Inspection on 13/03/06 for Balmoral Nursing Home

This inspection was carried out on 13th March 2006.

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 Nursing Home 04/10/07

Balmoral Nursing Home 22/11/06

Balmoral Nursing Home 14/07/05

Balmoral Nursing Home 01/12/04

Balmoral Nursing Home 24/08/04

Balmoral Nursing Home 10/02/04

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

CARE HOMES FOR OLDER PEOPLE Balmoral Nursing Home 29 Old Road Mottram Hyde Tameside SK14 6LW Lead Inspector Sandra Bennett Unannounced Inspection 13th March 2006 9.30am 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 Nursing Home DS0000025428.V263704.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 Nursing Home DS0000025428.V263704.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Balmoral Nursing Home Address 29 Old Road Mottram Hyde Tameside SK14 6LW 01457 765879 01457 765879 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 Robert Lambert Mrs Brenda Lambert Mrs Avril Marie Hunt Care Home 31 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (10), Physical disability (31), Physical disability of places over 65 years of age (31) Balmoral Nursing Home DS0000025428.V263704.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Maximum number of service users requiring nursing care must not exceed 31. A maximum of 2 Registered Nurses must be on duty between 7.30 a.m. and 12.30 p.m. Mon - Fri. A minimum of 1 Registered Nurse must be on duty at all other times. No service user may be admitted into the establishment who is under 55 years of age. 14th July 2005 Date of last inspection Brief Description of the Service: Balmoral is a large detached house, located in the Mottram area of Tameside in a semi–rural setting. They are registered to provide both nursing and residential care. Accommodation is in 31 single rooms, 21 of which have en-suite facilities. A separate dining room and lounge area are available to service users on the ground and first floors of the home. At the time of inspection the home had completed an extention to increase the number of single rooms and en-suite facilities. Pleasant garden areas are to the front with the rear of the property a secure enclosed patio leading from the main lounge which is accessible to service users. The home provides adequate toilet and bathing facilities with appropriate aids and adaptations to meet the assessed needs of the service users. Balmoral Nursing Home DS0000025428.V263704.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on the 13 March 2005. Time was spent talking to eight service users and two staff. The care for four service users were looked at in detail, looking at their experience of the home from the time of their admission to the present day. Records of care were examined staff duty rotas, and medical records were also looked at. Service users, relatives and health professional questionnaires were left for completion, two had been returned at the time of writing this report which stated they were very satisfied with the care provided at Balmoral. What the service does well: What has improved since the last inspection? Activities for service users have increased since the last inspection with social care plans being implemented. The number of staff enrolled on NVQ training has also increased. The carpet in the main downstairs lounge has been replaced. Balmoral Nursing Home DS0000025428.V263704.R01.S.doc Version 5.0 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. Balmoral Nursing Home DS0000025428.V263704.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Balmoral Nursing Home DS0000025428.V263704.R01.S.doc Version 5.0 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 the following standard(s): 1, 2, 3. Assessments of service users needs are completed prior to admission which ensures that service users can be confident that the home can meet their needs. There was a lack of contractual information for privately funded service users in which to understand financial implication of the placement. EVIDENCE: Four service users files were examined and found to contain an assessment of their needs. Examination of contracts for those service users who are privately funded found that these did not contain sufficient information regarding the fees payable especially what the service users can expect for a top up fee. This information should also be reflected in the service user guide. Balmoral Nursing Home DS0000025428.V263704.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. Inconsistencies in record keeping and care planning may pose a risk to service users. Medication administration, recording and safekeeping need to be improved for the protection of service users. EVIDENCE: Examination of service users case files found that an assessment of their need had been completed. In most instances care planning reflected service users assessed needs. However not all assessed needs had an individual care plan inconsistencies were noted in recording health care visits through to care planning and daily reports. An example of these being a GP visit had been recorded but the outcome had not. Also a social work visit was not dated or the outcome recorded. Some call bells were placed out of reach of service users. Discussions with staff on duty identified that the service users was unable to summon help independently. Balmoral Nursing Home DS0000025428.V263704.R01.S.doc Version 5.0 Page 10 In these instances a risk assessment must be completed which justifies this and a care plan completed which states how the service users needs are to be monitored. At the time of this inspection the outcomes for service users were not affected, however this may not be sustained unless record keeping improves. Service users commented that staff were very nice to them and that they could please themselves when they go to bed. One service users also said that “staff spend time talking to me.” The home had started to implement a care plan for the social and recreational needs of service users. A qualified pharmacist from the Primary Care Trust (immediately prior to this inspection) had undertaken an audit of the homes medication policies and procedures. They identified a number of errors in relation to medication not being held securely and not being stored as directed. There was also a the lack of adequate recording, administration and risk assessments for service users who self medicate. At the time of this visit the home was addressing these issues. It is recommended the home continue to address these issues, which will be monitored through subsequent CSCI inspections. Balmoral Nursing Home DS0000025428.V263704.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, 15. Activities in the home provide mental, physical and spiritual opportunities in order to increase the fulfilment of service users. Record keeping needs to be improved to show service users participation in activities in order to assess service users progress. EVIDENCE: The home has introduced social care plans, which reflect service users interests and hobbies. However no record was kept who was involved in each activity. The home had increased the number of activities for service users since the last inspection. Details of the activities were displayed on the homes notice board. These included films, bingo and outside entertainers. Dates of church services taking place were also reflected on the notice board for those who wished to participate. A number of service user interviewed maintained outside community links through their families and friends. One service user often went home for weekends. Balmoral Nursing Home DS0000025428.V263704.R01.S.doc Version 5.0 Page 12 One service user said, “I really enjoyed the sing a long we had the other week” with another saying “ I enjoyed the video afternoon were those that want can watch a musical of their choice Service users are also offered an alcoholic drink of their choice. There was evidence that one service user had made a special request for a video of their choosing. Meals times were well managed with service users commenting that they really enjoyed the food. Balmoral Nursing Home DS0000025428.V263704.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, 18. Service users were confident any complaints they may have about the home would be addressed promptly. Staff training is provided in the protection of vulnerable adults ensuring safety for service users. EVIDENCE: The home’s complaints procedure stipulates timescale for action. Service users said they would feel confident in raising any concerns they had with the manager and that their concerns would be acted on. A record of all complaints made to the home is maintained together with any action taken to rectify matters. The CSCI has not received any complaints since the last inspection. Staff at interview demonstrated a good understanding of how adult abuse may present and the action they would have to take in such an event. Balmoral Nursing Home DS0000025428.V263704.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, 24, 25, 26. The home was well-maintained and free form odour however some refurbishment is needed for the comfort of service users. EVIDENCE: A maintenance person is employed to ensure that all aspects of the home inside and out are kept in good order and safe for service users. Water damage has occurred on the upstairs landing area, which requires attention. Generally, the home is well maintained, however, there are still outstanding issues from the previous inspection i.e. bathroom and toilet floor covering. Also a number of chairs in both lounges require replacement or recovering in order to improve the environment for service users. A new carpet has been provided in the downstairs lounge. The home was clean tidy and free from odour. Balmoral Nursing Home DS0000025428.V263704.R01.S.doc Version 5.0 Page 15 Many of the service users rooms had been personalised and gave a homely appearance. Service users confirmed they were encouraged to bring into the home any personal items their room could safely accommodate. Balmoral Nursing Home DS0000025428.V263704.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): 27, 28, 30. Duty rotas did not provide adequate information regarding hours worked by ancillary staff in order to assure service users needs are met. Staff have access to training, however the number of qualified staff who holds NVQs needs to be increased to ensure the protection of service users. EVIDENCE: Hours worked by ancillary staff were not reflected on the duty rota making assessment of care staff workload difficult. Interviews with staff confirmed that regular staff meetings take place to discuss ongoing matters, training and development. Minutes of staff meetings were available for inspection. The home access Tameside Training Consortium to ensure staff receives training in line with the service users needs. Staff confirmed at interview that mandatory training of fire and health and safety take place. A notice was displayed in the home of forthcoming training for staff to enrol on these included, dementia care and refresher course in moving and handling. The number of staff who holds NVQs needs to be increased. The inspector acknowledges that a high proportion of staff have enrolled on NVQ training. Balmoral Nursing Home DS0000025428.V263704.R01.S.doc Version 5.0 Page 17 There was evidence that a new member of staff had commenced an induction course in line with Skills for Care guidelines. The home also liaises with the Dementia Care team in Tameside for training and information in line with the service users individual needs. Balmoral Nursing Home DS0000025428.V263704.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, 32, 33, 37. The lack of detailed record keeping may pose a risk to service users. Communication and quality assurance measures were sufficient to provide opportunities for service users and their families to offer their views on the running of the home. EVIDENCE: The registered manager is a qualified Registered General Nurse with many years experience. They have continued their professional development by attending short course relevant to the needs of the service users e.g. wound care. They are presently enrolled on NVQ4 registered managers award. Staff, service users and relatives spoke highly of the management team and the support they received. Balmoral Nursing Home DS0000025428.V263704.R01.S.doc Version 5.0 Page 19 Quality assurance questionnaires had been sent to service users, relatives or professionals during the last twelve months. Comments taken from the questionnaires included one from a relative which said “staff know the service users well and always keep me informed”, also a GP who commented that they were always satisfied with the care provided at Balmoral and another from a professional who said relationships with the home were all positive. Recording systems i.e. medication and care planning were not up to date. Records did not reflect the care delivery to service users. There was no evidence that the outcome for service users were affected at this time however this may not be sustained unless the manager’s supernumerary hours are reviewed. The manager is allocated two days supernumerary at present the remaining times are spent in care delivery. Balmoral Nursing Home DS0000025428.V263704.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 2 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X X X X 2 3 STAFFING Standard No Score 27 2 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X X X 2 X Balmoral Nursing Home DS0000025428.V263704.R01.S.doc Version 5.0 Page 21 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 Standard OP7 OP8OP37 Regulation 15(1) Requirement The registered person must ensure that all, instances were service users are unable to reach the call bell must be recorded with staff instrcutions on how to monitor service users in this situation. Visits from health care professionasl must be fully record in care planning and daily notes to ensure inconsistencies do not occur. (Timescale of 31/10/05 not met). The registered person must ensure that the requirements made by the Primary Care Trust Pharmacist are acted upon and that medication is held securely, stored and administered as directed. Risk assessments must also be completed for those service users who self medicate. The registered person must attend to the water seepage on the upstairs landing. The registered person must replace the floor covering in the bathrooms and toilets on the first floor. Timescale for action 31/03/06 2 OP9OP37 13(2) 31/03/06 3 4 OP19 OP20OP25 23 23 31/08/06 31/10/06 Balmoral Nursing Home DS0000025428.V263704.R01.S.doc Version 5.0 Page 22 5 OP27 18 6 OP28 18 The registered person must ensure that the hours worked by ancillary staff are reflected on the duty rota. The registered person must ensure that the number of staff who hold NVQs is increased 31/03/06 31/12/06 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 OP1 Good Practice Recommendations The registered person should ensure the statement of purpose and service user guide provide information to service users on all the facilities and service which are included in the fees. The registered person should ensure that refurbishment of several chairs in the lounges and bedrooms are reflected in the homes refurbishment plan. The registered person should ensure that daily notes and care planning state when a service users has been involved in activities. 2 3 OP20 OP12 Balmoral Nursing Home DS0000025428.V263704.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 Nursing Home DS0000025428.V263704.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. 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