Inspection on 14/07/05 for Balmoral Nursing Home

This inspection was carried out on 14th July 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 Nursing Home 04/10/07

Balmoral Nursing Home 22/11/06

Balmoral Nursing Home 13/03/06

Balmoral Nursing Home 01/12/04

Balmoral Nursing Home 24/08/04

Balmoral Nursing Home 10/02/04

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Sue Ryder Care Birchley Hall

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 14th July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Balmoral Nursing Home Address 29 Old Road Mottram Hyde Tameside SK14 6LW 01457 765879 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Robert Lambert & Mrs Brenda Lambert Avril Hunt CRH - Care Home N - Care home with nursing 31 Category(ies) of DE Dementia - 10 registration, with number DE(E) Dementia over 65 - 10 of places PD Physical Disability - 31 PD(E) Physical Disability over 65 - 31 Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 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. Date of last inspection 24th August 2004 Brief Description of the Service: Balmoral is a large detached house, located in the Mottram area of Tameside in a semi–rural setting. The home is registered to provide both nursing and residential care. Accommodation is provided in 31 single rooms, 21 of which have en-suite facilities. A separate dining room and lounge areas are available to service users on the ground and first floors of the home. The home has recently completed an extention to increase the number of single rooms and en-suite facilities. Pleasant garden areas are provided to the front of the home. The rear of the property has 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 F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on 12 July 2005. Time was spent talking to eight service users and four staff. The care for five service users was 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, personal files, financial and medical records were also looked at. A number of service users, relatives and health professional questionnaires were left for completion, none had been returned at the time of writing this report. At the end of the inspection the home was given feedback and advice on issues raised in this report. What the service does well: Detailed assessments of service users’ needs are obtained or completed prior to their admission. Communication is a key aspect of the home with all staff receiving a detailed handover on service users’ progress. Tasks are allocated to ensure service users’ needs are met. This was evident through interviews with staff who had a good knowledge of all the service users’ needs. A core of the staff team had been employed for a number of years, ensuring continuity of care for service users. Staff interacted with service users and relatives well. Service users were well groomed and commented on the care and support they received from the staff team. Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 Page 6 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 Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 & 3 There was a lack of information available to service users for them to make an informed choice about living in the home. Assessments of service users’ needs are completed prior to admission. EVIDENCE: Five service users’ case files were examined and found to contain detailed assessments 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 when the service user is charged a top up fee. Details of top up fees were not reflected in the home’s statement of purpose or service user guide. Discussions with relatives and service users found that most decisions on the placement came from families who lived in the local area and had previous connections or other friends and family in the home. Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Shortfalls in policies, procedures and recording systems have the potential to place service users at risk. Service users’ health care needs were met EVIDENCE: The care plans of service users contained details of their assessed needs. The provision of a social care plan would identify individual service users’ hobbies, interests and capabilities. Service users appeared well groomed and discussed having visits from the podiatrist and GP. All professional visits were recorded. The tissue viability nurse, who keeps a record of progress regarding pressure sore care, visits one service user. In between these visits the home is responsible for renewing the dressings. Full details regarding the width and depth of the wounds, in which to make comparisons on the progress, were not recorded on the service user’s file. Nursing staff had undertaken training in wound care. Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 Page 10 In one instance the monitoring of a service users had not been maintained. A number of service users were unable to access the nurse call bell. This risk to service users was not reflected in care planning, neither were there procedures to ensure regular visits were undertaken by staff to ensure these service users were safe. Those service users who required to be turned regularly and fluid intake recorded had charts maintained within their rooms. From the observations made during the inspection and interviews with service users, relatives and staff it was evident that service users were receiving appropriate care and attention. Unfortunately, this was not reflected in aspects of record keeping. All staff receive a detailed handover regarding the care and treatment of service users. During interviews they demonstrated a good knowledge of the service users. Examination of medication policies, procedures and administration found errors in recording and administration. Drugs were overstocked; particularly controlled drugs. In one instance, medication was still being retained by the home when the service user was no longer prescribed the medication. Medication policies and procedures required upgrading. Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14 & 15 Service users are able to exercise choices in their daily lives and activities. Meal times are well managed. EVIDENCE: The home has recently allocated a member of staff as an activities co-ordinator for 18 hours a week to increase stimulation for service users. Activities should be looked at on an individual level and recorded in care plans. Service users discussed the activities they enjoyed, including bingo, which is normally played on a Wednesday, and a forthcoming trip to see Daniel O’ Donnell. Several visitors were present throughout the day and were made welcome by staff. Service users discussed the choices they have in their daily lives, including when to rise and go to bed. A number of service users were still in the main lounge watching TV at 10:30pm because this was their preferred time to retire. Other service users were interviewed within their rooms and had chosen to retire early in order to watch TV in private or have personal space. Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 Page 12 Meals are served in a congenial setting. Service users said how much they enjoyed the food and choices available to them. They stated they are asked daily on the preferred meal with a record of their choices being given to the cook. Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 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 standard(s) 16 & 18 Service users were confident that complaints about the home would be addressed. Some policies needed to be reviewed to ensure service users are properly protected from abuse. EVIDENCE: 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. CSCI has not received any complaints since the last inspection. Adult protection and whistle blowing policies are in place, however aspects of these now need to be reviewed and updated. Guidance is available on multi agency working in the protection of vulnerable adults. Staff receive training in the protection of vulnerable adults. Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 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 standard(s) 19, 20, 21, 22, 25 & 26 The home provides a safe, clean and well-maintained environment with appropriate aids and adaptations to meet the needs of the service users. EVIDENCE: The gardens areas at the home are well maintained and include a safe enclosed patio area to the rear of the property off the main lounge. The home was clean, tidy and free from odours. Some refurbishment had taken place since the last inspection. A number of chairs and the floor covering to a number of bathrooms and toilets throughout the home need to be replaced. These matters should be included in the home’s refurbishment plan. Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 Page 15 Appropriate aids and adaptations are provided, including hoists, slide sheets and moving belts. Service users confirmed that they had sufficient aids to meet their needs. A number of rooms were selected for inspection and were well maintained and personalised. Several service users chose to retire to the privacy of their rooms to watch TV. Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 Staff recruitment, induction and training were robust and provided protection for service users. Duty rotas did not provide adequate information regarding hours worked by ancillary staff. The number of staff who hold NVQ’s needs to be increased. EVIDENCE: Examination of the duty rota found that gaps in staffing levels were covered by agency staff. The home requests agency staff that have previously worked in the home in order to provide continuity of care. Interview with the agency worker covering the night shift confirmed they had worked in the home previously on several occasions and were always given in-depth handovers of service users’ progress and needs. Although management confirmed that ancillary staff were provided over the weekend period, the hours worked by ancillary staff were not reflected on the duty rota. Minutes of staff meetings demonstrated that staff training was discussed regularly, with the home also being involved with Tameside Training Consortium. Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 Page 17 Staff undertake mandatory training of fire, health and safety, protection of vulnerable adults and moving and handling. The number of staff who hold NVQ needs to be increased. There was evidence that staff had received induction training. The home liaises with the Dementia Care team in Tameside for training and information in line with the service users’ assessed needs. Recruitment procedures were adequate to provide for the protection of vulnerable adults. Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36, 37 & 38 The home has developed good communication systems. The provision of staff training and supervision ensure service users’ needs are met. The lack of detailed record keeping and policies and procedures may pose a risk to service users. Service users’ finances were dealt with appropriately. Service users and their relatives should be given more opportunity to comment on how the home is run. Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 Page 19 EVIDENCE: The registered manager is a qualified Registered General Nurse with many years’ experience. She has continued her professional development by attending short courses relevant to the needs of the service users. The manager is presently enrolled on NVQ level 4, Registered Manager’s award. It is company policy that regular health and safety checks are made on the home’s environment and equipment. Staff training and supervision takes place with communication being a key issue in maintaining staff’s knowledge of the service users’ needs. A service user meeting was last held in April 2005; minutes stated that entertainment, special functions, keep fit and their preferred choices of DVD were discussed. Staff, service users and relatives spoke highly of the management team and the support they received. Quality assurance questionnaires had not been sent to service users, relatives or professionals during the last 12 months. Policies, procedures and other recording systems, including medication and care planning, were not up to date. There was no evidence that outcomes for service users were affected. The manager is allocated one day supernumerary time; the remaining times are spent in care delivery. A review of the supernumerary hours allocated to the manager should be undertaken in order for her to fulfil her statutory requirements and ensure service users are not placed at risk. Examination of financial records found them to be correct with receipts for any expenditure. Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 x x 3 3 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 Standard No 16 17 18 Score 3 x 3 2 3 2 3 3 3 2 3 Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 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 1 Regulation 4/5 Requirement The registered person must ensure the statement of purpose and service user guide provide information to service users on all the facilities and services which are included in the fees. The registered person must ensure that priviately funded service users are aware of what additional services are provided for the top up fee charged by the home. (Timescale of 31/3/05 not met). The registered person must ensure the social interest and activities of service users are reflected in care plans The registered person must ensure that all details of wound care are recorded on care plans. The registered person must ensure that all hours worked by ancillary staff are recorded on the duty rota. The registered person must ensure that a mininimum of 50 of the care staff hold an NVQ in care. The registered person must ensure that the views of service users, relatives and professionals Timescale for action 31/10/05 2. 2 5 31/10/05 3. 7, 12, 37 15(1) 30/9/05 4. 5. 8,37 27,37 15(1) 17(2) Schedule 3(7) 18(1) Immediate Immediate 6. 30 31/12/05 7. 33 24 31/3/06 Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 Page 22 8. 9 13(2) 9. 9,37 13(2) 10. 8,37 15(1) are sought through anonymous questionaires. The registered person must Immediate ensure that medication and controlled drugs are not overstocked. The registered person must Immediate ensure that reasons for medication being ommited is recorded on the medication record sheet and that all additions to medciation recording sheets are signed and dated. The registered person must Immediate ensure that in all instances where service users are unable to reach the call bell that the service users care plan details how staff should monitor the service user in this situation. 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 9 19 Good Practice Recommendations The registered person should ensure the all of the homes policies and procedures are annually reviewed and updated. The registered person should ensure the homes refurbishment plan includes timescales for the renewal of bathroom and toilet floor coverings and replacement of chairs throughout the home. The registered person should ensure that a review of the hours the manager is supernumary is undertaken to ensure that the manager is given sufficient time to complete the Registered Managers award and fulfill her other statutory obligations. 3. 31 Balmoral Nursing Home F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 2nd Floor, Heritage Wharf Portland Place Ashton-under-Lyne 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 F54 F04 s25428 Balmoral NH un v237853 140705 Stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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