Inspection on 23/06/05 for Balcombe Place

This inspection was carried out on 23rd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Balcombe Place 05/07/07

Balcombe Place 11/10/06

Balcombe Place 09/11/05

Balcombe Place 21/09/04

Balcombe Place 11/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Balcombe Place Haywards Heath Road Balcombe West Sussex RH17 6QJ Lead Inspector Helen Tomlinson Unannounced 23 June 2005, 11:00 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Balcombe Place Address Haywards Heath Road, Balcombe, West Sussex, RH17 6QJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01444 811066 Balcombe Care Homes Ltd Mrs Jill De Le Vingne Care Home (CRH) 40 Category(ies) of Old age not falling within any other category registration, with number (OP), (40) of places Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21 September 2004 Brief Description of the Service: Balcombe place is registered to provide accommodation and nursing care for up to forty older people. The property is a large, tastefully adapted country house which stands in twelve acres of its own grounds. It is situated down a private drive south of the village of Balcombe. Residents are accomodated in twenty four single and eight double rooms situated on the three floors of the home. A passenger lift is available to all floors. Communal areas consist of a large entrance hall with seating, a library, music room and dining room. There is outdoor seating in the extensive gardens and patio areas. Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection began at 11am and the inspector left the home at 6.30pm. The inspector spoke to 11 residents, some in their own bedrooms, two visitors and four members of staff. The registered manager was present throughout the inspection. A tour of premises took place, care records were read, interactions with staff and residents observed and other documents examined. What the service does well: What has improved since the last inspection? No recommendations or requirements were made at the last inspection. Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Residents were not accommodated in the home unless an assessment of their needs had been carried out. EVIDENCE: Three residents files were examined. All contained assessments of need which had been carried out prior to the resident living at the home. These varied in the amount of information provided. For one resident assessments from other professionals had also been obtained and the information from these used to draw up a care plan. Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10 Residents had a written plan of the care they required to meet their needs. These were not always up to date and did not make clear how needs should be met. Health assessments were done. These were not always reviewed as frequently as necessary to reflect the current situation. Not all medication administration procedures met with the relevant guidance and legislation. Residents were treated with dignity and respect. Their privacy was protected. Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 10 EVIDENCE: The care plans of three residents were examined. These all contained some information under the same specific headings. The resident’ needs were clearly written. How to meet these needs was not clearly documented and changes written on the care plans made it uncertain what the current care should be. The level of independence of the resident and how this was to be encouraged and maintained was included. A tick list was used as a review of the resident’s care. This would indicate any change in their care needs which should result in a review of that particular care plan. Assessments for various health issues were present. These included the risk of pressure sore development, general observations including weight, nutritional assessments and wound intervention charts. These had not always been reviewed frequently and the pressure sore risk assessment for one resident was dated January 2004 with no review documented. The wound intervention chart for one resident did not correspond with the information written in the daily notes, having a wound noted in a different place on the body. It was discussed with the manager that there was a large amount of information on the resident’s care plans and the various documentation used should be reviewed to ensure consistency throughout the records. All health assessments and resulting care plans must be reviewed on a regular basis, with reviews documented. The care plan for 1 resident who received their nutrition by parental feeding was thorough and contained good information regarding emergency procedures. On two of the resident’s assessments a risk of falls was identified. A specific risk assessment and record of intervention for the prevention of falls was not present. Some of this information was documented on the mobility assessment though this was not specific to falls prevention. One nurse in the home was taking part in a project regarding falls prevention and a tool for the assessment of falls risk was present. The manager said this would be adapted for use in the home. The storage of medication in the home met with current guidance and legislation. Some aspects of medication administration did not meet with the Nursing and Midwifery Council Code of Practice and current legislation. Several medications prescribed and labelled for one resident were being used for others. Although this was the same medication this practice must not take place. Some resident’s chose to hold their own medication and take it themselves. This choice was respected by the nurses in the home. There was no risk assessment carried out for the safety of this procedure for each individual resident. These must be done, documented and reviewed. It was discussed with the manager that although the crushing of medication to administer in a parental feeding tube had been agreed by the G.P. this practice must be reviewed and an alternative used wherever possible. Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 11 The resident’s spoken with said the staff respected their right to make choices in how they lived their lives and their care needs were met. They said whenever they were receiving help from staff they always protected their privacy and dignity. They said bedroom or bathroom doors were kept closed, staff knocked before entering, used their preferred name and were polite and respectful when speaking to them. These good practices were observed during the inspection. Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15. The lifestyle of the home matched the way resident’s had lived prior to admission. The routines were flexible around the wishes and choices of the residents. Residents were assisted and encouraged to maintain contact with relatives, friends and the local community. The food was excellent, beautifully presented and very well served. EVIDENCE: The lifestyle of the home was calm and genteel. The routines were flexible and residents said they could choose when to get up, whether or not to go out, walk in the grounds, spend time in their rooms or communal areas and to have visitors. They said the routine of the home was not fixed, but met with their preferences on any given day. More dependant residents said their choices were accepted even if they needed help to fulfil them. Residents said they could enjoy group activities, such as movement to music or board games, or they spent time in their rooms watching television, listening to the radio or reading. The library had an impressive supply of books for the residents to choose. Some residents spent their time out of doors, walking in the grounds or surrounding countryside. Two residents had Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 13 their own dogs whom they walked in the grounds, with the help of staff if needed. Visitors spoken with said they could visit at any reasonable time, some stayed for meals if they wished and could see their relative in private if they wanted. They spoke highly of the atmosphere in the home and the greeting they received on visiting. All residents spoken with said the food was of a very high standard with descriptions of “superb”, “exemplary” and “wonderful” used. On the day of the inspection residents had a buffet which is a weekly event. There was a choice of starter served to the table and each resident was assisted, individually, to the buffet table and chose from a selection of salads, cold meats, fish or a hot dish. A dessert trolley was taken round to each table with a selection of six cold sweets, one hot sweet or fresh fruit. Assistance was offered discreetly to those residents who needed it. The dining room is a large wood panelled room, with a minstrel’s gallery and large windows with a view to the grounds. The tables were set nicely and the atmosphere was one of a much enjoyed social event. Some residents had their meals served to their rooms if they preferred this. Residents said there was a good choice of food at all meal times and the food was always of a high standard. The chef served the meals himself and talked to the residents about the meals and food in the home. Hot and cold drinks were served throughout the day with home-made cakes and biscuits. Special diets and individual choices were understood and catered for. The dining room was opened for lunch only with other meals being served in the resident’s bedrooms. All residents spoken with about this said they preferred this arrangement and did not want to eat in the dining room at times other than lunch. Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 The procedures followed when an allegation of suspected abuse was made did not follow current guidance to ensure the protection of the residents. EVIDENCE: One allegation of suspected abuse had been made in the care home since the last inspection. This had been investigated and dealt with in line with the disciplinary procedures within the home. At no time had any outside agency been informed of the allegation. This does not follow West Sussex guidance of informing social services of any allegation of abuse made. The written procedures to be followed should an allegation of abuse be made said the person in charge will investigate. It was discussed that this may not be appropriate as other agencies may become involved and lead any investigation. It was discussed with the manager that the procedure should be reviewed and amended to ensure it is in line with the current guidance. All persons who may be in charge of the home must be aware of the correct procedure. Staff spoken with were aware of their responsibilities to protect vulnerable adults. Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 The home and grounds were well maintained, clean and tidy. The fire safety precautions where inadequate to protect residents and staff. EVIDENCE: All areas of the home were tastefully decorated and carpeted with fixtures, fittings and furniture being of a high standard. Despite the imposing nature of the building there was a homely feel to it with communal areas allowing for informal groups to gather. The extensive grounds were tidy. Patios and seating areas were available at various points in the grounds. The fire service had visited the home in November 2003 and 2004. They had required five improvements to be made in 2003 which had not been done at their visit in 2004. A requirement for these improvements was made again with a timescale applied. This timescale had lapsed. At this visit the inspector observed and the manager confirmed that not all these improvements had been made. Additional to this many of the residents were not protected in the event of a fire because their bedroom doors were propped open with wedges Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 16 underneath them. It was discussed with the manager that the improvements required by the fire service must be carried out and no fire doors must be propped open. The fire doors on the corridors were held open with magnetic automatic closures. Staff were aware of the fire procedures and had received fire safety training. Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Adequate numbers of staff with appropriate knowledge and skills were employed to meet the needs of the residents accommodated. The recruitment procedures were not adequate to ensure protection for the vulnerable adults in the home. EVIDENCE: The staff rota for week commencing 20th June 2005 was examined. This showed that staff were on duty in adequate numbers and with a relevant skill mix for the residents accommodated. There were catering and domestic staff in sufficient numbers to ensure the home was clean and the care staff were not working in the kitchen. The turnover of staff in the home is low and the manager said no new care staff had been employed since the introduction of the Protection of Vulnerable Adults register in July 2004. Two staff files were examined. One of these staff members had been recruited locally, for catering work, and the necessary checks had been carried out. The other staff member, a care assistant, had been employed from overseas, through an agency. The system of recruitment for staff from overseas was discussed. The manager has no involvement in this recruitment process which is carried out by the organisation which owns the home. There was no consultation with the manager and no interview by the manager for this member of staff. The references had been carried from the country of origin Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 18 and there was no evidence of verification of these. The manager was reminded of her responsibility to ensure that all persons working in the care home are fit to do so. The process for recruitment must be reviewed and include the registered manager of the home. Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 The home does not assist residents with financial management. EVIDENCE: The manager stated that all residents either manager their own finances or they are managed from someone outside of the home. She said that a relative would be asked to take on this responsibility or a solicitor if no relatives were available. Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x x x 3 x x x Balcombe Place H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 21 NO Are there any outstanding requirements from the last inspection? 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. 1. Standard 7 and 8 Regulation 15(2)(b) Requirement Health assessments and resulting care plans must be kept under review and reflect the current situation. All residents who wish to hold and administer their own medication must do so on a risk assessment basis. The procedures to be followed should an allegation of abuse be made must be in line with current guidance and be a multidisciplinary approach. The requirements of the fire service report dated 17/11/04 must be complied with. Fire doors must not be wedged open. All persons employed to work in the care home must be fit to do so. The necessary checks must be carried out. Timescale for action 30/8/05 2. 9 13(4)(b) 31/7/05 3. 18 13(6) 31/7/05 4. 19 23(4) 31/7/05 5. 29 19 and Schedule 2 30/6/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations H60-H11 S24111 Balcombe Place V224657 230605 Stage 4.doc Version 1.30 Page 22 Balcombe Place 1. 2. 3. 7 9 29 The care plans should include more information about how the residents needs are to be met. All medication administration procedures should be in line with the NMC guidance and current legislation. The registered manager should be involved in the recruitment of staff to work in the home. 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