Care Home: Broad Oak Manor Nursing Home

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What the care home does well The home provides good brochures and information for enquirers, and there are good admission processes in place. This ensures that the home will be able to meet the individual needs of the people who are admitted. Care planning documentation is well managed, and residents or their representatives are involved as fully as possible in the care planning processes. Residents feel that they are well cared for, and we received comments such as "the staff are excellent, and are very friendly"; the staff always provide the care and support I need and have a good team spirit"; and "this is a lovely place; the staff are very good, and I am very happy here". The staff are quick to contact other health professionals on behalf of the residents, for additional advice and treatment. The home provides a good range of activities and entertainment. The manager and senior staff ensure that the home runs smoothly and provides a good quality of care. What has improved since the last inspection? Regular outings have been implemented for residents who are able to go out. There is a greater emphasis on listening to residents` views and acting on their ideas. The variety and type of activities have been increased. There has been an ongoing programme of redecoration for some of the bedrooms and one of the lounges; and the outside of the home has been tidied up and repainted. What the care home could do better: The clincial room needs better storage for the amount of medication and dressings needed; and during the inspection visit the manager was working out where additional cupboards could be sited. A requirement has not been given for this, as we are confident that this is being addressed. The clinical room is generally in a poor state of repair, and needs redecorating; and the flooring is old and damaged and should be replaced so that it is easier to keep clean and maintain good infection control. A requirement has been given for this. Several survey forms included comments from residents that staff are sometimes slow to answer their call bells, and this was brought to the attention of the manager. Key inspection report Care homes for older people Name: Address: Broad Oak Manor Nursing Home Broad Oak Close Arnolds Lane Sutton At Hone Dartford Kent DA4 9HF     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: Susan Hall     Date: 0 1 0 4 2 0 1 0 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 27 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Broad Oak Manor Nursing Home Broad Oak Close Arnolds Lane Sutton At Hone Dartford Kent DA4 9HF 01322223591 01322288345 nevards@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Deborah Jayne Lane Type of registration: Number of places registered: care home 42 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 42 The registered person may provide the following category/ies of service only: 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 categories: Physical disability (PD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Broad Oak Manor Nursing Home is owned and managed by BUPA Care Homes, and provides nursing care for older people. It is set in its own grounds overlooking the Care Homes for Older People Page 4 of 27 Over 65 42 0 0 42 Brief description of the care home Darenth valley, and has pleasant gardens and a patio area. It can be easily accessed via the M20 and M25 motorways, but is in a quiet setting near to the village of Sutton at Hone. The nearest shops are within walking distance, and it is on a local bus route. Accommodation is provided on two floors, in single rooms, which have en-suite toilet facilities. There is a passenger lift which provides access between the floors. The home has variety of lounges and a separate dining room. The current fee levels are from £600.00 to £1275.00 per week, depending on the assessed needs of each individual resident. Care Homes for Older People Page 5 of 27 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 home is assessed as having a rating of Excellent, 3 stars This was a key inspection, which includes assessing all of the information obtained by the Commission since the previous inspection, as well as a visit to the home. Information is obtained from phone calls and letters about the service; legal notifications which the home is required to send in; any complaints or safeguarding issues in which we are involved; and an Annual Quality Assurance Assessment (AQAA) provided by the home. This is a comprehensive document which the home is required to complete each year, telling us about ongoing developments in the home, and any changes. The AQAA was well completed by the manager, and was returned to the Commission within the required timescale. We received eleven completed CQC survey forms, which contained very helpful information about peoples views of the home. Nine of these had been completed by Care Homes for Older People Page 6 of 27 residents or relatives; and two had been completed by staff. All of the surveys contained positive comments, particulary about the friendly environment and helpful staff. The inspection visit commenced at 09:30, and finished at 15.45. During this time we (i.e. CQC) viewed all areas of the home; talked with nine staff, five residents and three relatives; observed interaction between staff and residents; and inspected documentation such as care plans, medication charts, staff recruitment files, and maintenance files. The manager and deputy manager were both on duty and co-operated fully with the inspection process throughout the day. Care Homes for Older People Page 7 of 27 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. Care Homes for Older People Page 8 of 27 The report of this inspection is available from our website www.cqc.org.uk. 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 27 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 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides clear and detailed information to enable residents to make an informed choice about moving into the home. Evidence: The home provides detailed documentation for prospective residents and their representatives. This includes a well produced colour brochure with photographs of the home, which is sent out with a personal letter to all enquirers. The statement of purpose contains all the required information, which includes details of the providers (BUPA), the manager, staffing arrangements, visiting arrangements, and the facilities available. Prospective residents and their family members are invited to visit the home and to stay for a meal if they wish, to ensure they have sufficient time to look round, and to ask any questions. More detailed information is provided in the Service Users Guide. Both the Statement Care Homes for Older People Page 11 of 27 Evidence: of Purpose and the Service Users Guide are helpfully produced in large print. The Service Users Guide includes the times of meals, and a sample menu for one week; activities available; arrangements for medical input from GPs, optician, chiropody, physiotherapist etc.; pastoral care from visiting clergy; and the complaints procedure. There is good data explaining the BUPA organisational structure. All prospective residents have a pre-admission assessment carried out by the manager or a senior nurse. We viewed five pre-admission assessments, and found them to be very detailed and comprehensive in their content. The manager stated that nursing and care staff recognise the importance of obtaining as much information as possible about new residents, in order to provide the best care for them from the time of their arrival. Each resident has a named nurse and a key worker, to provide continuity of care. The Service Users Guide contains a helpful explanation of the role of a keyworker. All residents are provided with a contract which includes the terms and conditions of residency, and which specifies the room to be occupied, and the fees payable. Residents stay for a trial period to ensure that the placement is suitable, and a review is held at the end of this time. Care Homes for Older People Page 12 of 27 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. Residents are confident that staff will provide them with good care, attending to their personal and medical needs appropriately and sensitively. Evidence: BUPA homes use a specific system for care planning called the Quest system. We viewed five care plans, of which four were for residents who had been recently admitted. These were all well completed, and showed the involvement of the resident and/or their next of kin in discussions about details of their individual care plans. Care plans cover all aspects of care such as personal care, mobility, nutrition, continence, social preferences, skin integrity and end of life care; and include associated risk assessments where applicable. For example, if a resident has reduced mobility, their care plan will include a moving and handling assessment, which shows the equipment to be used for each move. Where a hoist is needed, the care plans show the type of hoist and sling, and that two staff are needed. There are health and safety risk assessments for equipment; and for the safety of residents who can use their rooms unsupervised. Care Homes for Older People Page 13 of 27 Evidence: Care plans for personal care include details for items such as if residents prefer a bath or shower; if they need assistance with oral hygiene and dental care; and if they wish to see the hairdresser or chiropodist. Care plans also show if a resident can manage to wash their own face and hands, choose their own clothes, or feed themselves, and this demonstrates that the staff promote residents independence, and treat them with dignity. We viewed wound care management for two residents, and found this to be properly documented, with a separate care plan for each wound, and records for each change of dressing. Photographs are taken (with the residents consent) to show the ongoing healing processes of the wound; and the Community Tissue Viability Nurse is requested to visit to provide additional support and advice. Records are retained for each change of position for residents who need staff to help them to move; and fluid charts are maintained for residents who need their fluid intake or output monitoring. We viewed a sample of these charts and noted that they were well completed. There is good documentation for residents who need bed rails and padded sides, showing the reason for the use of bed rails, the risks associated with using them, and obtaining written consent from the resident or their representative. Care plans also include assessments as needed to show if the resident has full mental capacity, or if they need a relative or representative to make decisions on their behalf. These plans are discussed as relevant, and signed and dated accordingly. Residents are able to retain their own GP if they wish to do so, or to be attended by a GP who is the visiting medical officer for the home. Referrals are made for other health professionals as appropriate, such as physiotherapy, speech and language therapist, dietitian, dentist and optician. Medication is stored in a clinical room on the ground floor, and is mostly administered via a monitored dosage system. There is a monthly delivery of medicines, and this occurred on the day of the inspection. We saw that there was insufficient room to store all of the medication safely and effectively, as some internal medication had to be stored alongside external medication; and the room was cluttered with items on shelves. We discussed this matter with the manager and with the nurse who oversees medication management, and they agreed that more storage space is needed. The manager immediately started to work out arrangements for providing more cupboard space in an adjacent area of the home. We are confident that this will be carried out, Care Homes for Older People Page 14 of 27 Evidence: and so a requirement has not been given. Daily medication is stored in two medication trolleys, and we examined one of these and found it to be in good order. Eye drops and liquid medication are dated on opening, which shows good practice. The room temperature and the drugs fridge temperature are recorded daily, and appropriate action is taken if either of these are high. We examined the Medication Administration Records (MAR charts) for one floor, and these are well completed records. Allergies are clearly highlighted, and there are detailed instructions for when to give as necessary medication for each person. An assessment is carried out for any resident who wishes to self medicate, to ensure that they can manage this safely and effectively. We observed staff interacting with residents and it was evident that staff are kind, conscientious, and caring. A residents survey form states I always find the staff to be friendly and caring, and have a good team spirit. On the day of the inspection visit, a resident said I am very happy here, staff are very kind and considerate; and a relative stated that the staff are wonderful; I cannot fault them. Four out of nine residents CQC survey forms expressed concern that the staff are sometimes slow to answer their call bells, and this was brought to the attention of the manager. Care planning showed that due attention is given to end of life care, trying to ensure that residents personal wishes can be met as much as possible e.g. preference to stay in the home rather than go to hospital. The staff access advice and support from the local Ellenor Hospice as needed. Care Homes for Older People Page 15 of 27 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. The home provides a varied range of activities for the residents enjoyment. The food is well cooked, and provides a nutritious diet. Evidence: The home provides a varied range of activities, with a weekly plan in place which is displayed in the front entrance hall. The programme is flexible to take account of residents preferences, and changes in the weather. The home has an attractive garden and patio area, looking out over the Darenth valley, and this is a pleasant place to sit or walk in warmer weather. Residents said that there is always a lot going on for those who wish to take part. This ranges from activities such as quizzes and crosswords to craft activities and armchair exercises. Residents had been busy during the preceding week making Easter bonnets, and photographs of these were displayed on a notice board. Others were looking forward to craft activities and card-making during the afternoon. We saw residents who were happy reading newspapers, watching television, knitting, and making wool pompoms during the morning. There are three lounges for residents use, and one of these is a quiet lounge which does not have a television, for those who prefer this. An activities co-ordinator said that she was able to spend time visiting residents on a one to one basis in their rooms, as well as carrying out group activities. Care Homes for Older People Page 16 of 27 Evidence: Pastoral care and private prayer is offered by visiting clergy, and Church services are held in the home for those who wish to attend. There are regular visits from entertainers, and outings are arranged during the Summer months. Visitors are made welcome at any time, and can stay for meals by arrangement if they wish to do so, for a set price. Residents are encouraged to bring in items for their own rooms, and are encouraged to take part in the life of the home by helping to choose new decor in the lounges, and by suggesting different items for the menus. Residents said that the food is very good, with plenty of choice and well prepared meals. A cooked breakfast is available for ordering any day, and there is a choice of main courses and desserts at other meals. Snacks are available at any time. The dining room tables are attractively laid with matching tablecloths, napkins and flowers, and a copy of the days menu is displayed on each table. All food is home cooked, and home made cakes are offered every day at afternoon tea. The kitchen seems to be rather small for the number of residents and staff, but was seen to be in good order when it was viewed immediately after lunch. The chef is assisted each day by a kitchen assistant in the morning, and another assistant in the afternoon and evening. The chefs are familiar with providing menus for residents with special dietary needs. Care Homes for Older People Page 17 of 27 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. Residents and visitors are confident that their views are listened to, and that any concerns or complaints will be addressed appropriately. Evidence: The complaints procedure is outlined for residents and visitors in a new complaints format, which is more straightforward than the previous format. There is a new computerised complaints system in place to ensure that managers and senior staff do not miss sending out letters or e-mails to complainants within the required timescales. We viewed the complaints log, and this showed that two recent complaints had been addressed on the same day as they were raised. The manager ensures that complainants are kept up to date with the processes of any complaints, and are informed of the action taken to address their concerns. Residents feel confident to voice any day to day concerns, and know that they can ask to speak to their named nurse or the manager at any time. The staff training matrix confirms that all staff are trained in the protection of vulnerable adults, and in understanding the importance of referring any suspicions of abuse to the Social Services Safeguarding Team. The home also has a whistleblowing policy for the protection of staff who may need to raise concerns about the behaviour of other staff. Care Homes for Older People Page 18 of 27 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 premises provide a comfortable and pleasant home for the residents. Evidence: The home is set in its own grounds overlooking the Darenth valley, and has pleasant gardens and a patio area. There are three lounges and a separate dining room. Two of the lounges have widescreen televisions, and the third lounge is a quiet room without television or radio. The home has an ongoing programme of redecoration, and residents are involved in choosing the decor for their own bedrooms and for communal areas. One of the lounges is due for redecoration, and the decor has been one of the subjects discussed at residents meetings. Some areas of the home have decor which is beginning to look tired, and the manager said that the whole home is probably due for refurbishment next year. This is kept under review by the Estates Management. All of the bedrooms are for single use and have en-suite toilet and wash basin facilities. Most bedrooms can be accessed via the passenger lift, and there is a wheelchair stairlift to a few rooms in one wing of the house. There are assisted baths and showers on each floor, enabling residents to choose their preference. We viewed evidence of plenty of nursing equipment, including profiling beds, pressure-relieving mattresses, hoists, slings, slide sheets and grab rails. There is a sluice on each floor. The home was clean in all areas, and there were no unpleasant Care Homes for Older People Page 19 of 27 Evidence: smells. The clinical room needs to be redecorated and have new flooring put in; the current state of the room is not effective for easy cleaning for infection control. There is a requirement for this to be addressed. The home has a full time maintenance man, and there are excellent records for general maintenance for items such as fire systems, call bell systems, checking bed rails fit properly, and checks for boilers, hot water temperatures and window restrictors. The radiators are of low surface temperature. The laundry room is rather small but was seen to be efficiently organised. The laundry equipment includes two washing machines, two tumble dryers, and a roller iron. There are dedicated laundry staff who ensure that clothing is well maintained. Care Homes for Older People Page 20 of 27 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. The residents are cared for by a team of competent and caring staff. Evidence: The home usually has two nurses on duty throughout the day time, and one nurse for night duties. The manager and deputy are often on duty as supernumerary nurses as well. The home usually has eight carers in the mornings, six in the afternoons and evening, and three at night. Residents spoke highly of the staff, and their kindness, consideration and care management. Several surveys expressed slight frustration with the level of time sometimes needed to answer call bells. The home encourages and arranges NVQ training for care staff, and there are approximately fifty per cent who have completed this training, and others who are in the process of commencing training. We viewed three staff files, and these show that good recruitment procedures are in place, except that two of the three files viewed did not include a recent photograph of the staff member. The manager was aware of this and was dealing with it, and so a requirement has not been given. Recruitment procedures include application forms with a history of the persons previous work experience; POVA first and CRB check; proof of identity; PIN number check for nurses; work permit checks where applicable; and an interview record. Applicants are required to show confirmation of previous Care Homes for Older People Page 21 of 27 Evidence: training. All staff are required to attend a four day induction, which is very detailed, and includes all mandatory training. After this has been satisfactorily completed, the new staff members work alongside existing staff as supernumerary, until they are assessed as suitable to work as part of the main workforce. We viewed the training matrix, which demonstrated that mandatory training is kept up to date; and refresher courses are available for different subjects throughout the year. Nursing staff are encouraged to develop their nursing skills and competencies, and take responsibility for different areas of work in the home e.g. medication, wound care. Care Homes for Older People Page 22 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run by an efficient manager; and she is ably supported by a management team and dedicated staff. Evidence: The manager is a trained nurse, and has completed the Registered Managers Award. She also holds a certificate for the nursing care of older people. She is suitably trained and experienced, and residents and staff are confident in her ability to run the home. She is supported by senior BUPA management staff, including a regional manager who carries out monthly visits to the home, and a national quality and compliance team which includes health and safety staff. BUPA homes have a monthly auditing process, which includes checks for most areas of the home, such as kitchen hygiene, health and safety, fire checks, maintenance, complaints, formal notifications recruitment, medication, staff training, and infection control. This ensures that there is ongoing support and guidance for the smooth running of the home. Relatives meetings are held every three months, and residents meetings every two Care Homes for Older People Page 23 of 27 Evidence: months; the minutes for the most recent meetings showed that these are well attended. Discussions are held on any subjects requested, and include items such as developing a herb garden, forthcoming events, health and safety issues and menu changes. There are also internal and external surveys carried out each year, and the results from these are available for viewing if requested. We noted that these can be very detailed, and a simpler format might encourage more residents and visitors to view these. Staff meetings are held on a regular basis, and include separate meetings for heads of departments, nurses, carers, maintenance, kitchen staff etc. The manager and nursing staff said that there is daily feedback and discussion at staff handovers. Staff and residents are fully aware that the manager has an open door policy, and is happy to discuss issues at any time. Residents are encouraged to manage their own finances if they are able to do so. The home can store small amounts of pocket monies on their behalf, and records are maintained for all debits and credits. Receipts are retained, and these records are audited on a monthly basis. All staff have ongoing one to one supervision every two to three months, and have yearly appraisals. This provides the opportunity for discussing any concerns, and for arranging training to develop their own knowledge and skills. Bupa care homes have a comprehensive set of policies and procedures which are reviewed at least once per year, and are updated as needed. We viewed a number of maintenance checks and were impressed with the quality of the documentation, and the procedures in place to ensure good overall maintenance of the home. Care Homes for Older People Page 24 of 27 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 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The clinical room should be redecorated and have new flooring put in, so as to make it easier to clean this area effectively for infection control. The providers must ensure that the premises are kept in a good state of repair both externally and internally. 01/06/2010 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 26 of 27 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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