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Inspection on 26/05/10 for De Baliol Nursing and Residential Care Home

Also see our care home review for De Baliol Nursing and Residential Care Home for more information

This is the latest available inspection report for this service, carried out on 26th May 2010.

CQC found this care home to be providing an Excellent service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home was generally clean and tidy. There were no mal odours evident. Residents and relatives said that the home was always kept clean. We spoke to three relatives who said that they were happy with the standard of care provided. They said that staff kept them informed of changes to the health of residents. They said that residents always looked clean and well cared for. Relatives told us that staff were kind and patient with residents. We checked the arrangements in place to ensure that residents receive good nutrition and sufficient fluids. There was very good information available in the kitchen about individual`s specific dietary needs. The chef had a copy of the nutritional care plans for people at risk of poor nutrition. He had a list of special diets and a white board indicating those residents who were losing or gaining weight. Staff were very knowledgeable about the nutritional needs of people. They were able to identify who required help to eat and who needed to have their food and fluid intake recorded. Records of food and fluid were properly filled in, this enabled staff to see at a glance if residents were eating or drinking enough. We ate the food at the home. It was roast chicken with potatoes, sprouts andmashed turnip followed by ginger sponge pudding and custard. The alternative was vegetable quiche. The food was very well cooked, hot enough and tasty. We noted that residents were offered good sized portions and staff helped people to eat where needed. Those people who were identified as at risk of tissue damage due to pressure were nursed on appropriate pressure relieving mattresses and cushions. There were care plans in place for staff to follow to ensure that people`s risk of getting pressure sores was reduced. One resident who had been nursed in bed for a long period of time did not have any pressure sores, this is an indication of good nursing care. We case tracked three people. This means that we identified three people and discussed their care needs with staff. We then matched our observations to what was written in the care plan. All three care plans did reflect the current needs of the residents. Care plans had been regularly evaluated and contained some good information about the health needs of people. The plans were very person centred and contained detailed individual information. Records relating to wound care and health care were particularly good. Where residents became ill, such as with a chest infection, a care plan was immediately put into place. We have made a recommendation about care planning because some of the information was not recorded in the correct sections, however on the whole they were very good. We examined the arrangements made for the storage, administration and disposal of medication. Medication was properly stored in a secure room. All administration records were fully completed. The auditing of medication was very good. All tablets are counted by the nurses every day and the manager completes a weekly audit and a daily check. The service has received very few complaints. Resident spoken to said they would complain to the manager if they needed but none of them had any current complaints. There is a complaints record. This showed that previous complaints were taken seriously and properly investigated. Staff have received recent training in the recognition and management of abuse. The manager is clear regarding her responsibilities for reporting this and there was evidence that she has done so in the past. There were sufficient numbers of staff on duty to care for residents. Staff confirmed that these numbers are maintained every day. Any shortfalls in staff levels due to sickness or holidays are generally covered by other staff, bank staff or as a last resort agency staff. Records showed that staff were up-to-date with mandatory training and had received some training in relevant subjects such as care of people with dementia. 78% of the staff are trained to NVQ level II or above. There are senior care staff employed at the home. We spoke to the senior care on duty who gave us an outline of her duties, which included dealing with medication and health professionals for the people receiving personal care in the home. She was very professional and knowledgeable and we observed that she was confident when dealing with a visiting doctor. The manager has a system of auditing which ensures that all areas of the home run smoothly. She has developed a reminder matrix to ensure that care plans are regularly reviewed. There is a similar system in place to ensure that staff receive regular formal supervision. This enables staff to contribute to the development of the service andaddress any training needs they might have. We examined the records of incidents and accidents in the home, including those that must be notified to CQC. All accidents, incidents and deaths had been appropriately notified. The manager has an overview of accidents and verifies every accident report in the home. The provider`s representative visits the home monthly. They are required under regulation 26 to produce a report of that visit. We examined the reports for the last six months and found that these visits have been taking place regularly. The manager has recently issued quality questionnaires to residents, relatives and health professionals. A relative told us that she had completed one of these questionnaires. We examined all of the questionnaires that had been returned. They were all very positive and contained some good comments about the standard of care and attitude of staff. Two were returned by health professionals and they praised the attitude of the manager, nurses and standard of care.

What the care home could do better:

The kitchen was not clean enough. There were crumbs and pieces of food under the benches. Some of the catering trolleys and preparation benches had stains down them as did the serving hatch. The mechanical ventilation system was dirty and the pull cord used to operate it was also dirty. In the preparation areas some of the pipes are not boxed in and these pipes were dirty. The kitchen also requires some redecoration and refurbishment. The cooker, though working, is old and has become blackened by use. It is therefore very difficult to clean. The wall tiles are cracked or missing and the grout in between them has become discoloured. The floor was in a reasonable state but is starting to crack and split at the seams. The exposed pipework should be boxed in. The walls in some of the storage cupboards and preparation areas were scuffed and require redecoration. The kitchen should be able to be washed from ceiling to floor and therefore all surfaces should be impermeable. Where there are cracked or worn areas there is a greater risk of infection. Generally the standard of the care records was very good, however some of the information that should be written in the actual plan of care was written in the evaluation of care. The most recent record of the providers visit to the home did not contain enough information. The record should identify the people interviewed and the actual records examined. The record`s previous to this one were good, therefore we have made a recommendation rather than a requirement. A recommendation was made in 2008 that the dining chairs and tables are replaced. Although these are kept in a good state of repair they are old. Some of them do not meet the needs of the current resident group because they do not have arms or skids. Skids enable the chairs to slide along the floor easier and therefore staff and residents can adjust their position at the table.

Random inspection report Care homes for older people Name: Address: De Baliol Nursing and Residential Care Home Woodhorn Road Newbiggin By The Sea Northumberland NE64 6HN three star excellent service 14/10/2008 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Janet Thompson Date: 2 6 0 5 2 0 1 0 Information about the care home Name of care home: Address: De Baliol Nursing and Residential Care Home Woodhorn Road Newbiggin By The Sea Northumberland NE64 6HN 01670852017 01670857650 debaliol@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Louise Veronica Spoors Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Cross OPCO Ltd care home 59 Number of places (if applicable): Under 65 Over 65 59 0 old age, not falling within any other category physical disability Conditions of registration: 0 1 The maximum number of service users who can be accommodated is: 59 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users 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 - maximum number of places 59 Physical Disability - Code PD, maximum number of places 1 Date of last inspection 1 4 1 0 2 0 0 8 Care Homes for Older People Page 2 of 11 Brief description of the care home DeBalliol accomondates frail elderly people, some of who require nursing care. Accomodation is over two floors. There is a passenger lift to the first floor and level access throughout the ground floor. Sitting and dining areas are on both floors. The home is situated in the centre of Newbiggin. Local shops and transport facilities are close by. There are attractive, well maintained gardens and sitting areas at the home for residents to use. Fees for the home vary and are available from the manager on request. Further information about the home can be found in the service users guide which is kept in the main entrance foyer. Care Homes for Older People Page 3 of 11 What we found: The quality rating for this service is three stars. This means the people who use this service experience excellent quality outcomes. We made this quality rating at a key inspection of the home in October 2008. The purpose of this inspection was to check that the home was still performing at an excellent level. We have reviewed our practice when making requirements. Some requirements from previous inspection reports may have been deleted or carried forward to this report as recommendations. This will only happen when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Before the visit we looked at information we received since the last visit to the home. This includes how the service dealt with any complaints, changes to how the home is run, the views of people who use the service and the managers views of how well they care for people. This inspection was unannounced and took place on 26 May 2010. During the visit we talked with people who use the service, some staff, some relatives and the manager. We looked at information about people who use the service and other records which must be kept. We checked that staff had the knowledge, skills and training to meet the needs of the people they care for and we looked around the building to make sure it was clean, safe and comfortable. Following the inspection feedback was given to the manager. What the care home does well: The home was generally clean and tidy. There were no mal odours evident. Residents and relatives said that the home was always kept clean. We spoke to three relatives who said that they were happy with the standard of care provided. They said that staff kept them informed of changes to the health of residents. They said that residents always looked clean and well cared for. Relatives told us that staff were kind and patient with residents. We checked the arrangements in place to ensure that residents receive good nutrition and sufficient fluids. There was very good information available in the kitchen about individuals specific dietary needs. The chef had a copy of the nutritional care plans for people at risk of poor nutrition. He had a list of special diets and a white board indicating those residents who were losing or gaining weight. Staff were very knowledgeable about the nutritional needs of people. They were able to identify who required help to eat and who needed to have their food and fluid intake recorded. Records of food and fluid were properly filled in, this enabled staff to see at a glance if residents were eating or drinking enough. We ate the food at the home. It was roast chicken with potatoes, sprouts and Care Homes for Older People Page 4 of 11 mashed turnip followed by ginger sponge pudding and custard. The alternative was vegetable quiche. The food was very well cooked, hot enough and tasty. We noted that residents were offered good sized portions and staff helped people to eat where needed. Those people who were identified as at risk of tissue damage due to pressure were nursed on appropriate pressure relieving mattresses and cushions. There were care plans in place for staff to follow to ensure that peoples risk of getting pressure sores was reduced. One resident who had been nursed in bed for a long period of time did not have any pressure sores, this is an indication of good nursing care. We case tracked three people. This means that we identified three people and discussed their care needs with staff. We then matched our observations to what was written in the care plan. All three care plans did reflect the current needs of the residents. Care plans had been regularly evaluated and contained some good information about the health needs of people. The plans were very person centred and contained detailed individual information. Records relating to wound care and health care were particularly good. Where residents became ill, such as with a chest infection, a care plan was immediately put into place. We have made a recommendation about care planning because some of the information was not recorded in the correct sections, however on the whole they were very good. We examined the arrangements made for the storage, administration and disposal of medication. Medication was properly stored in a secure room. All administration records were fully completed. The auditing of medication was very good. All tablets are counted by the nurses every day and the manager completes a weekly audit and a daily check. The service has received very few complaints. Resident spoken to said they would complain to the manager if they needed but none of them had any current complaints. There is a complaints record. This showed that previous complaints were taken seriously and properly investigated. Staff have received recent training in the recognition and management of abuse. The manager is clear regarding her responsibilities for reporting this and there was evidence that she has done so in the past. There were sufficient numbers of staff on duty to care for residents. Staff confirmed that these numbers are maintained every day. Any shortfalls in staff levels due to sickness or holidays are generally covered by other staff, bank staff or as a last resort agency staff. Records showed that staff were up-to-date with mandatory training and had received some training in relevant subjects such as care of people with dementia. 78 of the staff are trained to NVQ level II or above. There are senior care staff employed at the home. We spoke to the senior care on duty who gave us an outline of her duties, which included dealing with medication and health professionals for the people receiving personal care in the home. She was very professional and knowledgeable and we observed that she was confident when dealing with a visiting doctor. The manager has a system of auditing which ensures that all areas of the home run smoothly. She has developed a reminder matrix to ensure that care plans are regularly reviewed. There is a similar system in place to ensure that staff receive regular formal supervision. This enables staff to contribute to the development of the service and Care Homes for Older People Page 5 of 11 address any training needs they might have. We examined the records of incidents and accidents in the home, including those that must be notified to CQC. All accidents, incidents and deaths had been appropriately notified. The manager has an overview of accidents and verifies every accident report in the home. The providers representative visits the home monthly. They are required under regulation 26 to produce a report of that visit. We examined the reports for the last six months and found that these visits have been taking place regularly. The manager has recently issued quality questionnaires to residents, relatives and health professionals. A relative told us that she had completed one of these questionnaires. We examined all of the questionnaires that had been returned. They were all very positive and contained some good comments about the standard of care and attitude of staff. Two were returned by health professionals and they praised the attitude of the manager, nurses and standard of care. 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 2. Care Homes for Older People Page 6 of 11 Care Homes for Older People Page 7 of 11 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 13 13 The kitchen should be kept clean at all times. The wall tiles in the kitchen should be replaced. The walls, ceiling and floor should be remdered impermeable. All exposed pipes should be boxed in. The mechanical ventilation system should be kept clean. This will ensure that the kitchen is hygienic. 01/10/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 7 22 Ensure that current care needs are recorded in the relevant sections of the care plan. Provide dining chairs that have arms and skids. Renew dining furniture. Page 9 of 11 Care Homes for Older People 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 3 37 Records of regulation 26 visits should be of sufficient detail to demonstrate proper auditing of the home. Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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