Care Home: Crawfords Walk Nursing Home

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What the care home does well People living at the home all have single bedrooms, which they are able to personalise with their own belongings. People living there told us they liked their rooms. Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.2 Staff training and development is progressive and over 50% of care staff had an NVQ level 2 qualification. This is good practice and shows a high amount of staff having a qualification in care and working towards a qualification. The managers training records showed evidence of a lot of regular mandatory training covering diverse topics including e.g. health and safety, food hygiene, fire training, dementia care, moving and handling and infection control, protection of vulnerable adults. Staff also described various developmental training they had been on in eg palliative care, dementia care champions, which they felt they had brought back ideas and skills to further meet people’s needs. This training helps to ensure staff are aware of how to support people safely and helps them to meet their personal needs and requests. Staff records were well maintained and demonstrated that thorough employment checks are carried out during staff recruitment. This helps to make sure the right type of people are employed to care for people at the home. The company had previously introduced an initiative called, “night bites”. This meant that staff obtained supplies from the kitchen so that they also had various food and snacks available outside meal times in case anybody felt like a snack at any time in the day or night. The maintenance team have detailed records of how they manage the building and equipment making sure that it is always safe with any necessary actions taken to reduce any risks. Checks included e.g. small appliances, wheelchairs, bed rails, water temperature, and fire system checks. Their records were well maintained and regularly updated and included risks assessments on the environment. These records and practices showed good management of the environment which helped to assure people they have a comfortable and safe home to live and work in. What has improved since the last inspection? People that we met, told us they were happy with the staff and felt that they could always talk to the staff if they needed anything. We received 7 surveys from people living at the home which were mainly positive about their experience at Crawford’s Walk. People told us that they were happy living at the home. There comments included, “Good friendly atmosphere.” “The activities are very good.” “Nice and clean and friendly has a smoke room, nice bedrooms, nice food.” “I really like it here, I am very settled.” Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.2 We received 5 surveys from relatives and people acting on behalf of people at the home. There comments overall were very positive and include comments such as, “No complaints.” “The service provides nursing staff who understand ….mental illness and can meet their needs….” “It provides a good routine and well planned building and gardens for maximum comfort.” “The ward and office staff are always willing and friendly and sympathetic to myself….” “I am grateful to them for their support……” “All the staff work hard and are very caring.” Each unit has its own staff team with many staff working at the home for some time. Staff told us they were very happy working at the home and felt they had a really good atmosphere, they all felt well supported and fully trained and regularly offered ongoing training to help them do their job. We received 2 surveys from health professionals which were overall mostly positive and 6 surveys from staff which were overall mostly positive. Some of their comments included, “Provides a valuable service of care for vulnerable elderly people.” “Meets individual needs, works a team.” “….training and development improved-interesting courses for all levels of staff.” “The home looks after the health and welfare of all our residents.” “Good quality training for all staff.” “The management and staff at Crawford’s Walk genuinely have the best interest of the residents as top priority and promote high standards.” We found that the staff on one unit (Northgate) were very aware of people needs and interacted extremely well with people when supporting them to meet their needs. BUPA have introduced new records and procedures for staff to follow when someone is admitted to the home. They have been commended for this within the report as the assessment is very comprehensive and is regularly reviewed to show how they are continuing to meet the persons changing needs. The new records have extended to care planning, which means each person has a plan of care which clearly identifies their health and social needs. These plans are reviewed monthly to ensure staff have access to up to date instructions about the care each person needs and how they would like this care delivered. They had provided accurate medication records. They also had regular medication audits being carried out internally. This helps to show good Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.2 Page 8management of medications which helps achieve a consistently good standard that reduces any type of risks and errors with medications. The company also have various audits that are regularly carried out and the complaints records are also included in these detailed audits. This helps to show good management of ongoing comments, concerns and compliments. Following our last visit, the home had developed extensions to Northgate House to provide an additional ten bedrooms with en-suite toilet facilities and Eastgate House has another seven bedrooms with en-suite toilet facilities. They had been decorated and refurbished to a high standard with colour coordinating linen and furnishings and good quality matching bedroom furniture. They had also been supplied with additional day space offering attractive and comfortable sitting areas that some people were choosing to use. These areas had also been decorated and refurbished to a high standard offering good standards of equipment and furniture for people to enjoy. What the care home could do better: Full feed back was given to the manager and senior staff during our visit and on conclusion of day 2 of our visit. We found some areas that would benefit from further review and input. Staffing levels should be reviewed on each unit. There should be evidence in place of reviews around the dependencies of each person living there and how the company calculate the staffing levels based on peoples ongoing needs. These ongoing reviews should include ongoing feedback and views of the people living there, the staff and their representatives, next of kin. This will ensure they can be given feedback about their opinions and help to influence the management of appropriate staffing levels on each unit. Staffing levels for each unit should be easily accessible and displayed for peoples information and look at including them in each units newly revised statement of purpose. A review of the management of people’s finances and changes to their interest in bank accounts should be carried out with people living at the home and their representatives. This will ensure they are kept fully informed and supported to get best value for their money and will ensure they are in agreement with how their money is being managed in ways beneficial and acceptable to them. Audits should be undertaken to ensure everyone who lives at the home is offered the same experience at meal time and that every staff member is fully knowledgeable about “protected meal times”. Efforts should be made to address this with all of the staff teams to help promote quality of life and well-being when they are supported with their meals.Crawfords Walk Nursing HomeDS0000018716.V378677.R01.S.docVersion 5.2Just 2 of the units had evidence of malodorous smells. This should be reviewed so that each unit can provide an environment that respects people’s dignity and the right to enjoy living in a home that offers a fresh and enjoyable environment at all times. The home would benefit from maintenance and decorating plan that can be shared with everyone at the home. This will help to keep everyone up to date and included in the developments of their home and give them the opportunity to be able to influence the developments they would like to see at their home. Regular staff, relatives and residents meetings should be organised and provided on a regular basis throughout the year so that everyone has ongoing opportunities to raise comments and be kept up to date and included in the development of their home. Key inspection report CARE HOMES FOR OLDER PEOPLE Crawfords Walk Nursing Home Lightfoot Street Hoole Chester Cheshire CH2 3AD Lead Inspector Diane Sharrock Key Unannounced Inspection 26th 27th November 2009 10:30 DS0000018716.V378677.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.2 Page 2 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 Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crawfords Walk Nursing Home Address Lightfoot Street Hoole Chester Cheshire CH2 3AD 01244 318567 01244 344326 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.bupa.com BUPA Care Homes (CFHCare) Ltd Mrs Kathleen Margaret Webber Care Home 137 Category(ies) of Dementia (67), Mental disorder, excluding registration, with number learning disability or dementia (40), Old age, of places not falling within any other category (30) Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Mental disorder, excluding learning disability or dementia - Code MD The maximum number of people who can be accommodated is: 137 30th April 2008 thematic inspection. Date of last inspection Brief Description of the Service: Crawfords Walk Nursing Home comprises of five purpose-built bungalows set in landscaped gardens in the Hoole area of Chester. The home is owned and operated by BUPA Care Homes. Bridgegate House provides care for 30 frail older people; Eastgate House provides care for 37 older people with dementia, Watergate House provide care for 30 people with dementia, and Northgate House provides care for 40 people with enduring mental illness. The fifth building houses the kitchen, laundry, administration and staff facilities. A hairdressing salon is also on site. The four residential units are all single storey and everyone has access to a bedroom. The newly built extensions offer ensuite toilets to the bedrooms within those units. Crawford’s Walk benefits from having 3 in-house activities organisers, who arrange entertainment and trips out. The home statement of purpose, service user guide and most recent inspection report can be supplied by the home for people to view information about Crawford’s Walk. Fees range from £539.37 to £742. per week. Items such as toiletries, newspapers and hairdressing are not included in the fees. Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This visit was unannounced and was just one part of our visit. Other information received was also looked at. Due to various guidance from our department this inspection was carried out in November and took place over 2 days, the 26th 27th November 09. This meant we were able to use the previous annual questionnaire that the manager had submitted to us last year. This is a document, which gives information about the services strengths and weakness, and future plans for the home to develop. A selection of questionnaires were also sent out for people living at the home, families, staff and health and social care professionals to find out their views. In total we have received 20 surveys from a selection of people with their comments and opinions included below. During our visit we looked at various company audits and various areas within the environment. We visited all of the 4 units and spent the majority of time on 2 of the units. We spoke to a sample of people living on 2 of the units and we met a selection of staff (approximately 10 staff) from all of the units and they gave their views about the service. A variety of records were looked at which told us about the health and welfare and care received by the people who live at the home. This review also included looking at staff records. We watched how staff interact with the people who live at the home and how staff deliver care. We also carried out a one and a half hour observation as part of the inspection on Northgate Unit, which supports people who have an enduring mental illness. A specialist tool was used to do this, it helps to highlight the levels of staff interaction, peoples well being and any type of engagement with the people we observed. The findings were very positive and were used in parts of the report. What the service does well: People living at the home all have single bedrooms, which they are able to personalise with their own belongings. People living there told us they liked their rooms. Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.2 Page 6 Staff training and development is progressive and over 50 of care staff had an NVQ level 2 qualification. This is good practice and shows a high amount of staff having a qualification in care and working towards a qualification. The managers training records showed evidence of a lot of regular mandatory training covering diverse topics including e.g. health and safety, food hygiene, fire training, dementia care, moving and handling and infection control, protection of vulnerable adults. Staff also described various developmental training they had been on in eg palliative care, dementia care champions, which they felt they had brought back ideas and skills to further meet people’s needs. This training helps to ensure staff are aware of how to support people safely and helps them to meet their personal needs and requests. Staff records were well maintained and demonstrated that thorough employment checks are carried out during staff recruitment. This helps to make sure the right type of people are employed to care for people at the home. The company had previously introduced an initiative called, “night bites”. This meant that staff obtained supplies from the kitchen so that they also had various food and snacks available outside meal times in case anybody felt like a snack at any time in the day or night. The maintenance team have detailed records of how they manage the building and equipment making sure that it is always safe with any necessary actions taken to reduce any risks. Checks included e.g. small appliances, wheelchairs, bed rails, water temperature, and fire system checks. Their records were well maintained and regularly updated and included risks assessments on the environment. These records and practices showed good management of the environment which helped to assure people they have a comfortable and safe home to live and work in. What has improved since the last inspection? People that we met, told us they were happy with the staff and felt that they could always talk to the staff if they needed anything. We received 7 surveys from people living at the home which were mainly positive about their experience at Crawford’s Walk. People told us that they were happy living at the home. There comments included, “Good friendly atmosphere.” “The activities are very good.” “Nice and clean and friendly has a smoke room, nice bedrooms, nice food.” “I really like it here, I am very settled.” Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.2 Page 7 We received 5 surveys from relatives and people acting on behalf of people at the home. There comments overall were very positive and include comments such as, “No complaints.” “The service provides nursing staff who understand ….mental illness and can meet their needs….” “It provides a good routine and well planned building and gardens for maximum comfort.” “The ward and office staff are always willing and friendly and sympathetic to myself….” “I am grateful to them for their support……” “All the staff work hard and are very caring.” Each unit has its own staff team with many staff working at the home for some time. Staff told us they were very happy working at the home and felt they had a really good atmosphere, they all felt well supported and fully trained and regularly offered ongoing training to help them do their job. We received 2 surveys from health professionals which were overall mostly positive and 6 surveys from staff which were overall mostly positive. Some of their comments included, “Provides a valuable service of care for vulnerable elderly people.” “Meets individual needs, works a team.” “….training and development improved-interesting courses for all levels of staff.” “The home looks after the health and welfare of all our residents.” “Good quality training for all staff.” “The management and staff at Crawford’s Walk genuinely have the best interest of the residents as top priority and promote high standards.” We found that the staff on one unit (Northgate) were very aware of people needs and interacted extremely well with people when supporting them to meet their needs. BUPA have introduced new records and procedures for staff to follow when someone is admitted to the home. They have been commended for this within the report as the assessment is very comprehensive and is regularly reviewed to show how they are continuing to meet the persons changing needs. The new records have extended to care planning, which means each person has a plan of care which clearly identifies their health and social needs. These plans are reviewed monthly to ensure staff have access to up to date instructions about the care each person needs and how they would like this care delivered. They had provided accurate medication records. They also had regular medication audits being carried out internally. This helps to show good Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.2 Page 8 management of medications which helps achieve a consistently good standard that reduces any type of risks and errors with medications. The company also have various audits that are regularly carried out and the complaints records are also included in these detailed audits. This helps to show good management of ongoing comments, concerns and compliments. Following our last visit, the home had developed extensions to Northgate House to provide an additional ten bedrooms with en-suite toilet facilities and Eastgate House has another seven bedrooms with en-suite toilet facilities. They had been decorated and refurbished to a high standard with colour coordinating linen and furnishings and good quality matching bedroom furniture. They had also been supplied with additional day space offering attractive and comfortable sitting areas that some people were choosing to use. These areas had also been decorated and refurbished to a high standard offering good standards of equipment and furniture for people to enjoy. What they could do better: Full feed back was given to the manager and senior staff during our visit and on conclusion of day 2 of our visit. We found some areas that would benefit from further review and input. Staffing levels should be reviewed on each unit. There should be evidence in place of reviews around the dependencies of each person living there and how the company calculate the staffing levels based on peoples ongoing needs. These ongoing reviews should include ongoing feedback and views of the people living there, the staff and their representatives, next of kin. This will ensure they can be given feedback about their opinions and help to influence the management of appropriate staffing levels on each unit. Staffing levels for each unit should be easily accessible and displayed for peoples information and look at including them in each units newly revised statement of purpose. A review of the management of people’s finances and changes to their interest in bank accounts should be carried out with people living at the home and their representatives. This will ensure they are kept fully informed and supported to get best value for their money and will ensure they are in agreement with how their money is being managed in ways beneficial and acceptable to them. Audits should be undertaken to ensure everyone who lives at the home is offered the same experience at meal time and that every staff member is fully knowledgeable about “protected meal times”. Efforts should be made to address this with all of the staff teams to help promote quality of life and well-being when they are supported with their meals. Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.2 Page 9 Just 2 of the units had evidence of malodorous smells. This should be reviewed so that each unit can provide an environment that respects people’s dignity and the right to enjoy living in a home that offers a fresh and enjoyable environment at all times. The home would benefit from maintenance and decorating plan that can be shared with everyone at the home. This will help to keep everyone up to date and included in the developments of their home and give them the opportunity to be able to influence the developments they would like to see at their home. Regular staff, relatives and residents meetings should be organised and provided on a regular basis throughout the year so that everyone has ongoing opportunities to raise comments and be kept up to date and included in the development of their home. 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. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 10 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available for everyone so they can make a choice about where they want to live. People’s needs are assessed prior to moving in so appropriate care can be provided to them. EVIDENCE: We visited the four units and looked at records that belonged to six people on two of the units. These showed us that senior staff from the home visit people before people decide whether they want to move in. During the visit staff record all the person’s health needs and wishes. They also get a copy of any other records that have been completed by other health care professionals such as social workers which helps them assess the person’s needs before they move to Crawford Walk. Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 12 All of this information is then used to make a plan of care, which tells staff how to care for the person in the way that they would choose. The assessment is repeated six months after the person moves in. This is an example of good practise. It provides an ongoing and detailed assessment of their each persons care and support which helps to show if any changes are needed from when they first moved in to the home. The staff told us that they provide people with a copy of the service users’ guide and statement of purpose. These documents were very formal and referred to a lot of company policies but the manager advised that she is in the process of developing revised copies and some will be able to meet peoples needs a lot better, such as the use of large print. These documents contained details of the facilities and services provided to people while residing at Crawford’s Walk. At present the home has one statement of purpose for all 4 units although the manager is looking at developing individual information for each unit. Each unit is very different and offers different forms of care and support and individual guides would help people to know about what is on offer on each unit. Survey’s returned from people residents prior to our site visit confirmed that they had received information on Crawford’s Walk’s that helped them or their relative to choose to live there. Relatives surveys returned prior to the site visit were complimentary about the choices they made on behalf of their relative. Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Everyone has a plan of care so staff have clear written instructions which tells them how to care and support people. Staff care about peoples health and involve specialist support whenever needed. EVIDENCE: We looked at six plans. Each was reviewed regularly, which shows that staff have up to date instructions to follow about each persons care. The plans provided clear information and guidance to staff on how to support the person safely and some contained clear details on how the person wanted to be supported, which is good practise. There were good examples of care plans in place that monitored people’s health. Care plans were individualised to each person. The plans relating to each person medical conditions gave detailed guidance to staff how to care for that person. Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 14 A good example of this was the records for recording the treatment and improvements to any type of wound, especially the use of pictures which helped the staff to monitor the progress and reactions to the treatments they had given. Advice from the tissue viability specialist had also been regularly sought. The records showed that nursing staff have the skills and the understanding of how to encourage wounds to heal. Staff were keeping daily records of the care and support they had given to each person and how they had spent their day. These varied in standard. Some staff recorded a lot of detail and other staff wrote brief details and limited information about their social and personal care needs and limited information about the management of pain relief and support for one person. We discussed one plan regarding how they were managing the person’s pain relief. Staff were able to verbally explain what reviews and actions were taking place. However the care plan did not reflect their actions and needed to be updated to make it clear that the person’s pain relief was being appropriately management. The plans also contained risk assessments which showed if people were at risk of eg, falling, developing pressure sores or at risk of becoming malnourished. Staff were providing care to reduce these risks. People that we met, told us they were happy with the staff and felt that they could always talk to the staff if they needed anything. People told us that they were happy living at the home. We received 7 surveys from people living at the home which were mainly positive about their experience at Crawford’s Walk. Their comments included, “Good friendly atmosphere.” “Nice and clean and friendly has a smoke room, nice bedrooms, nice food.” “I really like it here, I am very settled.” “Very satisfied with Crawfords Walk.” “Crawfords Walk has a lovely friendly relaxed atmosphere, nothing is too much trouble for the staff, from the sister down, this is a great quality…” We received 5 surveys from relatives and people acting on behalf of people at the home. Their comments overall were very positive and include comments such as, “No complaints.” “The service provides nursing staff who understand ….mental illness and can meet their needs….” “It provides a good routine and well planned building and gardens for maximum comfort.” Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 15 “The ward and office staff are always willing and friendly and sympathetic to myself….” “I am grateful to them for their support……” “All the staff work hard and are very caring.” Staff described how they support people to see other health professionals such as their GP, Opticians and Dentists when needed. Records showed that staff plan and arrange regular contact to these professionals which helps to keep people healthy and safe. We received 2 surveys from health care professionals, who were mostly positive in their feedback and included comments such as, “Provides a valuable service of care for vulnerable elderly people.” We looked at a sample of the medicines management and administration on one unit. They had organised accurate medication records. They also had regular medication audits being carried out internally. This helps to show good management of medications which helps achieve a consistently good standard that reduces any type of risks and errors. Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 living at Crawford’s Walk felt they were supported to exercise choice and control over their lives. EVIDENCE: Crawford’s Walk employs three activities coordinators and the manager is in the process of employing a 4th so that each unit eventually has their own coordinator. Each unit had a notice board in the main foyer, some had advertised more information than others and some advertised forthcoming events for Christmas, such as the Christmas fairs on each unit and the planned Christmas parties. One unit had their activity rota displayed in the office which would have kept staff informed but would have been difficult for the people living there to see it. We received 7 surveys from people living at the home. Four people felt they “always” had enough activities, and 3 people said they, “usually” had enough activities available. Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 17 Some people made various comments and suggestions stating, “The activities are very good.” “Would like a job to keep me busy.” “I would like to go for a weekend break with a carer…..” “….more walks to Hoole.” “I would like to go on holiday somewhere when I am well enough.” “Nice and clean and friendly, smoking room, nice bedroom, nice room.” Peoples care plans and comments should be reviewed so that they can be included in developing their aims and expectations and work towards achieving their desired activities. Regular meetings and communication with people on each unit will help to include people in the developments of the activities programme on offer so they can be given the opportunity influence what is on offer. Throughout the visit we saw staff talking to people respectfully and with dignity. Staff were seen knocking on doors before entering. We noted that on each unit some bedroom doors were left open and some people were seen lying in bed. Staff advised they left the doors open so they could “keep a close watch on them while in bed.” This practice should be reviewed for each individual to see if it achieves anything as at times the persons privacy can be compromised especially with visitors walking past. However we did notice that each unit was very different and the staff advised that the dependency of people living on each unit was very different. One unit had approximately 8 people that were cared for in their bed due to their condition. Staff felt that staffing levels meant they had to spend a lot of time offering personal care and they had little time to spend with people in the lounges. They felt this was especially difficult when they had shortages of staff due to sickness or having to move to other units. However staff generally did feel there had been improvements to the organising of activities and felt they had a lot more on offer. We noted the staff had displayed various pictures of recent events were staff had gone to a lot of work to organise themed events such as a taste of India and a Cruise were everyone had been encouraged to get dressed up and take part in the fun. On one unit we looked at the activities organiser’s records for the month of November and looked at a variety of activities that she had organised on 11 occasions. The activities involved various people either on a one to one basis or a small group and included, eg, Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 18 Walks to Hoole, hand and foot massages, manicures, magazines, general chats, looking at photos, making Christmas cards, reading the newspaper, a visiting entertainer, crossword, watching television, colouring pictures, chatting and visit to the homes summer house in the garden. During day one we noticed that the activity person was off on one unit and the staff felt they had no time to organise anything socially for the people living there. Some people were sat in the conservatory with no activity, television or anyone to talk to for various periods in the day. Others sat quietly watching televisions while staff carried on with their daily duties around the home. During the site visit a new method on gathering the experiences of people living at Crawford’s Walk was used. A small group of people who lived on the Northgate unit were watched for a period of one and a half hours. Information on how they related to one another, staff, visitors, meals, activities and their environment were noted and recorded. This included staff interactions and practice. The findings of the observation were that there were very positive interactions between people living there and the staff. This method helped to highlight a lot of good practices especially catering for the individual needs of each person. In a short space of time, people were observed being friendly, polite and respectful to the people they supported. Staff were seen supporting people in a variety of ways eg choosing when to have a bath, to prepare Christmas crafts and pictures, one person was supported in reading their book, another was able to have a hand massage, some people were watching television and others were independently doing what they wanted to do, such as going out to the shops, walking around the home, going to the smoking room, making a cup of tea. It was obvious they had a good relationship with people and everyone took the time to interact with a person even if it was a passing visit were they were able to say hello to them enroute to going to do another job. The staff had been appropriately trained and managed in achieving a very good standard of care and support which meets people’s individual needs on Northgate unit. The good practices and skills achieved on this unit should be shared throughout the home to achieve similar high standards and experiences. The lunchtime meal was observed on two units during our 2 day visit. Protected meal times are in place across the home which is a good practice initiative that had been introduced throughout the company. This means that disruptions are kept to a minimum to enable people to eat their food in a relaxed and calm atmosphere. We saw a poster up on one notice board to make visitors aware of this. However during the meal on one unit, the lounge/ diner doors and kitchen doors were left open, the phone was ringing, the dish washer was on, staff chatted loudly in the kitchen and in walking though the dining room, and one Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 19 staff was seen collecting plates from some people, whilst staff were still seated on another table quietly supporting a small group with their meal. One staff member was also seen leaving windows open in the conservatory, while some people were still eating and had no blanket or cover to keep them warm. This should be reviewed so that everyone is aware of what protected meal times means and can revise their practice to try and lessen the noise during mealtimes and to ensure everyone who lives at the home is offered the same experience at meal times. We looked at the sample of menus that had been developed for the home. People had the choice of a cooked breakfast or lighter option. People are supported by staff to choose their meals. Menus were on display on each unit to inform people and visitors of the choices on offer. The company had also previously introduced an initiative called, “night bites”. Staff explained that this meant they obtained supplies from the kitchen so that they also had various food and snacks available outside meal times in case anybody felt like a snack at any time in the day. The chef said they also make sure they supply snacks and foods for people with special diets, such as offering diabetic jams and ice cream to be stored and available on each unit. The kitchen area was well stocked and very organised and able to provide various choices for people including any special diets. From the 7 surveys that we received from people living at the home 2 people said they, “always” like the meals, 2 people said they, “usually” like the meals and 3 people said they “sometimes” like the meals. Some suggestions included, “Would like to see grilled salmon on the menu, we get it at Easter and Christmas but would like it more often, new potatoes and liver and onions.” staff surveys made suggestions saying, “Improve the choices for pureed diets.” “Improve the quality of the food provided for residents.” “…perhaps food could be more varied and bit better quality.” One health care professional’s survey made a comment suggesting, “Improve diets for diabetic clients.” The above comments should be reviewed with people at the home so they are given feedback about their comments and suggestions. Regular opinions should be sought throughout the year so that people are included in the managing and developing of their home. Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have the skills to support people to stay safe and protect their rights. EVIDENCE: We received 7 surveys from people living at the home which were mainly positive about their experience at Crawford’s Walk. Overall the information given in the surveys and in speaking to the people we met, told us that they are aware of how to raise any concerns or complaints and that they are confident the staff team will address any comments they make. We received 5 surveys from relatives and people acting on behalf of people at the home. There comments overall were very positive and include comments such as, “No complaints.” We spoke to a sample of staff from each unit and they had a good understanding of how to recognise and deal with any adult protection issues that arose. Training records showed that the majority of staff had received training on this subject. This helps to ensure that the people living at Crawford’s Walk are supported to stay safe. Records showed us that the manager does investigate all complaints within set timescales and that she lets the complainant know in writing of any action she Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 21 has taken to resolve their concerns. The company also have various audits that are regularly carried out and the complaints records are also included in these detailed audits. This helps to show good management of ongoing comments, concerns and compliments. Each unit has a copy of the homes complaints procedure telling people how to complain and what would happen to address their concerns. The manager had also carried out a detailed referral to the local authorities following the “deprivation of liberty” guidance. This showed a good understanding and knowledge in carrying out the right procedures to try to maintain people’s safety and rights. Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 live in a safe and comfortable environment, which is equipped to meet their needs. EVIDENCE: The home is set in its own grounds and each of the residential units has its own enclosed garden. The home has a maintenance manager and one part time member of staff who assists him and maintains the gardens. The maintenance team have a detailed record of how they manage the building and equipment making sure that it is always safe with any necessary actions taken to reduce any risks. Their records showed regular checks on e.g. small appliances, wheelchairs, bed rails, water temperature, and fire system checks. The maintenance staff explained that the radiators throughout the home are controlled by a main computer so this ensures the temperatures do not exceed safe levels. Their records were well maintained and regularly updated and Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 23 included risks assessments on the environment. These records and practices showed good management of the environment which helped to assure people they have a comfortable and safe home to live and work in. Everyone living at Crawford’s Walk has their own bedroom which they can personalise as they choose. A number of bedrooms have a patio door, which faces onto the grounds and provides a pleasant view. We saw a sample of bedrooms on 2 of the units we visited, which were kept in a good standard, all being clean and tidy. Various rooms had evidence of lots of personal belongings such as pictures, ornaments and some personal furniture that some people had brought in with them. This helped people to settle into their room and feel more comfortable with their personal belongings. Each bedroom had a washbasin and there were sufficient bathrooms and toilets throughout the home for people to use. The manager advised that the bathrooms would be part of the major refurbishment and would be completely redecorated and refurbished. All areas of the home are on ground level, which makes it easy for people with mobility difficulties to get around. In addition there are a number of aids and adaptations to support people with their mobility and personal care. This includes a nurse call system, wheelchairs, grab rails and hoists. Following our last visit the home have now developed extensions to Northgate House to provide an additional ten bedrooms with en-suite toilet facilities and Eastgate House has another seven bedrooms with en-suite toilet facilities. They had been decorated and refurbished to a high standard with colour coordinating linen and furnishings and good quality matching bedroom furniture. They had also been supplied with additional day space offering attractive and comfortable sitting areas that some people were choosing to use. These areas had also been decorated and refurbished to a high standard offering good standards of equipment and furniture for people to enjoy. Communal space consists of shared living and dining areas with some units having an additional small quiet lounge. Each unit has an enclosed room designated for smoking. Just 2 of the units had evidence of malodorous smells; the other 2 units were fresh with no unpleasant smells evident. This should be reviewed so that each unit can provide an environment that respects people’s dignity and the right to enjoy living in a home that offers a fresh and enjoyable environment at all times. Some areas of the home were beginning to look worn, with some woodwork showing signs of scrapes and wear and tear. They would benefit from redecoration to match the high standards already achieved within the new extensions. The manager advised that the company already had plans for a Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 24 major refurbishment programme to all of the units which they are hoping to start very soon. Although the home did not have a maintenance and decorating plan to share with people, the staff advised that the refurbishment programme would include the painting and decorating of all communal areas, bedrooms, and replacement of carpets. The home has a large laundry with a team of staff that are employed for laundry duties. It is equipped with industrial style machines and was found to be very organised, clean and tidy. There had been no concerns or complaints made about the laundry. This should be commended as the staff have to deal with 4 units which manages a lot of laundry and personal items for people living at the home to a good standard. Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 receive care and support from staff that they like who have had the training to deliver their care. EVIDENCE: We looked at staff files, which showed us that before anyone starts work in the home a series of checks, are carried out. This includes obtaining a full application form, references and Criminal Records Bureau check (CRB). These checks help to ensure that staff are suitable and safe to work with the people living at Crawford’s Walk. Training had been provided for staff called, personal best, which is the BUPA customer care training. This training contained examples of staff thinking about how they did their job and giving examples of working with people to demonstrate good practice. Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 26 The managers training records showed evidence of a lot of regular mandatory training covering diverse topics including e.g. health and safety, food hygiene, fire training, dementia care, moving and handling and infection control, protection of vulnerable adults. This training helps to ensure staff are aware of how to support people safely. Staff also described various developmental training they had been on in eg palliative care, dementia care champions, which they felt they had brought back ideas and skills to further meet people’s needs. Over half of the staff working at the home have obtained a qualification in care called a national vocational qualification (NVQ) and there are plans in place for other staff to obtain this award. This is an example of good practice as it exceeds the basic standards which suggest that at least 50 of workforces should have an NVQ qualification. Each unit has its own staff team with many staff working at the home for some time. Staff told us they were very happy working at the home and felt they had a really good atmosphere, they all felt well supported and fully trained and regularly offered ongoing training to help them do their job. We received 6 surveys from staff which were overall mostly positive. Some of their comments included, “Provides a valuable service of care for vulnerable elderly people.” “Meets individual needs, works as a team.” “….training and development improved-interesting courses for all levels of staff.” “The home looks after the health and welfare of all our residents.” “Good quality training for all staff.” “The management and staff at Crawford’s Walk, genuinely have the best interest of the residents as top priority and promote high standards.” Various comments overall were made from the surveys received and from the people we met regarding their opinions on the different levels of staffing on each unit and the levels of dependencies and needs of the people living in the units. We received 7 surveys from people living at the home. Five people felt they, “usually” had enough staff available, 2 people felt they, “always had enough” people available. Four people felt they, “always” received the care and support they needed, 3 felt they, “usually” received the care they needed. Comments made around the staffing levels included, Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 27 “As with most homes ideally more staff would provide a better care package but the management do an excellent job with the staff they have. All the staff work hard and are very caring…” We received 2 surveys from health care professionals, who were positive about the home but made comments and suggestions saying, “At times they need more staff on each unit.” They both indicated that staff, “usually” had the right skills and experiences to support peoples social and health care needs. Staff surveys indicated that 4 people felt they, “usually” had enough staff on duty and 2 staff felt they, “sometimes” had enough staff on duty. Staff comments and suggestions included, “Supply more staff for meeting high standards and extensive that are promoted by the company.” “Sometimes it’s difficult when the needs of our residents are so high, sometimes we have to move to other units to cover for sickness this can put a strain on everyone.” “We d like to get involved more with the social side and be able to sit with the residents but we just don’t have that time.” The comments and suggestions raised about the ongoing review of staffing levels should be discussed with everyone so that they are provided with feedback about their comments and are included in any organised review of staffing levels. Each unit should have the staffing levels clearly displayed and accessible to everyone so they are kept informed and up to date regarding how the staffing levels are reviewed and managed. From the general observations that we made and the more specific observations using the short observational tool used on one unit, it was clear that most staff have very good skills and provide individual care to the people living at the home. The positive practices and skills observed and noted on Northgate should be shared with the other units to share and promote good practices throughout the home. Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 well managed and provides an experienced manager who makes sure that Crawford’s Walk is a safe place to live. EVIDENCE: The homes manager has been in post for approximately 10 years. She is a registered mental nurse and has the registered manager award. A clinical services manager supports her to manage the home. We looked at a sample of certificates and records, which showed us that a series of checks are carried out on the environment and equipment at Crawford’s Walk to ensure it is safe. This includes regular checks of water temperatures and fire equipment, gas and electricity. Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 29 The manager ensures there are a number of audits and checks in place to check the quality of the service provided. This includes regular reviewing of e.g. peoples care plans, medications, checks on maintenance and management of health and safety within the home, regular reviews and audits of any concerns, complaints and compliments, regular reports on wound care management, analysis of any notifications sent to our department including safeguarding referrals and detailed monthly visits by the regional manager. The regional manager carry’s out detailed monthly audits and reviews all of the original data gathered by the manager. These detailed records and practices showed good management of the home which help to show and assure people that they have a home that is well managed and able to achieve consistently good standards throughout the service. In addition surveys are carried out each year to obtain the views of the people living at Crawford’s Walk and their relatives. The company arrange for the results to be published each year and we were shown the completed publication for 2008 results. Crawford’s Walk scored well in their own company survey, particularly in questions about care, activities provision and choice, variety and choice of menu and personal choices. The company provided a good honest selection of responses received. They also included some negative comments and suggestions which they used in developing an action plan of what they were going to do with their comments. These checks and surveys help to ensure that the service is consistently meeting good standards and quickly identify and address any issues that arise as well as helping plan future improvement. We discussed the necessity and benefits of having ways to offer people regular ways to gain their opinions and views about the home. We did see a sample of senior staff minutes but there was limited evidence of other meetings within the units. We noted that on some units there were no minutes and organised meetings for people to be included and supported in airing their views, aside from the annual surveys that the company organise. Regular meetings for both staff, relatives, representatives and people living at the home would help achieve better communication on each unit and will help to review all of the comments raised in this visit and report. We did not see any evidence of how staffing levels are calculated for each unit and how they are reviewed with regards the individual needs of people living there. The manager and staff did say they would always try to provide extra staff when needed. Staff in Northgate advised that in January 2010 they were due to have their staffing levels increased due to their requests for the need to Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 30 have more staff on duty to help meet the differing needs of the people living there. Staffing levels should be reviewed on each unit. There should be evidence in place of reviews around the dependencies of each person living there and how the company calculate the staffing levels based on peoples ongoing needs. These ongoing reviews should include ongoing feedback and views of the people living there, the staff and their representatives, next of kin. This will ensure they can be given feedback about their opinions and help to influence the management of appropriate staffing levels on each unit. The home has a full time administrator and a part time receptionist. The administrator is a corporate appointee for 10 people, mainly living on Northgate House, under long standing arrangements. People’s money are not kept on the premises but paid into a “residents” bank account. All monies are held in one bank account in which each person has a separate account that yields its own interest. The administrator draws out personal spending money weekly. Records, both written and electronic, were kept and were examined and were found to be organised. However we noted that the interest generated on this account was much more in 2008 than in 2009 and for the last 8 months there had been no interest generated. This was discussed with staff as there was a lack of consultation with people at the home regarding these changes to their accounts. A review of these changes should be carried out with people living at the home and their representatives. This will ensure they are kept fully informed and supported to get best value for their money and will ensure they are in agreement with how their money is being managed in this way. At the time of our visit we noted there was no explanation of how the company offer to manage people’s money and there was no written agreement or support plan or permission given by people, most information had been taken verbally. Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 3 3 4 4 X N/A ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X X X 3 HEALTH AND PERSONAL CARE Standard No Score 3 7 3 8 4 9 3 10 3 11 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 3 12 3 13 3 14 3 15 COMPLAINTS AND PROTECTION Standard No Score 4 16 X 17 3 18 STAFFING Standard No Score 3 27 4 28 3 29 3 30 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 x 2 3 3 4 Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 32 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations Audits should be undertaken to ensure everyone who lives at the home is offered the same experience at meal time and that every staff member is fully knowledgeable about “protected meal times”. Efforts should be made to address this with all of the staff teams to help promote quality of life and well-being when they are supported with their meals. Malodorous smells should be reviewed so that each unit can provide an environment that respects people’s dignity and the right to enjoy living in a home that offers a fresh and enjoyable environment at all times. The home would benefit from maintenance and decorating plan that can be shared with everyone at the home. This will help to keep everyone up to date and included in the developments of their home and give them the DS0000018716.V378677.R01.S.doc Version 5.3 Page 33 2. OP26 3. OP19 Crawfords Walk Nursing Home opportunity to be able to influence the developments they would like to see at their home. 4 OP12 Regular staff, relatives and residents meetings should be organised and provided on a regular basis throughout the year so that everyone has ongoing opportunities to raise comments and be kept up to date and included in the development of their home. Staffing levels should be reviewed on each unit. There should be evidence in place of reviews around the dependencies of each person living there and how the company calculate the staffing levels based on peoples ongoing needs. These ongoing reviews should include ongoing feedback and views of the people living there, the staff and their representatives, next of kin. This will ensure they can be given feedback about their opinions and help to influence the management of appropriate staffing levels on each unit. Staffing levels for each unit should be easily accessible and displayed for peoples information, including them in each units newly revised statement of purpose. A review of the management of people’s finances and changes to their interest in bank accounts should be carried out with people living at the home and their representatives. This will ensure they are kept fully informed and supported to get best value for their money and will ensure they are in agreement with how their money is being managed in ways beneficial and acceptable to them. 5 OP27 6 OP35 Crawfords Walk Nursing Home DS0000018716.V378677.R01.S.doc Version 5.3 Page 34 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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