WHEN Ruth Jones was inspecting care homes, she followed her eyes, ears and nose. She says: "I want to know why something does not smell nice."
She adds: "A lift might be making a dreadful noise.
"I'll look at the level of furnishing, and maybe the curtains are a bit tired."
Ruth, who retired last month, was a care home inspector employed by the Care and Social Inspectorate Wales (CSSIW).
She would turn up unannounced in council and privately-run homes in Neath Port Talbot.
"We have got a right of entry," she says. "Nobody can say, 'Today is not a good day'. I have never ever been turned away."
The CSSIW, an independent body which also acts on behalf of ministers, has been keen to shift its inspection emphasis from checking minimum standards to putting the experience of the residents at its core.
Ruth was usually on her own during an inspection, but might have a social or health worker in tow.
She said she would sit where residents congregated, observe and talk to them, or walk around.
She would judge a resident's mood after a member of staff had spoken to them, note whether they had been treated with respect, and assess whether they were generally stimulated.
"It is a case of acting on what you find," says Ruth, 61, of Alltwen, near Pontardawe. "Mostly I have seen kindness."
Ruth would also look at residents' care plans, their medical care, potential weight loss, and medication administration.
"People's care plans are very important," she says. "Are they given an involvement? Or is a relative, or a social worker or good friend?"
CSSIW inspectors focus on four themes: quality of life, staff, leadership and management, and environment.
Ruth says care workers must provide references and declare where they have worked previously and why they left.
"We also look at training — it must be carried out on a regular basis," she says.
Care home managers must have a particular leadership and management in care qualification and employ enough staff to meet residents' needs. But Ruth says there is not a minimum employee to resident ratio.
"If staff say they don't feel supported, we tell the manager," she adds. "If staff are happy it's going to be a happy home."
So what makes a good care home manager?
"A good listener, but someone who can say, 'We need to do it like this', and give evidence why," she says.
"And also those who try new things out."
On the environment theme Ruth would look to see if residents' rooms were homely, with photos and other personal items.
As well as these so-called baseline inspections, Ruth also undertook focused ones which home in on one particular theme — for example quality of staff if there had been a lot of falls.
At the end of an inspection Ruth would give feedback to the manager and then submit a written report.
"We don't score in Wales, we write what we think," she says.
Ruth's own father is in a care home.
"He can invite us into his room, and he is very much master of all he surveys!" she says.
Ruth has seen more care homes than any of us will.
"It will never be home, but they are the best thing people can have to remain independent," she says.
Tomorrow, health board work and the elderly.
'You can't sit back and say it's all fine'CARE homes are regularly in the news, and rarely make for good reading.
Last week the doors were shut at Amber House in Abergele, North Wales, after managers were severely criticised by Care and Social Services Inspectorate Wales (CSSIW) inspectors for neglect, unsafe practices and poor conditions.
Care homes and homecare companies in Wales are inspected annually. This may prompt follow-up visits, explains CSSIW chief inspector Imelda Richardson, if a series of concerns are raised.
She has been overseeing a shift to focusing on residents' experiences and outcomes rather than checking minimum standards, which might not equate to good care.
Action against a care provider includes non-compliance notices, up to what is deemed a "service of concern". This in turn can lead to civil or criminal proceedings.
"We are not complacent," says Mrs Richardson.
"This is not an area of work where you can sit back and say, 'Everything is fine'. Because you can't."
In Wales there are some 680 care homes, and 400 homecare companies.
The CSSIW is facing a budget squeeze but is, says Mrs Richardson, doing "more with less".
It has set up a national advisory board, comprising care home users and representatives from the sector, to help set the agenda. Three regional boards are in the pipeline, while pilot schemes have involved inspections by charities. The CSSIW cannot be everywhere at once — the more ears and eyes the better. In addition, its inspection reports are published online.
Mrs Richardson says: "There are some very good care homes, and a few that need to improve."
If you have concerns about care, phone the CSSIW on 0300 790126.
Health!['Follow your nose': Ruth Jones lifts the lid on life as a care home inspector 'Follow your nose': Ruth Jones lifts the lid on life as a care home inspector]()