using equipment to aid their mobility. During this visit we looked at the homes medication administration practises in the Annexe. Information in the AQAA states that people may self medicate if this is their wish, which is assessed on admission and then reviewed regularly. During this visit we viewed a self medication risk assessment for one person. Medication is administered by registered nurses and a medication administration procedure is in place. Medication is obtained from a local pharmacy using the monitored dose system (MDS). Medication was observed to be stored safely including the controlled drugs cupboard. A controlled drugs register was appropriately recorded and maintained. Systems were in place for the receipt and disposal of medication. Staff receive training and we were informed that the pharmacist visits to carry out audits. We sampled some of the medication administration records, which contained a photograph of the person for identification. Medication administration records had been signed. Two medication administration records sampled had some medication recorded on them that had been hand transcribed by staff and it was recommended that these are signed and checked by two members of staff ensuring the wellbeing and safety of people. Registered nurses are trained in end of life care. The Golden standard framework and Liverpool pathway. The service liaises with McMillan nurses, where necessary. Care Homes for Older People Page 15 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples preferences, recreational social, cultural and religious needs are met. People maintain contact with their family , friends , representatives and the local community. People are supported to exercise choice over their lives and are provided with varied and well balanced meals. Evidence: Birtley House provides a good range of activities and entertainment run by a team of three activity coordinators, which is headed by one of the companys directors.A monthly entertainment programme is in place, which is provided to people. Activities were also advertised in the homes reception area. The activity programme is available in large print and illustrated with photographs. At the time of this visit a sensory session was held in the afternoon that we observed, where good interaction was seen between people and staff. Other activities include, musical events, sing a longs, gentle exercise, film afternoons, flower arranging, cooking, multi activities afternoons, word games, quizzes, a range of talks and demonstrations take place on topics of interest such as a forth coming world of chocolate talk and taste afternoon. The home has held a strawberry and cream afternoon and a sculpture exhibition was held in the grounds earlier in the year. The Care Homes for Older People Page 16 of 28 Evidence: service has a hairdressing salon and a manicurist is available. Massages can also be arranged and news papers can be delivered. The home is currently replacing analogue televisions with flat screen, digital televisions in peoples bedrooms. Occasional outings take place and we were informed that a new wheelchair accessible vehicle has been purchased. Charity fund raising raising events take place, which people participate in such as coffee mornings. An event has been arranged to commemorate the International day for the elderly, where local school children are being invited to visit and read out some of their poems and show their artwork. Events such as birthdays and wedding anniversaries are celebrated.Pastoral care is provided with a church service being held monthly and the clergy attend the home twice weekly. Visitors from other denominations are welcome to visit and can attend at any time. Peoples preferred social activities and hobbies are recorded in their care plan and written records are maintained of all activities that people participate in . Seven out of eight people surveyed said that the home always or usually arranges activities that they can take part in. A person commented, The activities are very innovative. During this visit two people said that they choose not to attend activities sometimes and one person said that they like to walk down to the lake. Another person said that they have their own car and go out for drives. One persons representative said that the activities provided were more geared to older people and did not always meet their relatives needs. People maintain links with their family and friends who are able to visit in their bedrooms, lounges and use of the extensive gardens. Friends and families are welcome to join their relatives for lunch. Information supplied the AQAA states that staff assist people with reading and writing letters, where people may require support. Telephone points are provided in bedrooms should people choose to use a phone and a computer with Internet access has been installed in the activities room. People living in the service are consulted about all aspects of living in the home and regular meetings take place and news letters are provided. People are able to personalise their rooms to their choice and preference and to bring any of their preferred belongings into the home. Care Homes for Older People Page 17 of 28 Evidence: The service has a weekly and seasonal menu, which is provided to people and was seen on display in the dining room. Two main choices are offered at lunchtime and for supper with lighter alternatives available on request. A member of staff is employed as the meals and dining room coordinator who meets with people to discuss their choices and preferences. We spoke with homes chef who said that fresh produce is always used and some is supplied from the homes own estate. People take their breakfast in their bedrooms and a cooked breakfast is available if requested. Most people spoken with during this visit said they enjoyed their meals, which was also confirmed from surveys received. Comments included, The service provides good and appropriate food; The menus are excellent and There is very good food. The menu was observed to be well balanced and varied, which included a mix of traditional English and Continental dishes. During this visit the lunchtime meal was well presented and mid afternoon tea was served, which consisted of a range of sandwiches and home made cakes. Meals are taken in the orangery dining room, which is attractively presented and a second separate dining area. People who require assistance with eating their meals were observed to be appropriately supported by staff who were sitting and interacting with people throughout. Care Homes for Older People Page 18 of 28 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. If people have concerns they know how to complain and they are safeguarded from abuse. Evidence: The service has a detailed complaints procedure, which is provided in the service guide. The procedure includes timescales and the up to date contact details for the Commission should anybody wish to contact us. The registered manager maintains a complaints and compliments register. Over the last year one complaint has been received and information seen demonstrated that appropriate action had been taken to investigate these concerns. People spoken with during this visit and surveys received confirmed that people and their representatives know how to raise any complaints and and concerns. The registered provider is also present on site and is also available to discuss any problems with people and their representatives. The service has safeguarding vulnerable adults from abuse procedures in place, which also includes the most recent local authority procedure. The manager told us that they and the deputy have both completed local authority training. Information supplied in the AQAA states that all staff working in the home whether they are providing care or not receive safeguarding training. Four members of staff files sampled demonstrated this and two members of staff spoken with also confirmed their attendance at this training. There have been no safeguarding referrals made over the last year. Care Homes for Older People Page 19 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is safe, well maintained comfortable, homely and clean. Evidence: Birtley house is situated in extensive grounds,which has a lake and woods, which are within walking distance. There are also rose gardens, kitchen garden and an orchard. There are a range of communal areas including two dining rooms, lounges and an activities area. The home provides a comfortable environment, which was enhanced with displays of freshly cut flowers. Information supplied in the AQAA states that a number of environmental improvements have taken place since our previous visit. Some bedrooms have been redecorated and re carpeted. A bedroom with no bath room has been combined with another room and made into a large apartment with complete en suite bathroom. Former staff accommodation has been turned into two apartments with sitting rooms and en suite bathroom. A herb garden has been constructed outside the kitchen and paths to the herb and kitchen pathways have been improved. Some of the corridors in the Annexe look a little tired and in need of repainting, which is being addressed and a sitting room was being redecorated at the time of this visit. A person surveyed said, The facilities and grounds are wonderful and The home provides very pleasant surroundings. Care Homes for Older People Page 20 of 28 Evidence: Some people invited us to visit them in their bedrooms, which are of varying sizes and were comfortable and well furnished . The majority of bedrooms have en suite toilet and hand wash basin and many have bath or shower facilities as well. The service is accessible through out and provides two passenger lifts. Equipment is provided to assist people such as computerised call bell systems, hoists assisted bathrooms, walk in shower and grab rails. The service has also purchased an appropriate microphone amplification system, which is now used in the activities room and can be moved from room to room. During this visit the service was observed to be clean and hygienic. Laundry and sewing facilities are available and two people spoke positively about this service. Infection control procedures were in place and adequate facilities and equipment were supplied for hand hygiene. New bedpan/commode washers have been installed in both sluice rooms Seven peopled surveyed stated that the home is always or usually fresh and clean. Care Homes for Older People Page 21 of 28 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. People using the service are supported by staff that are competent and trained to meet their needs and they are protected by the homes recruitment policies and practises. Evidence: Two registered nurses are supplied during the day that are each supported by five members of care staff on each side of the buliding. The registered manager and deputy are also in addition to this. In the afternoon there are two registered nurses supported by three carers. At night time people are supported by one registered nurse each side supported by one carer and a floating carer. Seven out of eight people surveyed said that there are usually enough staff available and one person said sometimes. Comments included, They sometimes seem to be short staffed between midday and two oclock as there is often a long wait for help to arrive and another person said, I feel there are less staff at weekends. Five members of staff said that there is usually enough staff to meet the needs of people they support. However some comments were received that indicated that staffing levels at night would benefit from two carers being supplied on both sides of the home. It is recommended that the staffing levels are regularly reviewed ensuring that peoples needs can be met. Care Homes for Older People Page 22 of 28 Evidence: The service is also supported by activity coordinators,housekeeping, catering, administration. Sixty eight percent of care staff have gained or are studying National Vocational Qualifications (Level 2) or above. New staff receive induction following skills for care core induction standards. Five members of staff surveyed confirmed that they received induction, which covered everything that they needed to know Staff training takes place internally and externally. The registered manager maintains a training matrix . During this visit we sampled training records for two registered nurses and two members of care staff. Information seen demonstrated that they had received up to date statutory training and a range of specialist training courses had been completed by registered nurses including, palliative care, catheterisation, wound care, continence care, , deaf awareness, vena puncture and dementia awareness. We were also informed that external specialist nurses provide training in Parkinsons disease and multiple sclerosis. The registered manager has completed mental capacity act and deprivation of liberty safeguarding training. Five members of staff surveyed state that that they feel they have enough support, experience and knowledge to meet the differing needs of people who live in the home. A member of staff said, The home makes sure that staff receive the relevant training for the benefit of the residents. Staff recruitment follows equal opportunities policies. The staff team are mixed ethnicity and predominately female, although the service has recently recruited to male carers. During this visit we sampled four members of staff recruitment files, which contained the required information including,a completed application form, written references, protection of vulnerable adult(POVA) first check and enhanced criminal record bureau check (CRB). At the time of this visit the service was waiting for receipt of a CRB for a new member of staff and was being appropriately supervised. Up to date nursing and midwifery personal identification numbers were available for registered nurses ensuring that they are fit to practise. Care Homes for Older People Page 23 of 28 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 home is well run in the best interests of people living there and their safety and wellbeing is protected. Evidence: There is an experienced Registered Manager,who has been in post for four years. The manager has obtained the registered managers award and keeps up to date with their continuous professional development. Throughout this visit the manager was observed to have an open approach and made themselves accessible to people, visitors and staff. Two people surveyed said, The service has a caring management and They communicate with relatives well. Members of staff surveyed and those spoken with during this visit all stated that were happy working in the service. Comments included, Management are very supportive and will always take time to listen to what you have to say and Everyone is well informed of whats happening through meetings with the managerial team. Care Homes for Older People Page 24 of 28 Evidence: The Responsible Individual has been resident at Birtley House for eleven years is closely involved with the running of the service and sees people living in the service frequently . Quality monitoring reports are completed quarterly, which we sampled, although management were advised that these must be completed monthly. Feedback surveys are carried out to gain the views of people and their representatives every eighteen months and have been updated this year. The results are analysed and the outcomes are distributed to people and discussed at consultation meetings, which take place quarterly. Feedback surveys have also recently been provided to other stakeholders. The manager was advised to make copies of the results available with the service user guide for prospective people and their representatives. Information supplied in the AQAA states that people are notified in advance of meetings and are asked if they would like to add anything to the agenda, which includes people who do not attend. The minutes are recorded and distributed to people. We were informed that the service does not hold any monies on peoples behalf. People or their family/representatives manage their finances on their behalf. The service uses an invoice system and maintain receipts for any expenditure such as hairdressing. A range of health and safety systems are in place. Staff training records sampled confirmed that staff receive up to date statutory training including moving and handling, food hygiene, fire safety and infection control. An environmental health visit took place in January 2009 and action was taken to renew the floor covering in the walk in chiller room.A health and safety audit was carried out this year and the report was actioned by the Committee. Water temperatures are recorded monthly, which is assigned to a member of staff.This member of staff is currently not available and the manager will reassign this task to ensure that these records are up to date. The manager also informed us that bath temperature records are maintained in the bathroom.Records were maintained of accidents and incidents and information supplied and sampled during this visit confirmed that regular routine servicing and maintenance of equipment is carried out. Care Homes for Older People Page 25 of 28 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 26 of 28 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 1 It is recommended that where the service is providing support to younger adults the statement of purpose should include how their needs are to met. It is recommended as good practise that where medication is hand transcribed by staff on to the medication administration record that this is checked and signed by two members of staff. It is recomended that the service reviews the staffing levels provided at night tme 2 9 3 27 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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