Inspection on 04/10/05 for Balmoral Court

This inspection was carried out on 4th October 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 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 17/07/07

Balmoral Court 02/05/07

Balmoral Court 23/05/06

Balmoral Court 07/06/05

Balmoral Court 13/03/05

Balmoral Court 10/09/04

Similar services:

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Balmoral Court Ayton Street Byker Newcastle Upon Tyne Tyne & Wear NE6 2DB Lead Inspector Aileen Beatty Unannounced Inspection 4th October 2005 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.V249371.R01.S.doc Version 5.0 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.V249371.R01.S.doc Version 5.0 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 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 Care Home 62 Category(ies) of Dementia - over 65 years of age (62) registration, with number of places Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. One resident category OP as per variation application 41598, received 24/12/02 may be accommodated. Should this resident leave the home, the Commission for Social Care Inspection must be notified. Three named persons under the age of 65 in the DE category are accommodated in the home. Should any of these residents leave the home, the Commission for Social Care Inspection must be notified. 07/06/05 2. Date of last inspection Brief Description of the Service: Balmoral Court is a purpose-built home providing nursing and social care to elderly people suffering from Dementia. It is a large home providing 62 beds. The home is set in a traditional community in Byker close to shops, public transport, a library and other public amenities within easy reach of the busy Shields Road and Chillingham Road. The home adjoins Kensington, a general nursing care home owned by the same proprietor. Both homes share joint laundering and catering facilities. Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 04/10/05. It involved a review of records, a tour of the premises and discussions with residents, staff and relatives. It found that there has been a measurable improvement in standards since the last inspection. What the service does well: What has improved since the last inspection? 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. Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 Page 6 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.V249371.R01.S.doc Version 5.0 Page 7 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 the following standard(s): 1,2,3,4 and 5. Intermediate care is not provided. Prospective service users are given information to make informed choice about where to live. Each resident has a written contract / statement of terms and conditions with the home. No service user moves into the home without having their needs assessed. Staff in home generally have the skills to meet the needs of service users. Prospective service users and their families have the opportunity to visit and assess the suitability and quality of the home. EVIDENCE: A service user guide is available to all prospective service users and provides a description of the home and services available. A copy of the most recent inspection report is available. A statement of terms and conditions is provided and a copy given to relatives if necessary. A review of care records found that a pre admission assessment has been carried out prior to admitting new service users to the home. A copy of the Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 Page 8 comprehensive assessment carried out by the care manager is also held on file. Relatives spoken to felt that the home is generally able to meet the needs of service users. The family of one resident, who spent a short time in the home, sent a letter to the inspector. They said they were very happy with the standard of care provided. Some additional training is required to enable staff to care more effectively for residents. This includes training in moving and handling, dementia care, and person centred care in particular. It was confirmed that residents and their representatives may visit the home before admission, including for a short stay. Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9 and 10. Health personal and social care needs of service users are set out in an individual plan of care. Service users health needs are usually met. Medication procedures are satisfactory. Service users are not always treated with respect and their right to privacy upheld. EVIDENCE: There has been a marked improvement in care plans since the last inspection. Managers have been working closely with qualified staff by providing additional guidance regarding the care planning process. Regular monitoring of care plans has lead to a significant improvement. Most care plans examined contained all of the required information including; assessments of nutritional status, social assessments, physical assessments, dependency rating scales, moving and handling assessments, pressure area risk assessment, night time risk assessments and specific risk assessments behaviour rating scales and psychological assessments. A personal profile is completed by relatives, which assists in social care planning. Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 Page 10 In the majority of the records examined, these were up to date although some were slightly out of date. One care plan omitted to mention that the resident has an MRSA positive wound, although the actual care plan itself was much better than at the last inspection. One risk assessment required more detail – this was pointed out to staff present. There is room for some further improvement but the improvements made since June 2005 must be emphasised, and things are clearly progressing in the right direction. Training has been provided to staff since the last inspection, which should help them to meet the health needs of residents, which includes training in wound care. Some additional training in person centred care would be beneficial. This type of training helps staff to put themselves in the shoes of the people they are caring for, enabling them to be more empathetic and sensitive to them. It is strongly recommended that staff receive this training, based on the principles of Dementia Care Mapping for example. Medication procedures have improved immensely since the last inspection. There were no unexplained gaps in medication records and where it is important to take a pulse before giving a particular drug, this has been recorded, which it was not in the past. There are no residents who selfadminister medication. Some clutter was found in the treatment room such as a broken mug, light fittings and window lock. The infection control audit carried out in March advised against unnecessary items being stored in the treatment room. It harbours dust, which harbours bacteria. This room should therefore be strictly kept tidy. Some tubs of cream found in bedrooms were found to belong to one resident, but had been used for other people. This must not happen and care must be taken to ensure that creams are used for the prescribed person only, and that they are in date. Privacy and dignity is usually maintained, in that staff knock on doors before entering and personal care is carried out in private. It was noted that a number of times, staff spoke about residents when they were present, without including them in the conversation, which is inappropriate. It was also noticed that sometimes the routines in the home take precedence. For example, medicines were administered when residents were having lunch, as this was easier for the nurse. It was not, however better for residents who had their lunch interrupted. Care must be taken not to allow routines to dictate patterns of care, which can be a symptom of institutionalisation. As mentioned previously, training in person centred care would help to resolve some of these issues. At the inspection in March, many residents were not wearing tights and socks, were unshaven and had food on their clothes and faces. There was also a lot of faeces around the home which was very undignified. At this inspection, residents were wearing tights and socks, most men had been assisted to shave, and people appeared generally well cared for. The environment is also much more pleasant. Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 12,13,14 and 15. Service users do not always find the lifestyle experiences in the home matches their needs and preferences. Service users maintain contact family, friends and their community as they wish. Service users exercise some control over their lives but this needs to be improved. A reasonably balanced diet is provided but not always in the most pleasant environment. EVIDENCE: The activities co-ordinator post remains vacant. Some activities are available, and the very experienced and skilled activities worker from the adjoining home is available for some time. Staff were observed to interact positively with residents although some more spontaneous interaction would be beneficial. Staff are very busy, and often, the interaction with residents appears to be linked to a task, and as such involved the issuing of directions and instructions. The variety of activities provided by the home needs to be increased. Visitors are encouraged to visit the home. Residents are often seen being taken out by relatives and friends, and contact with the local community is now encouraged. Residents are sometimes encouraged to make choices abut their lives. An area that is frequently a problem is that of choice of meals. At this visit, the cook Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 Page 12 confirmed that meal choices are not always received for all areas of the home. This can mean that some choices run out as they are more popular, which makes it appear as though not enough food has been sent. The cook must advise managers when menu choices have not been received so that action can be taken to find out why. Residents must be given choices at meal times. Diaries used by kitchen staff are being re-vamped as they are not practical to use at present, but all of the required information is being recorded. An environmental health inspection just prior to the inspection found that most areas are satisfactory. The wall in the kitchen is badly marked by benches leaning against them. It is recommended that these are tiled. The kitchen was clean and tidy. The cook has completed basic food hygiene and is doing a more advanced qualification. The inspector joined residents for lunch, which was served at an appropriate temperature, and was tasty. The actual atmosphere in the dining area was not particularly pleasant. Due to the sharing of a trolley to serve meals, there are times when people have to wait for long periods. This is not always easy for someone with limited concentration, and some residents become quite restless. It is again recommended that a second serving trolley is made available. Tables are nicely set with tablecloths but salt and pepper etc. are not readily available. As mentioned above, medication should not be given to people while they are eating. Relatives spoken to confirm that some food has improved, including quiches, and they have been pleased to see more home made items such as, mince pie. There was some concern expressed that while fruit is provided, not all staff actually prepare this and give it to residents, meaning it gets sent back to the kitchen. The remote dining areas were found to be very clean at this inspection, which is an improvement. Fridge temperatures are taken regularly. Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 16 and 18. There are satisfactory complaints procedures in place. Service users are protected from abuse. EVIDENCE: There has been one complaint since the last inspection, which was upheld. It related mainly to the poor standards of care evident at the last two inspections. The overall standard of care has improved since then. There are adult protection procedures in place, including whistle blowing. It is recommended that these be reiterated to all staff. Protection of vulnerable adults (POVA) training has been arranged. Standards have been monitored by adult protection and Newcastle contracts department to ensure improvements are maintained. Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 19, 21, and 26. The environment is generally safe and well maintained. Service users have access to safe and comfortable indoor and outdoor facilities. There are suitable and sufficient lavatories. Service users live in safe and comfortable bedrooms with their own possessions around them. Service users live in safe comfortable surroundings that are usually clean, pleasant and hygienic. EVIDENCE: The environment is generally clean and tidy. A number of areas have been redecorated since the last inspection. It is recommended that where there is a low window in resident’s bedrooms, a net be provided for privacy. The windows in one lounge were found to be damaged and the seal between the doubleglazing is ineffective and has condensation between the panes. These windows must be replaced. The TV cabinet in the first floor lounge is scratched and must be replaced. Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 Page 15 There are sufficient washing and bathing facilities. It is recommended that they are made more homely in style as they are quite bare and clinical. All bedrooms are en- suite. The premises are generally clean and hygienic. The stairs down to the lower ground floor were not clean. The dining room carpets have been replaced removing some of the malodour present at the previous inspection. Dining room chairs were found to be heavily marked with food, and must be cleaned after each meal. Hand washing signs were observed above dining room sinks. These must be removed, as they are not hand washing basins. The laundry is very clean and well organised. Clinical waste was found to be appropriately managed and stored. Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 and 30. Service users are supported by the home’s recruitment policy and practices. Some staff are trained and competent to do their jobs. EVIDENCE: An examination of staff records found that all of the required information is held on file. Staff are subject the appropriate criminal records checks prior to commencing employment. Qualified nurses and care workers staff the home. Some care staff have NVQ qualifications but the home must continue working towards having 50 of staff trained to NVQ level 2 or above. Some additional training has been provided to qualified staff, including in – house refresher training relating to care planning as the overall standards of these was not satisfactory at the last inspection. Moving and handling training has been commenced, with a 12-week distance learning theory and also practical training provided. Correct moving and handling techniques are still not always followed – see standard 38. Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 Page 17 Some staff (including qualified) require training in dementia care and the basics of good practice. This includes not speaking about people as though they are not there, explaining what is about to happen, and generally treating people as an individual. Some staff relate well to residents with warmth and a caring attitude being demonstrated. Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36,37, and 38. There is no permanent manager at present. The home is generally run in the best interests of service users. Staff are appropriately supervised. Record keeping and policies and procedures are mainly satisfactory. Health safety and welfare of service users are generally promoted and protected. EVIDENCE: There is currently no permanent manager in the home. The manager from Kensington nursing home is assisting an acting deputy manager to run the home at present. The Operations Director is also supporting them. It is not satisfactory that this continues to be a long- standing arrangement but advertisements for a new manager have proved unsuccessful. There have been improvements in a number of areas and staff have worked hard to achieve this in the past four months. It is hoped that this improvement will continue. Quality monitoring has been ongoing, by the home and also Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 Page 19 externally (POVA and CSCI). Meetings with relatives have been held on a regular basis due to the problems experienced earlier in the year. These must continue. Detailed checklists have been provided to all staff to remind them of the full range of their responsibilities. Staff supervision is now being held on a regular basis, which is a major improvement. Systems for record keeping in the home have improved. Care records examined were found to be up to date and accurate at the time of the inspection. Safety procedures have improved since the last inspection. Residents are living in much more sanitary conditions. Hazardous substances are stored correctly. Moving and handling training has been provided but some staff still do not always follow correct techniques, such as transferring residents on a wheelchair with no footplates. It is not thought that this is an isolated incident and the importance of following correct procedures must be re-iterated to all staff. One staff member was found to be wearing flip-flops, which would be unsafe in a manual handling and workplace situation. Some staff were also wearing several rings which is contrary to infection control guidance. The current management team have carried out an audit of all accidents dating back to May 2005. This was not being routinely done by the previous manager. This enables staff to monitor whether there is a pattern to accidents such as frequent falls or hazards in the home. Maintenance records checked were found to be satisfactory. A random check of water temperature found that it was within the required limits. Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X X X X 2 STAFFING Standard No Score 27 X 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 3 3 2 Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 Page 21 YES 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 OP7 Regulation 15 17 Requirement Care plans must be kept up to date and contain sufficient detail. Tippex must not be used in care plans. 2 OP9 13 The treatment room must be kept free from clutter. Sudocrem must be used by prescribed resident and must be in date. Residents must be offered a choice at every meal time. Medication must not be administered to people while they are eating. Immediate. Two trolleys must be provided to serve meals. Tables must be fully set or condiments made available. Immediate Windows in first floor lounge must be replaced. The TV cabinet in the first floor Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 Page 22 Timescale for action 04/10/05 04/10/05 3 4 OP14 OP15 16 (2) (i) 16 (2) (g) 04/10/05 04/02/05 5 OP19 23 (2) (b) 04/01/05 6 OP26 23 (2) (d) lounge must be replaced. All areas of the home must be kept clean. OUTSTANDING Dining chairs must be cleaned after each use. Hand washing signs must be removed from dining area sinks. NVQ level 2 and above must be achieved by 50 of staff. Training must be provided in person centred care. Practical manual handling training must be provided to all staff. Appropriate footwear must be worn by all staff. Manual handling regulations must be followed by all staff. Excessive jewellery must not be worn on hands. 04/10/05 7 OP30 18 (c) 31/12/05 8 OP38 13 (5) (3) 04/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP15 OP21 Good Practice Recommendations It is recommended that tiles are put on the wall in the kitchen to prevent further damage to the wall. It is recommended that bathroom areas are made more warm and homely in appearance. Balmoral Court DS0000000493.V249371.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 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.V249371.R01.S.doc Version 5.0 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!