Inspection on 17/07/07 for Balmoral Court

This inspection was carried out on 17th July 2007.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Balmoral Court 02/05/07

Balmoral Court 23/05/06

Balmoral Court 04/10/05

Balmoral Court 07/06/05

Balmoral Court 13/03/05

Balmoral Court 10/09/04

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Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Balmoral Court Ayton Street Byker Newcastle Upon Tyne Tyne & Wear NE6 2DB Lead Inspector Aileen Beatty Key Unannounced Inspection 17th June 2008 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 Balmoral Court DS0000000493.V368027.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. Balmoral Court DS0000000493.V368027.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Balmoral Court Address Ayton Street Byker Newcastle Upon Tyne Tyne & Wear NE6 2DB 0191 265 2666 0191 265 2777 balmoral@ladhar.co.uk 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) Mr Baldev Singh Ladhar James Alvin Cranmer Care Home 62 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (62) of places Balmoral Court DS0000000493.V368027.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Date of last inspection 2nd May 2007 Brief Description of the Service: Balmoral Court is a purpose built home providing nursing and social care to people suffering from Dementia. It is a large home providing 62 beds. The home is in Byker close to local shops and other public amenities. There are good transport links. The home is within easy reach of the busy Shields and Chillingham Roads. The home adjoins Kensington, a general nursing care home owned by the same proprietor. Both homes share joint laundering and catering facilities. The fees range from £376 - £496 per week depending on whether social or nursing care is provided. Information brochures are available and the last inspection report is always available. Balmoral Court DS0000000493.V368027.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Before the visit: We looked at: • Information we have received since the last visit on 4th December 2006. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on two days, 22nd January and 29th January 2008. During the visit we: • Talked with people who use the service, relatives, staff, the manager & visitors. • Looked at information about the people who use the service & how well their needs are met, • Looked at other records which must be kept, • Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, • Looked around the building/parts of the building to make sure it was clean, safe & comfortable. We told the Operations Manager what we found. What the service does well: Most areas of the home are clean and tidy and well maintained. Comprehensive assessments are carried out before and after admission to ensure that people’s needs can be planned for and properly met. There is a good complaints procedure in place. This makes it easy for relatives and representatives to know whom to contact if they have concerns. Balmoral Court DS0000000493.V368027.R01.S.doc Version 5.2 Page 6 Care records are well organised making them easy for staff to record information in and retrieve information from. Bedrooms are nicely personalised and homely in appearance. There are some nice decorative features, adding interest to otherwise plain and identical corridors. What has improved since the last inspection? What they could do better: Daily records continue to be out of date at times. This means the most current information is not always available. Training information is not easily located for inspection purposes. The written responses to complaints investigations are not all available for inspection. Some toilet areas are very bare and clinical, which means they are not very homely. The standard of meals is not satisfactory, prompting numerous complaints, meaning residents do not always enjoy meals. The choice of meals for vegetarian residents is inadequate. Balmoral Court DS0000000493.V368027.R01.S.doc Version 5.2 Page 7 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. Balmoral Court DS0000000493.V368027.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 Balmoral Court DS0000000493.V368027.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): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a comprehensive assessment undertaken by the staff prior to admission, which forms the basis for the development of the care plan. The home does not offer intermediate care. EVIDENCE: The standard of brochure information available to prospective residents is good. All residents have access to a copy of the statement of purpose and service user guide for the home. Pre admission procedures remain the same and are comprehensive and detailed. The care files for three residents were read. Pre admission information and initial care plans were found to be in place in all three. Balmoral Court DS0000000493.V368027.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): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users needs are generally set out in individual plans of care, meaning health needs are usually met. Residents are treated with respect and their dignity maintained. EVIDENCE: All residents in Balmoral Court have an individual plan of care. The care plans for three residents were read during the inspection. the format of care files is good, with information being easy to find and well organised. Residents and relatives are invited to read care plans, and sign that they have seen and agreed with them. Where residents are unable to sign, this has been recorded. Some daily records and evaluations were out of date, and this might have been due to the deputy having to take charge of the home at short notice. Balmoral Court DS0000000493.V368027.R01.S.doc Version 5.2 Page 11 Most care plan interventions are detailed and contain personally relevant information. It was noted that some care plans are standardised, and just have the name of the resident added which means it is not very person centred or individualised. Moving and handling care plans are generally good, with one example stating “The assistance offered is by no means always necessary, and staff must allow (resident) the opportunity to mobilise independently while making it clear help is available if needed” This is an example of good practice as it gives staff a very clear instruction about what is required while acknowledging a judgement must be made on their part. Behaviour care plans are also very good, with detailed analysis of potential triggers to challenging behaviour, and how staff might prevent occurrence or deal with it if it does happen. The health needs of residents appear to be met. Residents appear well cared for and staff were attentive and friendly. One resident was noticed to have very dirty teeth, his care plan records how he refuses to allow anyone to help him to care for his teeth, and interventions tried by staff to improve his oral hygiene. This demonstrates staff are aware of issues and try to resolve them. There was a comment from a relative that sometimes night staff forget to take teeth out. The health of residents is carefully monitored. Regular assessments of their physical state such as nutrition, pressure ulcer risk and weight are carried out. All residents under 50kg are automatically placed on more stringent observation. There are currently 2 residents in the home at this weight, and this has been reported to the manager and care plans put in place. Residents in the home are treated with respect, and their dignity is generally well maintained. There was a very strong odour problem on the top floor of the home, and it was recognised that this very strong urine smell was not only offensive, but compromised the dignity of people living there. The corridor and communal carpets on this floor have therefore been replaced as a matter of urgency. Net curtains provide additional privacy in overlooked bedrooms. Balmoral Court DS0000000493.V368027.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): 12,13,14,15 Quality in this outcome area is adequate . This judgement has been made using available evidence including a visit to this service. Residents are usually well supported to maintain social contacts and be involved in activities in the home. EVIDENCE: The activity coordinator was leaving on the day of the inspection, so there are plans in place to recruit a new one. Care records show that personal interests have been taken into account to use when planning activities. One care file contains pictures of the resident’s favourite places to visit. A record is kept where possible of their “favourite things such as film star, pet etc. Notice boards display what events are happening and there are newsletters around the home. The notice board also records who has a birthday that month and links it to famous birthdays in the same month. Visitors are encouraged to visit the home at any reasonable time, and there were a number of visitors at the home during the inspection. Most are happy Balmoral Court DS0000000493.V368027.R01.S.doc Version 5.2 Page 13 with the care provided, with the exception of the food. Visitors are able to visit in private. There were a number of complaints about the standard of the food provided. A new chef has been appointed, and some changes have been made to the menu. Complaints are about the standard of the meals provided, the quantity and also the lack of choice on some days. On one occasion, it was reported that the meal was so unappetising that the manager sent for fish and chips for residents. The Operations Manager is aware of this and is monitoring the situation closely, including eating meals when she is in the home. On the first day of the inspection the meal was fish and chips and looked appetising and well presented. The dining room was very quiet and peaceful during the meal, and residents were offered discreet assistance. Tables were fully set, and there were choices of tea coffee juice and milk shakes to drink. The kitchen was inspected and found to be clean and tidy. The chef has experience of fortifying meals, and has a list if the profile of residents needs on each floor for use in his absence. The chef said that “Splenda” is used instead of sugar so that resident with diabetes may enjoy the same meals. There was, however, a comment received on a survey from a resident in the adjoining home (who share a kitchen) that she is diabetic and often sees nice things “that are forbidden to me” so perhaps better choices for people with diabetes are required. The foods available for residents who are vegetarian is poor. In addition to salad the choices were mainly frozen 3663 Smart choice foods such as frozen vegetable burgers, sausage, kievs and omelettes although fresh omelettes are also available. Balmoral Court DS0000000493.V368027.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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are generally well protected by the complaints and adult protection procedures in the home. EVIDENCE: A detailed list of complaints is available, and in many cases follow up information is also available. A response is usually initially in writing, with an estimated time for completion of the investigation into the complaint given. Where this might take longer, another letter is sent indicating this. The outcome of some complaints is not available in the home, although they appear to have been addressed. The complaints procedure is clearly displayed and easy to follow. There have been some adult protection issues in the home since the last inspection which have been reported appropriately and dealt with by the home and relevant external professionals. Staff have received training in safeguarding adults issues and procedures. Balmoral Court DS0000000493.V368027.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most areas of the home are clean and well maintained. EVIDENCE: A number of areas in the home have been redecorated since the last inspection, and the layout and use of some communal rooms has changed which has improved the environment making it more homely. Bedrooms are nicely personalised and lounges are very homely and tastefully decorated. There has been an attempt to introduce environmental changes that will help to provide more interesting spaces for people with dementia to explore, and also provide visual clues as to their whereabouts. Balmoral Court DS0000000493.V368027.R01.S.doc Version 5.2 Page 16 In many ways, this has been effective. Corridors no longer all look the same and there has been an increase in the use of signage to show residents where the toilet is. This could be further improved, as there is still no indication of where the nearest toilet is in some corridors for example. This has been shown to reduce incidences of incontinence. Bedroom doors also need improved signage or clues as to who the room belongs to, as there is often just a number, and no name which is very confusing for people with dementia. The top floor has been decorated with murals, in an attempt to add interest and contrast between areas. These include meadows and snowy mountain scenes, which are quite pleasant, but unfortunately make the upstairs (which lacks natural light anyway) very dark. Park style benches are placed at intervals along the corridor, which seem popular with residents but are hard to sit on and need cushions. One resident was asked, “what do you think of the mountains?” and he replied, “very nice, I like them”. There was also a very bad odour problem, which developed on this floor, and the carpets are now being replaced to remove the strong urine smell. In addition to this, strategies to prevent re occurrence are being carefully considered. The home is generally very clean and tidy. All remote kitchen areas are very clean and communal lounges bedrooms and dining areas were all clean on both days of the inspection. There have been complaints about the standard of cleanliness, both in writing and to the inspector during the visit. It was suggested that the standard of cleanliness depends who is on duty, as it fluctuates. The Operations Manager regularly monitors the standard of cleanliness in the home, as part of her monthly visiting and reporting. En suite bathrooms are clean and tidy but a little bare and would benefit from pictures to personalise some of them. Balmoral Court DS0000000493.V368027.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are usually sufficient staff on duty and staff are recruited safely. EVIDENCE: On the first day of the inspection, there was a staff shortage due to sickness. Upon arrival upstairs, the inspector spent some time walking around before any staff appeared, and then there was only one person on the floor for a short time. The night nurse had stayed later in the morning to help with medication administration, and another member of staff was due to arrive at 2pm. There appeared therefore to be a plan to manage the shortage at short notice, but there was a clear lack of staff especially on the top floor. Recruitment procedures are good. Two staff files were checked and found to contain all of the required information including criminal record checks and references. On the first day of the inspection, the deputy manager was unable to locate the training file and information about training completed. There was evidence in staff files that training has been carried out in food hygiene, infection control, health and safety, nutrition, dementia awareness, conflict resolution, safeguarding adults and fire awareness. The Operations manager confirmed Balmoral Court DS0000000493.V368027.R01.S.doc Version 5.2 Page 18 that fire safety training has been carried out by day and night staff, with night staff receiving it at the required three monthly intervals. Balmoral Court DS0000000493.V368027.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is currently no registered manager in post. The rights and interests of service users are safeguarded by the policies and procedures in the home. EVIDENCE: There is currently no registered manager in post. An experienced manager has been appointed from another ladhar home, but has yet to go through the fit person process with CSCI. The home is generally run in the best interests of service users. There are good quality monitoring procedures and there are regular audits carried out by the senior managers. Balmoral Court DS0000000493.V368027.R01.S.doc Version 5.2 Page 20 The financial procedures have not changed since the last inspection. A random check was carried out on the balance of residents’ accounts and found to be correct. A written record of all transactions is maintained, and money is stored in the safe. Regular audits are carried out. Regular safety checks are carried out by maintenance staff and outside contractors. Hoists are checked twice a year and the lift is also serviced regularly. Regular maintenance checks are carried out, including fire alarms, emergency lighting, bed rails, boiler, fire blankets and window restrictors. There were no safety concerns identified during the inspection. Balmoral Court DS0000000493.V368027.R01.S.doc Version 5.2 Page 21 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X 3 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Balmoral Court DS0000000493.V368027.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES 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. 2. Standard OP7 OP8 Regulation 15 (2) 18 (1) (c) Requirement Daily care records must be kept up to date. OUTSTANDING Training records must be centrally held and updated regularly to ensure they are current and accurate. The standard of meals must be improved. Vegetarian options must be varied and fresh. Full complaint details must be held including action taken and outcome of complaint. Adequate signage in corridors and bedroom doors must be provided to enable residents to find their way around the home. Cushions must be provided and secured to benches for the comfort of residents. 6. 7. OP26 OP27 16 (k) 18 (1) (a) Confirm all areas of the home are odour free. Sufficient staff must be on duty DS0000000493.V368027.R01.S.doc Timescale for action 02/09/08 02/09/08 3. OP15 12 (3) 02/08/08 4. 5. OP16 OP19 22 (4) 23 (1) (a) 02/08/08 02/09/08 02/09/08 02/08/08 Page 23 Balmoral Court Version 5.2 8. OP30 18 (c) at all times to ensure the safety of residents is maintained at all times. NVQ level 2 and above must be achieved by 50 of staff. OUTSTANDING 02/12/08 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. 2. Refer to Standard OP19 OP19 Good Practice Recommendations Consider painting toilet walls to make grab rails stand out. En suite bathrooms could be personalised and made more homely. Balmoral Court DS0000000493.V368027.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 © 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 Balmoral Court DS0000000493.V368027.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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