CARE HOMES FOR OLDER PEOPLE
Balcombe Place Haywards Heath Road Balcombe West Sussex RH17 6QJ Lead Inspector
Mrs S Gawley Unannounced Inspection 05th July 2007 09:30 X10015.doc Version 1.40 Page 1 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 Balcombe Place DS0000024111.V341081.R01.S.doc Version 5.2 Page 2 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 DS0000024111.V341081.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Balcombe Place Address Haywards Heath Road Balcombe West Sussex RH17 6QJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01444 811066 01444 811139 Balcombe Care Homes Ltd Post Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Balcombe Place DS0000024111.V341081.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th October 2006 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 accommodated 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. The fees currently charged are £600-£1200. Balcombe Place DS0000024111.V341081.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This site visit as part of the inspection process took place on the morning and afternoon of 05 07 07. The acting manager facilitated the inspection. The commission was in receipt of an Annual Quality Assurance Assessment (AQAA) and any documents required on the day were made available. Three residents were case tracked, their care plans and Medicine administration charts were inspected and two of these three were spoken to. They expressed satisfaction with all aspects of the home saying that staff were very caring and the food was exceptionally good. Other residents spoken to throughout the day stated that they received the care they need in a respectful manner and that they enjoyed the activities. Three relatives were spoken to on the day and all expressed satisfaction with the home. The stated that the staff were approachable and any concerns were quickly dealt with. A relative of one of the residents case tracked was spoken to and she made positive comments about the home. The atmosphere in the home was very relaxed and sociable. The majority of the residents were sitting in the reception rooms or in the large foyer. This report is compiled using information as described above and also information held on file at the Commission. All of the standards were met today mostly judged as good with some being excellent. Residents in this home experience a very good standard of care from a dedicated staff team. Balcombe Place DS0000024111.V341081.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
Residents’ opinion has been sought on the provision of activities. The activities coordinator has compiled a comprehensive folder on the activities programme and individual choice. This can be accessed by other staff in her absence. The key worker system has been improved. Nurses and the keyworkers meet weekly to discuss the residents. The keyworkers spend quality time each week with their residents to form a relationship, so the resident feels confident with them. Training has given staff have a better understanding of the action they are required to take if they witness or suspect any form of abuse. The domestic team has increased to maintain high standards of cleanliness throughout the home. The home was neat and clean throughout. The process of assessing , ordering and fitting door guards which automatically
Balcombe Place DS0000024111.V341081.R01.S.doc Version 5.2 Page 7 close the door in the event of fire. A supervision schedule now in place and all staff are currently up to date. 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. The summary of this inspection report can be made available in other formats on request. Balcombe Place DS0000024111.V341081.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Balcombe Place DS0000024111.V341081.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply All Residents have an assessment of need carried out prior to admission. People who use this service experience good outcomes, as there is a clear assessment and admission process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans of those residents case tracked had evidence of preadmission assessment. Documentation for a prospective resident to be admitted for respite care was in place but this resident had not been seen at home as he is a long distance away. The family is involved in the admission process and discussions had been held with the carers and health care professionals involved. Prospective residents and their relatives are encouraged to visit and have lunch prior to admission Balcombe Place DS0000024111.V341081.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7-10 Residents have a comprehensive plan of care documented. The resident’s health care needs are met. Medication is safely stored and administered in the home. Resident’s privacy and dignity is respected and protected by the staff People who use this service experience good outcomes because all needs are assessed and met and residents are treated with respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents had a plan of care. Three residents were case tracked. The care plans inspected contained comprehensive information on health, personal and social need. The care plans were drawn up following an assessment of their needs. These included nutritional assessments, nursing need, mobility, sensory, hygiene, cognitive, continence, safety/risk assessment and social and recreational needs. Access to specialist health support is available as required. A resident informed me that someone who comes to the home assesses her hearing
Balcombe Place DS0000024111.V341081.R01.S.doc Version 5.2 Page 11 Registered nurses administer all medication in the home, unless a resident wishes to self medicate and has been assessed as able to do this safely. A locked space is available in resident’s rooms to facilitate this. Medicine administration charts inspected were up to date. Two of the residents case tracked were spoken to and they confirmed that they are treated with respect at all times and that their privacy and dignity are protected. These and other residents spoken to throughout the day confirmed that treatments are carried out in their rooms. All residents have a telephone. Throughout the inspection it was observed that residents are spoken to with respect. Residents spoken to stated that their clothes were looked after with care in the laundry. Balcombe Place DS0000024111.V341081.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): The lifestyle offered in the home meets resident’s needs and preferences. Visitors are welcome and residents enjoy a varied diet People who use this service experience excellent outcomes as activities and events provided satisfy their social, cultural and recreational needs. Nutritional food is offered of a very high quality This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is an excellent activities programme in the home which one of the senior carers coordinates. A profile of all residents’ social history, needs and activities is kept on file. This includes in house activities, outside entertainers and trips out. The in house entertainment includes quizzes, films, bingo, and reading. One resident unable to participate in most activities enjoys having his books read to him. Community involvement is encouraged; the village shop visits to take orders, which it then delivers. Children’s visits are encouraged and the local beaver group came recently. The home also has themed meals
Balcombe Place DS0000024111.V341081.R01.S.doc Version 5.2 Page 13 such as a Wimbledon themed lunch this week and a Chinese evening last month. Outside entertainment includes musicals, plays, pet therapy, pianist, choir and armchair aerobics, which was in progress during the inspection. Trips are organised to places such as the Bluebell railway. A monthly newsletter is produced with the aid of some residents for the residents. The home is also involved in fundraising for local charities and arranges cake sales for that. There is a well-provisioned library and a music room. The carer responsible for activities was spoken to and she had comprehensive documentation to support her work. She is also completing a Activities Provision Course, a component of which is stimulating people with dementia. All residents spoken to stated that were extremely satisfied with the food and that there was always choice. Lunch was served in the very attractive wood panelled dining room, which is tastefully furnished. The atmosphere was quiet and unhurried. Residents were offered any help as required and in a respectful manner. A dessert trolley was brought round after the main course offering several choices. The chef was spoken to. There is a four-week menu in place taking into consideration residents wishes. He attends the residents meeting six monthly to switch from summer to winter menu and he solicits resident’s opinions on this. The kitchen meets the requirements of the Environmental Health Department. Balcombe Place DS0000024111.V341081.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Complaints are appropriately managed. Residents are fully protected from abuse People who use this service experience good outcomes because complaints procedure is followed and suitably trained staff protect residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Complaints are recorded and are investigated within the published timescales. Complaints documentation inspected evidenced this. The acting manager is giving consideration to changing the format of the complaints book from the loose-leaf system in place to a fixed leaf system. Residents and relatives spoken to stated that they could complain or express concern about any matter and it would be dealt with quickly. Two key workers of the residents case tracked were interviewed and they confirmed that they had received adult protection training. Training records were available to support this. One staff member stated that she understands she is the residents advocate and that the protection of the Residents is a key part of her role.
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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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Residents live in a safe and well-maintained environment. The home appears clean and hygienic but the storage of mops may be and infection control risk. People who use this service experience good outcomes, as the home is safe and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is a tastefully adapted large stately home. It is a listed building and has original features intact. All parts of the home inspected were neat, clean and free from offensive odour. All areas are decorated and furnished to a high quality. Some of the hallways and a stair well are currently being decorated. Bedrooms were personalised with resident’s own belongings. Many of the
Balcombe Place DS0000024111.V341081.R01.S.doc Version 5.2 Page 17 rooms enjoy excellent views of the well-maintained grounds and surrounding countryside. The sitting areas, dining and outdoors space are attractive and comfortably and tastefully furnished. Residents confirmed that they are satisfied with the comfort and furnishings in the home. There is one area of the patio, which is uneven and was highlighted for repair in the last inspection. Entry to this area is prevented for residents’ protection. The homes listed status requires the same stone to be used and this has caused a delay. There are adequate bathing, shower and toilet facilities throughout with all of the rooms having ensuite facilities. There are the necessary aids and adaptations available for the residents, in the form of handrails, assisted baths, hoists and adjustable height beds. All sinks have temperature control valves and temperatures are recorded monthly. It was a requirement of the last inspection that doors are not wedged open. Doors were not seen wedged open on this occasion. The AQAA stated that the organisation is now assessing which doors require automatic closure devices. Documentation was seen on inspection confirming the ordering process of door guards which automatically close the door in the event of fire and the acting manager confirmed that the completion of this project would be a high priority. In a sink and sluice areas mops were seen stored in the bucket. It is a recommendation of this report that this practice cease for infection control purposes. Balcombe Place DS0000024111.V341081.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-29 Residents are protected by the homes recruitment policies and procedures and by an induction and training programme. People who use this service experience good outcomes because their needs are met by suitably recruited and trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff rota evidence that suitably qualified and numbers of staff are on duty. Staff training files show ongoing training to meet the needs of residents. Staff spoken to confirmed that they receive mandatory training and that they had also received an induction. Induction records were seen in staff files. Personnel files inspected showed that the home follows a recruitment policy and all documents required were in place. The staff do not commence work without having a Criminal Records Bureau Clearance and POVA check. Staff were observed offering care in a safe and dignified manner. Residents spoken to confirmed that their needs are met by competent staff and in a respectful manner.
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The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Residents and staff benefit from experienced management. The home is run in their best interests. Quality assurance procedures are in place and are being further developed. People who use this service experience good outcomes as the home is well managed and is run in their best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The previous registered manager has left and the Commission is in receipt of an application to register to acting manager who has been in post since March 2007. She is a Registered Nurse and also intends to complete the Registered Manager Award. She completes required training and updates to maintain registration with the Nursing and Midwifery Council. She believes in person
Balcombe Place DS0000024111.V341081.R01.S.doc Version 5.2 Page 21 centred care and has modified the key worker system and has put supervision in place. Staff spoken to confirmed this and there was also documentation to support this. A company quality assurance system is being put in place and as stated that AQAA received by the Commission There is to be staff training in this throughout July. Residents meetings are currently held twice annually. A monthly newsletter is completed with the aid of and for residents. Surveys are sent by the home to residents, relatives and staff. The acting manager is to collate this information and is considering sending surveys to professionals. There is a schedule of staff/dept meetings until the end of 2007. Residents spoken to stated that the staff and management of the home are approachable and responsive to requests. Balcombe Place DS0000024111.V341081.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Balcombe Place DS0000024111.V341081.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP26 Good Practice Recommendations It is a recommendation of this inspection that mops are not stored in buckets to prevent the spread of infection in the home. Balcombe Place DS0000024111.V341081.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 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
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