Care Home: Woodlands View Residential And Nursing Home

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What the care home does well Staff at the home provide high standards of care for all the residents who include those with intensive nursing needs and those who have a dementia. Staff are well trained in all basic areas and in specialist areas such as palliative care, dementia care and tissue viability. The visitors we spoke with said that care staff are thorough in all they do and always ask " if there is anything else they can do" when completing a task with a resident. Care provided on the dementia unit is excellent and in the report are examples of the good practice we observed. We found that current guidelines for providing good dementia care were all being implemented in the home including a variety of ways of providing food, varied activities and ways of people spending their days and good and on-going interaction with staff. All care records were detailed and meaningful and all up to date. The plans are "working doccuments " for care staff and residents and families are involved in completing them. Activity provision throughout the home was praised by residents and visitors and no one told us they felt bored in the home. The food is also of a very high standard and plentiful with four main meals being provided with a wide range of choice offered. The home is well maintained and all areas are kept clean and hygienic. The manager has been registered with the Commission and provides clear and supportive leadership. The manager has kept up to date with all the changing care guidelines and requirements and was praised by the staff and residents who said their views were listened to and acted on where appropriate. What has improved since the last inspection? The system for administering medication is sound and no errors were found in the records, storage or administration when we observed two medication rounds during the visit. What the care home could do better: No requirements were made as a result of this inspection. The system for providing hot water in the home is in need of improvement but is being addressed at this time. Since the inspection took place the manager has confirmed that the problem with the hot water supplies to the houses has been resolved. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Woodlands View Residential And Nursing Home Magpie Crescent Stevenage Hertfordshire SG2 9RZ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Patricia House     Date: 2 4 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Woodlands View Residential And Nursing Home Magpie Crescent Stevenage Hertfordshire SG2 9RZ 01438740230 01438745967 edjen@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Jacqueline Jackson Type of registration: Number of places registered: BUPA Care Homes (CFHCare) Ltd care home 120 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability terminally ill Additional conditions: This home may accommodate (in Wellfield House) 30 older people with dementia who require nursing care. This home may accommodate 10 people (aged between 50-65 years) who require nursing care. This home may accommodate 30 older people who require personal care. This home may accommodate 6 older people with physical disability who require nursing care. This home may accommodate 90 older people who require general nursing care. Date of last inspection Care Homes for Older People Page 4 of 29 Over 65 30 120 6 0 0 0 0 6 Brief description of the care home Woodlands View is a purpose built residential care home for 120 Older People who may have dementia and who require nursing and/or personal care. It was first registered with Hertfordshire County Council Inspection Unit on 25th November 1994. The provider is BUPA Care Homes Limited. The home is situated on the eastern outskirts of Stevenage, enjoying the benefits of a rural and suburban location. It is opposite a large superstore, which can easily be accessed by wheelchair users. Woodlands View comprises an administration unit, which also houses the main kitchen and laundry and four single storey units (called houses). Each house can accommodate up to thirty service users. Newton House is a 30-bed unit for service users requiring residential care, six of whom may have physical disability. Wellfield House is a Dementia and Nursing Unit. Lucas House is a Nursing unit. Astonbury House is a 30 bed Nursing Unit, six of which are palliative beds. Each house has a large day area that is subdivided into a lounge, dining area and smoking section and a well equipped kitchenette. Two houses now have small television room separated off from the main lounge. A small quiet lounge is provided separate from the main day area adjacent to the entrance to each house. All assisted bathroom and toilet facilities are nearby. Care Homes for Older People Page 5 of 29 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 quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. The information in this report is based on an unannounced visit to the home by two regulation inspectors carrying out the work of the Commission. For the purposes of this report the Commission will be referred to as we. The manager was on duty during the inspection and we spoke with staff members, residents, visitors and a visiting Health professional. We inspected all areas of the home and examined a selection of records. Care Homes for Older People Page 6 of 29 The manager has recently completed and returned to the Commission an annual selfassessment quality review, the Annual Quality Assurance Assessment. Information from this document was used during the inspection and has been incorporated into this report. Current fees for the home range from 420 Pounds to 899 Pounds per week according to specific needs. The homes Statement of Purpose, Service Users Guide and latest CSCI inspection report are displayed in the entrance hall and available on request. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 29 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 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. Standards 1, 3 and 4. People who use the service receive detailed information and have their needs fully assessed before entering the home so that all parties can be sure their needs can be met by staff in the home. People who have specialist dementia needs can be sure that staff training and good practice in the home will ensure they receive the best possible care and will have their assessed needs met. Evidence: The homes Statement of Purpose, Service Users Guide and last inspection report are on display in the entrance to the home. We spoke with some visitors during the inspection and they confirmed they were given detailed information about the home and the fees when their relatives considered entering Woodlands View. Care Homes for Older People Page 11 of 29 Evidence: We checked a selection of residents records during the visit and saw evidence that full assessments had been completed by senior staff at the home before the individual moved in. The home provides dedicated accommodation for people who have a dementia and both the homes manager and deputy manager have completed nurse training in dementia care. We spoke with care staff who confirmed they have all completed dementia training and that all staff at the home have access to and briefings from a dementia care specialist, employed by BUPA. This well known specialist also gives talks at the home about all areas of dementia care and relatives are invited to these events. The manager also explained that three care workers had completed an intensive three day course in dementia care and were cascading guidance from this training to their colleagues. We spent a large part of the day observing and speaking to residents, staff and visitors on the dementia unit and found that standards of care for the more confused people there were excellent. The staff concerned were demonstrating a real understanding of the needs of the residents and visitors confirmed that the good practices we saw were the norm in this unit. Individual examples of good practice in this specialist area are described throughout this report. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9 and 10. Individual residents records are thorough and up to date and enable care staff to be sure they meet everyones needs in an appropriate way. The standards of care provided in the home are high and people who use the service are protected by procedures followed when staff administer medication. Evidence: We spent time during the visit on all four units of the home. After speaking with residents and visitors we tracked a selection of the care plans linked to the residents concerned. All the records seen were up to date and accurately described the needs of the residents we had noted. The agreed plans of care listed in the records also reflected the care we had seen provided by staff on the units. The plans contained detailed risk assessments covering the individual needs of the residents and all had assessments for the risk of falls and had moving and handling plans. Nutritional needs and risks of skin damadge are assessed when an individual enters the home and are Care Homes for Older People Page 13 of 29 Evidence: continually monitored and recorded. Every new resident has a food and drink diary completed for the first two weeks they are in the home and staff said that this monitoring continues where appropriate. All care plans we looked at had monthly reviews completed. The care staff we spoke with confirmed that they are involved in updating the care plans and said that they find the format clear and the information essential for ensuring they provide appropriate care for all residents. Staff at the home continue to operate a resident of the day system where the linked key worker and other involved staff review and update all aspects of the care planning for an individual resident and a key worker diary is completed. In addition, the resident of the day has the offer of breakfast in bed, has their hair done if they wish, can choose music in the lounge, can choose a special meal and is spoiled by staff. We also noted that end of life requirements had been completed for residents on their records, which, in a nursing home, is important for ensuring that personal choices are met. We looked at the records detailing the teatment and progress of people needing pressure area care and these records contained full details and photographs of wounds where appropriate. We tracked some residents who were listed as needing pressure relieving care and in all cases appropriate aids and equipment had been provided. The staff we spoke with demonstrated an awareness of the need to reduce the risk of skin breakdown and it is commendable that, despite significant numbers of residents needing the use of hoists and wheel chairs for all transfers, we saw no one sitting in wheel chairs during the visit, and no one eating their meal while in a wheel chair at the tables in the dining room at dinner time. Care staff told us that their training included them trying to eat a meal at a table while sitting in a wheel chair, and they realised how uncomfortable this was. The visitors we spoke with also confimed that people in the home were never left sitting in wheel chairs during the day. Care staff also told us that at night, residents were checked every 20 or 30 minutes, depending on their agreed plan. Staff also said that, where appropriate, residents were turned at night at agreed intervals. Details of this night care are not recorded at the time, but are documented in the care report updates when completed at a later time. Visitors said that their relatives were really well cared for and always had clean nails and teeth, although they said that care staff respected individual wishes about personal care and support. Those residents we spoke with who were able to say, told us that call alarms were always responded to promptly, both at night and in the day and confirmed that care staff made frequent checks at night. Staff at the home use guidelines from The Liverpool Care Pathway training report when dealing with people needing palliative care and told us that they had good relations with local Health professionals, ensuring residents received the best possible care. We spoke with one visiting Community Nurse who told us that the nursing care provided at the home was very good and that they felt the staff were very Care Homes for Older People Page 14 of 29 Evidence: knowledgeable and made appropriate referrals to Health professionals. Care staff also said they work with Macmillan nurses and District nurses where appropriate to ensure every resident has all their nursing needs met. We checked the systems for storing and administering medication in the home. Only qualified nurses give medication on nursing houses. On Newton House medication is administered by care staff once they have been trained in this procedure. We saw written evidence that all nurses have their competency to administer drugs checked by senior staff at least annually. Medication was being stored securely, and at appropriate temperatures. We observed two medication rounds and checked the records used. The system we saw was thorough and no errors were found in the amounts of medication checked against the records. The nursing staff we spoke with said that everyone entering the home has their medication reviewed by a G.P. and that everyone has a review at least annually. One nurse said that currently no sedatives were prescribed for the people on her unit and that the staff at the home preferred to manage individual behaviour with special plans rather than use sedatives to calm people. Each unit of the home is visited by a local pharmacist and written reports were available for inspection detailing these visits. The manager also provided copies of the new audit tool introduced by BUPA. This tool helps to ensure that all aspects of medication administration in the home is checked and seen to be sound. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 14 and 15. Residents in the home are provided with a wide range of activities which ensure they receive appropriate stimulation and continue to feel part of the community. People who use the service enjoy the meals provided which are varied and well balanced and help to promote individual good health. Evidence: The home has three activity co-ordinators who each link to one unit or house. Care staff on the dementia unit told us that practice has shown that regular care workers are the best people to provided activities on this unit, as they know the residents and their likes and dislikes best. We observed the interaction between care staff and residents on this unit and there were clearly enough staff on duty to provide one-to -one interaction with individuals and to ensure that everyone was engaged in the event they preferred or were able to remain quiet if they wanted. We saw no-one ignored at any time and the visitors we spoke with, some of whom called daily, said this was always the case. The residents and visitors we spoke with on the other units said there are always interesting activites going on and we saw weekly plans on the Care Homes for Older People Page 16 of 29 Evidence: notice boards. There are photographs displayed of a recent trip to the coast which relatives also took part in and details are given of regular services held at the home, covering several different religious faiths. Residents told us that they have regular manicure sessions, tea parties, visits from the Pat a dog charity, craft sessions and visits from local schools. We saw plans for a Harvest Festival event and for a party to celebrate a 70th wedding anniversary. One of the activity co-ordinators told us that information documented in care plans describing individul likes and dislikes, together with everyones completed Map of Life, is used to plan activities which reflect the interests of the residents. We spoke with one resident on the dementia unit who was busy knitting and who said that staff support them to follow this pursuit. Another resident whose care plan described a love of shopping, was taken to Sainsburys by a care worker, during the inspection. We noted that the layout of communal areas in the home means that residents do not all have to sit around the edges of the rooms. The units have a variety of seating areas and visitors told us that people are not always in the same place but sit in different places and spend their time in a variety of ways. We also noted that the television was only on in designated areas and some visitors also said it was really good that the television was not switched on at all times, even when no one was watching it . One family member said that their relative was always well dressed and that the colours of clothing were always co-ordinated and that most of the men wore ties. They also said that care staff asked them at Christmas if there were any special clothes their relative would like to wear for the Christmas celebrations although they confirmed that it was always the resident who had the final say with these choices. The manager said that most residents had families who handled their finances. One resident we spoke with said they looked after their own money and that staff supported them to do this. The manager also said that she has contacted the Local Authority for help with introducing advocates to those people in the home who might want this support. We saw the mid-day meal served on each unit and the food was well presented, hot and looked very nutritious. Tables were attractively laid and menus were displayed on the notice board and on each table so that all residents could be clear about the food for the day. There are four meals listed for each day and care staff said that, although all residents choose their food before the meal is served, the chef will prepare any alternative meal on the day, if this is requested. The home uses BUPAs Menu Master and Night Bite meal plans to ensure that food is well balanced and varied and that drinks and snacks are available at all times. This ensures that anyone not wanting to eat at the main meal times is still able to eat when they want and have a healthy diet. This system is especially relevant to the dementia unit where residents sometimes cannot cope with formal meals. The staff on the dementia unit said that, in addition, if Care Homes for Older People Page 17 of 29 Evidence: they saw any resident sitting at the dining room table, they were offered food and drink, even if it was not a meal time. Care staff also told us that they meet briefly after each meal to assess if any of the residents need additional food and to report when food and drink monitoring needs to take place. One visitor we spoke with said that it was also nice that tea and coffee was offered to all residents after the meals as well as the water and juice available on the tables. We saw care staff assisting some residents with eating their meals, both in the dining room and in bedrooms. This assistance was given appropriately and without anyone being rushed. All the staff we saw and spoke with on the day were clearly aware of the importance of nutrition to the wellbeing of the residents and the systems in operation ensure that no-one has their dietary needs missed. All staff at the home undertake food hygiene training and we saw certificates for this training on the staff files we checked. We visited the kitchen briefly and this area was clean and had records of all appropriate food and equipment checks in place. The home has achieved an excellent 5 Stars from the local Environmental Health Authority after a recent inspection visit was made to assess food standards at the home. Care Homes for Older People Page 18 of 29 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. Standards 16 and 18. The procedures followed in the home ensure that people who use the service are protected from abuse and have any concerns listened to and acted on. Evidence: The manager has recently completed Safeguarding training with the Local Authority and demonstrated a clear knowledge of these procedures during the inspection. A recent incident had been reported to the Commission and had been approproately dealt with by the manager. We saw evidence that the induction training provided for all new staff includes an overview of Adult Safeguarding procedures. The home has written policies covering Safeguarding, Complaints and Whistle Blowing and the staff we spoke with were clear about these policies and their implications. The homes complaints policy is displayed in the entrance hall and the residents and visitors we spoke with said they would not hesitate to voice a concern if they had one. Care Homes for Older People Page 19 of 29 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. Standards 19 and 26. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable environment for people who use the service and procedures followed by staff in the home help to protect residents from the risk of infection. Evidence: We visited all areas of the home briefly and several residents showed us their bedrooms and confirmed they had brought their own fittings into the rooms to personalise them. All areas of the home were clean and well maintained. Most bedroom doors are either numbered or have pictures on them. On the dementia unit the pictures are relevant to the individual concerned and enable the people to find their own rooms. The manager told us that a full refurbishment programme is planned for early 2009. This will include new flooring throughout and new blinds for conservatories. In particular, flooring in the dementia unit will be replaced with wood effect laminate to allow cleanliness to be maintained in the dining area. Bathrooms are being refurbished and one will become a wet room. The home has a sensory garden, with raised flower beds to enable residents to assist with planting. The gardens at the Care Homes for Older People Page 20 of 29 Evidence: home are secure so that all residents can go out independently without risk. During the visit we noted that there was no hot water available in some bedrooms and bathrooms. Some residents also said that this was often the case and that sometimes staff had to transport hot water in flasks. This is an unacceptable situation, especially for a home providing nursing care. However, since the visit, the manager has confirmed that BUPA has commissioned engineers to repair or replace the hot water system and the manager will confirm when this work has been completed. A fridge in the kitchen also appeared to be leaking and the manager will investigate if the appliance needs repair. The visitors we spoke with said that their relatives always received their own clothes back from the laundry and that clothing was kept in good condition. All bathrooms and toilets contained liquid soap and soft paper towels and liquid hand gell is provided at the entrance to each house, as required or advised in guidelines for good infection control. Care Homes for Older People Page 21 of 29 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. Standards 27, 28, 29 and 30. People who use the service are supported by a well trained staff team which ensures their needs are met in a professional way. Procedures followed for staff recruitment are thorough and ensure that residents are protected from the risk of abuse. Evidence: We have already noted that there appeared to be enough staff on the demetia unit to ensure individual needs could be met. Comments from residents on the other units also indicate that staffing levels are adequate and the Community nurse spoken with felt that staffing levels for nursing care were good. The manager said that agency staff are not used at the home and that where additional staff are required, they are provided from the homes bank of staff or by existing staff doing extra shifts. This procedure ensures that there is continuity of staff providing care for the residents. The visitors we spoke with said that care staff were very good and well trained and always ask residents if there is anything else they can do for them. Each resident has a named key worker and they update care plans and share information with senior staff so that individual current needs can be met. Care staff said that everyone is written about, in their care plan, at least twice in every 24 hours. Care Homes for Older People Page 22 of 29 Evidence: We spoke with a variety of staff during the visit and they all confirmed they received high levels of training which includes Safeguarding and all other topics considered as basic for care staff. We checked some staff records and copies of training records were in place on the files. We saw staff first aid certificates displated on notice boards around the home. Staff also take part in the BUPA Personal Best training initiative. The Personal Best is an initiative which aims to make staff aware to actively listen and consider through the customers eyes to ensure that residents individual desires, as well as their care needs, are met. Specialist training is also provided for staff and the manager said that four nurses had recently completed Tissue Viability training and were now cascading this training to their colleagues. This training will ensure that current guidelines for preventing skin breakdown will be implemented for the benefit of residents in the home. The manager said that all care staff are encouraged to undertake NVQ training and that currently over 50 have achieved NVQ 2 and that all but three of the remaining care staff have started this training. We examined a selection of staff recruitment files and all had evidence that all appropriate checks were in place before the candidate started work at the home. Full employment histories had also been completed by all applicants and we saw evidence of ongoing supervision and staff appraisals. The staff we spoke with confirmed that the recruitment process had been thorough and this provides protection for people who use the service and helps maintain a professional work force. Care Homes for Older People Page 23 of 29 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. Standards 31, 33, 35 and 38. People who use the service can be confident that the home is very well run and that their views will influence how it is managed. Procedures followed by staff in the home ensure that residents have their finances protected and have their health and safety promoted. Evidence: When we arrived at the home the manager had just been working on the floor of the home, where a member of staff was off sick until another member of staff arrived. The manager is clearly aware and involved in all aspects of practice in the home and the staff we spoke with said they appreciated this involvement and knew the manager understood their working roles. In all the areas we discussed during the visit, the manager demonstrated a working knowledge of all current legislation and good practice guidelines. The manager is registered with the Commission, is a qualified Care Homes for Older People Page 24 of 29 Evidence: nurse and has almost completed the Registered Managers award. As already noted the manager has also been on recent training courses and attends management meetings with the BUPA company. We saw evidence of the monthly monitoring, which the manager undertakes. This includes looking at possible trends in accidents, complaints and the incidence of pressure sores. Reports are then sent to the company Head Office and any recommendations would be incorporated in the next business plan for the home. The manager also completes a three-monthly news letter about the home and events and changes and this goes to residents and staff. We spoke with the House Manager on each unit and they described an efficient management structure, where each house has a junior nursing sister or a deputy care manager. They said that all managers in the home are fully trained and can deputise for the manager if necessary. They also said that the lines of communication in the home were excellent, and kept all staff involved in the day to day running. The home has a written policy on Quality Assurance and surveys are sent at regular intervals to residents, families and other stakeholders. These surveys are sent out twice each year by a company, independent of BUPA, so that results are totally impartial. The manager said that comments from these surveys are used, together with outcomes from residents and staff meetings, to influence how the home is run. Staff told us that the home holds meetings for relatives and visitors, although these are often not well attended. We also saw evidence that company auditing visits are made to the home at regular intevals and reports from these visits were available for inspection. Some residents have small amounts of money handled by staff at the home. We checked the system for this procedure. Monies are held in a bank account with separate records held for individual residents. The monthly interest from this account is calculated by the company Head Office who allocates the correct amonts to the individual resident. Cheques are cashed when a resident wants an amount of money to spend, otherwise invoices, for hairdressing for example, are used to deduct the payment from the bank account. The homes administrator keeps a small cash float which residents can use to obtain immediate cash. In all cases receipts are provided in triplicate. We spot checked some of the equipment during the visit and in all cases saw evidence that hoists and fire fighting equipment had been regularly serviced. We examined fire records and these showed that appropriate tests and precautions are made. During the visit the fire alarm sounded, unexpectedly, and it was commendable that the procedures we saw followed were swift and thorough with all parties clearly aware of what to do in such circumstances. The home has a Health and Safety Committee and Care Homes for Older People Page 25 of 29 Evidence: this group meet every three months to ensure that all areas of the home run safely. We saw staff assisting residents to transfer in all areas of the home during the visit. A variety of equipment and aids were used and in all cases the practice was completed safely and appropriately. Care Homes for Older People Page 26 of 29 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 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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