Inspection on 15/07/08 for Balmoral Nursing Home

This inspection was carried out on 15th July 2008.

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 Nursing Home 08/10/07

Balmoral Nursing Home 17/04/07

Balmoral Nursing Home 18/08/06

Balmoral Nursing Home 19/04/06

Balmoral Nursing Home 22/09/05

Balmoral Nursing Home 06/05/05

Balmoral Nursing Home 02/11/04

Balmoral Nursing Home 01/06/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Balmoral Nursing Home 6 Beighton Road Woodhouse Sheffield South Yorkshire S13 7PR Lead Inspector Sue Turner Key Unannounced Inspection 15th July 2008 07:30 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 Nursing Home DS0000021767.V364349.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 Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Balmoral Nursing Home Address 6 Beighton Road Woodhouse Sheffield South Yorkshire S13 7PR 0114 254 0635 0114 254 8159 balmoral@fshc.co.uk None Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) Manager post vacant Care Home 85 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) Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (60) of places Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Old Age not falling within any other category - 5 places to be for people over 60 years old within the total of 60 places. Dementia, over the age of 60 years - 5 places within the total of 25 places. 8th October 2007 Date of last inspection Brief Description of the Service: Balmoral is a purpose built home, which provides nursing and personal care to older people. It is situated in the village of Woodhouse, within easy reach of shops, churches, public transport and small parks. Balmoral is a large home and accommodation is provided over three floors. There are stairs and lifts to each floor. There are TV lounges; sitting rooms and separate dining rooms were people are able to have meals with others and their relatives. Chiropodist, hairdressers and various complementary therapists attend the home. Whist the majority of people are permanent, the home also provides short term and respite care. A copy of the previous inspection report was on display and available for anyone visiting or using the home. Information about how to raise any issues of concern or make a complaint was on display in the entrance hall. The manager confirmed that the range of monthly fees from 1st April 2008 were £327.00 - £592.00 per week. Additional charges included newspapers, hairdressing and private chiropody. Balmoral Nursing Home DS0000021767.V364349.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 that the people who use this service experience adequate quality outcomes. This was an unannounced key inspection carried out by Sue Turner and Shirley Samuels, regulation inspectors. This site visit took place between the hours of 7:30 am and 3:30 pm. The manager is Jane Watson was present during the site visit and received feedback at the end of the visit. Prior to the visit the manager had submitted an Annual Quality Assurance Assessment (AQAA) which detailed what the home was doing well, what had improved since the last inspection and any plans for improving the service in the next twelve months. Information from the AQAA is included in the main body of the report. Questionnaires, regarding the quality of the care and support provided, were sent to people living in the home, their relatives and any professionals involved in peoples care. We received six from people living in the home, eight from relatives and four from staff. Comments and feedback from these have been included in this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home and check the homes policies and procedures. Time was spent observing and interacting with staff and people. Eight staff, three relatives and three people living in the home were spoken to. The inspector checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection in October 2007 and random inspection in April 2008. The progress made has been reported on under the relevant standard in this report. The inspector wishes to thank the people living in the home, staff, and relatives for their time, friendliness and co-operation throughout the inspection process. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 6 What the service does well: People living in the home made comments such as: “I like the fact that I always get a choice at mealtimes”. “They do their very best for you and make sure you’re happy”. “There must be something wrong with anyone that grumbles about this place”. “The food is good and there’s plenty of variety”. Comments received from questionnaires and from talking to relatives included: “The staff are friendly, approachable, caring and patient”. “I have no complaints about the care”. “My wife says the carers do a wonderful job”. “The staff seem very competent and never seem to lose their rag”. “To me they do a damn good job”. “I think people are looked after very well. People are kept clean and well fed”. “At the present time I am well satisfied with the care my relative receives thank you”. “I think they do a good job”. “We are quite pleased with the home and the staff are very good”. “Staff show dedication well above the call of duty”. We observed that people were in the main well dressed in clean clothes and had received a good standard of personal care. People’s health care was monitored and access to health specialists was available. People confirmed that staff were always respectful towards them. People said that they had a choice of food and that the quality of food served was “well cooked with just the right amount” and “ I always enjoy my food”. There was a complaints procedure and Adult Protection procedure in place, to promote people’s safety. People said they had confidence in the home’s manager and staff, who would listen to any concerns and take them seriously. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 7 People said that they felt safe living at the home. The home was clean and tidy. No unpleasant odours were noticeable in the home. People living in the home and their relatives said that the home was always kept “clean and tidy”. Agreed levels of staff were being maintained. A staff training record was in place, and individual training records were maintained. Staff supervision took place, to support and give guidance to staff on an individual basis. Mandatory training took place, to equip staff with the essential skills needed. Records within the home were stored securely, to safeguard confidentiality. What has improved since the last inspection? At the last inspection thirteen requirements were issued. Twelve of these had been actioned. One requirement is carried over into this report with a short timescale for completion. At feedback we discussed with the registered manager the importance of ensuring that she acts in accordance with this requirement so that people are kept safe. Care plans contained sufficient detail to ensure that people received consistent care. People’s emotional, personal and social care needs were recorded. Staffing numbers/levels were being maintained which ensured that in the main people’s individual needs were being met. Staff had received training, which was appropriate to their work role. This had included training in Parkinson’s Disease Awareness. Radiators were guarded or had guaranteed low surface temperature, this kept people safe. Satisfactory standards of hygiene were being maintained. Care plans included up to date information about any falls. Attention had been paid to the prevention of falls. Activities were provided. Some people said that more consideration should be given to activities being more suitable to people’s individual needs and preferences Complaints received in the home were recorded in detail. Complaints made under the complaints procedure had been fully investigated. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 8 Reports written by the provider’s representative included information about changes that have been made. This evidences that the home is run in the best interests of the people living there. There were records of accidents that had affected people living in the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 9 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 DS0000021767.V364349.R01.S.doc Version 5.2 Page 10 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): Standards 1, 3 and 5. Standard 6 is not applicable to this home. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided sufficient information to inform people about their rights and choices. Trial visits were encouraged to enable people to look around the home, meet other people living there and give them the information needed to make informed choices. EVIDENCE: The home’s Statement of Purpose and Service User Guide were available, both in the entrance hall, for anyone visiting the home and a copy was also in each persons room. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 11 These included useful information about the home and the services offered. Both the Statement of Purpose and Service User Guide were in need of updating. When someone showed an interest in the home the manager carried out a pre assessment. This meant that they could be assured that they could meet the person’s needs. The home had introduced the Dependency Assessment Rating Tool (DART) aimed at ensuring a comprehensive pre assessment prior to anyone being admitted into the home. This tool applied to all categories of people including those choosing a respite or short-term stay. People were invited to visit the home, try out the meals and spend time meeting the staff and seeing the services available. One person who returned a survey said they had received enough information about the home before they moved in so they could decide if it was the right place for them. When staff were asked if they were given up to date information about the needs of the people they cared for two said “always” and two said “usually”. This home does not provide intermediate care services. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 12 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): Standards 7, 8, 9 and 10. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported by visits to the home by health care professionals. The arrangement for the administration of medication was not robust and could pose a risk to people. The health and personal care needs of people were in the main met. More consideration should be given to people’s privacy and dignity. EVIDENCE: People living in the home had an individualised plan of care. Three people’s plans of care were checked. Care plans contained a wide range of information on many aspects of personal, social and health care needs. The care plan was developed at the time of the person’s admission. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 13 The AQAA stated that from the DART assessment a comprehensive care plan was generated which was delivered in a person centred approach. However the care plans seen were not written in a person centred way. Plans seen focused more on the tasks necessary to care for the person. There was little information about what the person themselves felt their care needs were and how they wanted their specific needs to be met. Staff showed us two other care plans that they had started to complete where the person’s personal wishes and choices were the main focus. These were better, however there was so much information they could be off putting to read. Staff completed daily records. These were done at the end of each shift. There was good quality information in the daily records, which linked with the information in people’s care plans. Staff said that they reviewed and updated care plans each month or as necessary. Care plans seen had been reviewed in part, however as there were so many pages to the plans, some parts had been missed. The evidence seen suggested that if a persons needs changed a new care plan sheet was added, rather than the original being updated. This meant that the care plans were becoming more and more cumbersome. There was evidence in the care plans seen that relatives had been involved with them. Two relatives spoken to said that they had been involved in reviews or updates of their relatives care plan. Some people had been assessed as high risk of developing pressure areas. Charts that recorded when staff had ‘turned’ people to alleviate pressure were seen in people’s rooms. Some charts seen were not up to date. For some days there were clear recordings of turning on a regular basis. On other days there were few or no records of when a person was turned. Some people had been assessed as being at high risk of falling. For these people there were observation sheets in their rooms. People were checked at regular intervals of usually one hour. When we arrived at the home at 7.30am we saw that one persons chart was signed by the staff stating that they had been checked at 8am. Care plans identified that a range of health professionals visited the home to assist in maintaining peoples health care needs. People said that GP’s, dentist, opticians and chiropodists visited the home as requested. Six people who returned surveys said that staff did listen and act on what they said and that they did receive the care and support they needed. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 14 Relatives surveyed were asked, “Does the care service meet the different needs of people? And “does the care home give the support or care to your relative/friend that you expect or agreed? Two relatives said “always” and six said “usually”. Relatives said: “Dad usually tells us if he’s had a fall, nobody else gives any information to us”. “Staff always keep us informed by phone if there are any problems or concerns regarding my relative”. Medicines were securely stored around the home in locked trolleys within locked cupboards. Controlled drugs (CD) were kept in a clinical room and within a double locking cabinet. People spoken to said that staff administered their medication at appropriate times. There was evidence that managers and trained staff were auditing medication administration procedures, however there were some gaps in the medication administration records (MAR). This was also highlighted at the last inspection. Medication audit sheets identified when staff had not signed for medication. The sheet prompted them to sign retrospectively. The risks associated with this were discussed with the manager. The manager said that this was not the intention of the check. We observed a number of things that did not make sure that people’s dignity was respected at all times. One person was seen receiving attention from the staff; the bathroom door was left open. Many ladies were not wearing stockings or tights and men were wearing odd socks and no socks at all. A number of people were walking around without shoes or slippers. We acknowledge and advocate that people do make choices about their lifestyle, however these observations told us that people were not always receiving a good standard of care. Observations on the Elderly Mentally Infirm (EMI) unit showed us that staff did communicate with people during care delivery. Staff were comfortable when interacting with people. There were a number of times when staff responded to people in a way that showed they were mindful of how to speak to someone who has dementia. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 15 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): Standards 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had a choice of lifestyle within the home and were able to maintain contact with family and friends ensuring that they continued to be involved in community life. A range of activities was on offer, further activities would promote choice and maintain peoples interests. Meals served at the home offered choice and ensured people received a healthy balanced diet. EVIDENCE: People were seen to walk freely around the home, if able. Relatives spoken to said they were able to visit at any time and were made to feel very welcome. We saw that everyone coming to the home was made to feel comfortable whilst visiting their loved one. Care plans seen included details of a person’s previous lifestyle and interests. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 16 Staff were seen and heard offering people choices about many things. People were asked their meal preferences, where they wanted to sit and how they wanted to spend their day. Staff working on the EMI unit were helping people to exercise choice and manage their lives in a supportive and considerate way. The home employed an activities worker who worked five days each week. Examples of the activities available were crafts, quizzes and reminiscing sessions. Outside entertainers visited the home and shopping trips were occasionally organised. When asked “are there activities arranged by the home that you can take part in?” Four surveys said “always” and two said “sometimes”. Relatives said: “There should be more interaction with people who spend most of their time in their rooms and are undemanding”. “I visit most days and feel more stimulation would be welcome”. “Activities and outings are arranged for the ones who are capable of taking part. Unfortunately my mother is not able to participate in most of these”. “There ought to be more trips out of the home”. On the day of the site visit the activities coordinator wasn’t working. The manager said that when she wasn’t at work the carers would organise activities for people. People on the EMI unit were seen playing bingo. Activities weren’t arranged elsewhere, however the hairdresser and chiropodist were seeing people for appointments. The main meal of the day was served in the evening, which suited people living in the home. At lunchtime a light meal was served and alternatives were always available. The cook said that there were a number of people who required special diets. People on diets were offered equivalent choices and a variety of specially made desserts. The inspectors observed lunch being served in two dining rooms. The tables were set nicely with cloths, place mats, cutlery and matching crockery. The dining rooms were quite small and had a pleasant relaxed ambience. Staff were seen assisting people to eat in a supportive way. When asked “do you like the meals at the home?” Two surveys said “always”, three said “usually” and one said “sometimes”. People spoken to said: Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 17 “Meals are good with a choice everyday.” “Food is not bad, with a choice. There is plenty to eat.” Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 18 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): Standards 16 and 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints procedures were in place and people felt confident that any concerns they voiced would be listened to. Staff had received adult safeguarding training and had an understanding of the procedures to be followed should they suspect any abuse at the home, so helping to ensure that people were protected. EVIDENCE: In January 2008 one staff member was suspended pending an investigation into misconduct. Following the investigation the staff member was dismissed. On 28th April 2008 an unannounced random inspection took place. This was in response to a serious incident meeting held on the 22nd April 2008 as we had received some information, of an adult safeguarding nature. At the serious incident meeting it was agreed that the incidents relating to two people would be investigated by Sheffield local authority social workers. The provider and Sheffield social services would investigate the information received by us. So that people were kept safe, the provider suspended five members of staff whilst the investigations took place. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 19 On 30th June 2008 a serious incident progress meeting was held. The investigations were completed and the provider had taken appropriate action to ensure that people continued to be kept safe. Further issues of concern, relating to two other people were raised on 3rd July and a strategy meeting took place on the 5th July. The outcome of one issue was that a number of recommendations were made. The manager and provider were informed of these and asked to respond in writing to confirm the action they had taken to prevent a reoccurrence. The other issue was still being investigated. Throughout these investigations the provider was quick to respond. They worked with Sheffield social services and us to ensure that the investigations were thorough, open and transparent. Since the last inspection the manager had received three complaints. All three had been investigated and resolved. People and their families had been provided with a copy of the homes complaints procedure, which was also on display in the entrance hall. This contained details of who to speak to at the home and who to contact outside of the home to make a complaint should they wish to do so. When asked, “do you know who to speak to if you are unhappy?” Four surveys said “always” and two said “usually”. Relatives surveyed were asked, “Do you know how to make a complaint about the care provided by the home if you need to? Six relatives said “yes” and two didn’t answer. Relatives said: “Any concerns or queries I have raised have always been received with a positive attitude and addressed ASAP”. “I can speak to any of the staff and they will sort things out”. “I haven’t had to complain about anything since the new manager started, but I know I could go to her if I needed to”. Four staff surveys were returned. When staff were asked, “Do you know what to do if a person/relative/advocate or friend has concerns about the home? All the staff said “yes”. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 20 The homes adult safe guarding policy included information on local procedures. Staff spoken to said that they would report any allegations of abuse to their manager. Staff spoken to had received formal training in adult protection procedures and were able to describe types of abuse that people could be susceptible to. In conversation with staff, we noted that they had a good understanding of safeguarding adults and whistle blowing policies, procedures and practices. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 21 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): Standards 19, 24 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean and generally well maintained, providing a pleasant environment for people and their visitors. EVIDENCE: The AQAA stated: The refurbishment of the gardens, garden furniture, purchase of entertainment equipment and purchase of furniture via the Capital Grant Scheme has added to the already pleasant environment for our residents. The home was clean and tidy. Lounge and dining areas were domestically furnished and a tour of the building identified that some areas of the home Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 22 were in need of minor repair. A handy person was employed to help maintain the environment. Some homely touches were provided, however some bathrooms and toilets looked quite bare. There was a competition running at the home for staff to become involved in restyling the bathrooms, a prize was on offer for the one voted the best. Staff working in the EMI unit should be commended for their hard work and effort in providing an environment that enhanced the well being of people living with dementia. Corridors displayed items of interest that initiated conversation and brought back happy memories. The ambience within this unit was very responsive, relaxed and homely. Bedrooms checked were homely and people said their beds were comfortable, bed linen was clean and in a good condition. Radiators were guarded or had guaranteed low surface temperature. When people were asked is the home clean and fresh, five people said “always” and one didn’t answer. The manager said that a housekeeper was now in post who had the responsibility of checking all areas of the home daily and reviewing the cleaning schedules. Controls of infection procedures were in place. Staff were observed using protective aprons and gloves. Staff said they had not received training in infection control. One relative said: “The home provides a safe and secure environment, especially as my relative has dementia. Rooms are well prepared”. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 23 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): Standards 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff were provided to meet the needs of people. Recruitment information obtained for staff was sufficient to protect the welfare of people. Newly employed staff had completed induction training. EVIDENCE: Staff interviewed said that they enjoyed working at the home and got a lot of job satisfaction. On the day of the site visit staffing numbers were at an acceptable level. Four staff returned surveys. When asked are there usually enough staff on duty to meet the individual needs of people. Two staff said “usually” and two said “sometimes”. People were asked are the staff available when you need them. Four people said “always” and two said “usually”. Staff interviewed said that when they started work they received induction. Three staff files checked identified that the member of staff had received induction training when they commenced work. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 24 Staff were able to talk about the various training courses that they had attended, which included all of the mandatory training, for example, Moving and Handling, Food Hygiene, First Aid and Fire. Staff had also undertaken training in specialised topics, such as dementia, Parkinson disease and dealing with aggression. Of the 39 care staff, 3 staff had achieved NVQ level 2 in care. This falls well below the recommended 50 of the care staff trained to NVQ level 2 in care by 2005 to ensure the staff team were qualified and competent to carry out their duties. When staff were asked are you being given training, which is relevant to your role? All four said “yes”. One relative said: “For the time I have had my relative in their care I have observed staff to have all the skills and experience necessary”. Three records of employment were checked. These included all of the required information including interview assessment, verification of identity, references, certificates of training, health checks and evidence of Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) check. Application forms fully recorded previous employment. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 25 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): Standards 31, 33, 35, 36 and 38. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager’s approach benefited people and staff. The quality assurance system needed further development to ensure that the home was run in the best interests of everyone. People’s monies were safely handled, which ensured that finances were accurate and safeguarded. People’s health and safety had been put at risk, in some areas. EVIDENCE: The manager at the home had been in post since April this year and had yet to register with us. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 26 The manager is a qualified nurse with many years experience of working with older people. Since the last inspection the manager, with the support of the regional manager, had worked hard to action the requirements made and this was evidenced by the many developments made within the service. Everyone spoken to and information from questionnaires confirmed that people, staff and relatives were all happy to approach the manager at any time for advice, guidance or to look at any issues. They all said that they were confident that she would respond to them appropriately and swiftly. Relatives said: “Since the new manager started things seem to be getting done quickly”. “The manager has made many improvements and if you need anything she will sort it out”. The area manager visited the home on a very regular basis. Each month she spent time speaking to people and staff and then reported her findings. Surveys asking people their views and opinions of the service were sent out from the organisations head office. Following this there was no report that gave details about the results of the surveys and any actions that were being taken in response to what people said. Staff meeting had taken place. The minutes from these meetings were recorded and made available for all staff to see. The home handles money on behalf of some people. This was checked for three people. Account sheets were kept, receipts were seen for all transactions and monies kept balanced with what was recorded on the account sheet. Staff spoken to said they had recently had, or were booked in, for formal one to one supervision with the manager. Four staff surveys were received. When asked “Does your manager meet with you to give you support and discuss how you are working?” Three staff said “often” and one said “regularly”. Equipment at the home was serviced and maintained. Fire records evidenced that weekly fire alarm checks took place. Staff said fire drill training took place on a regular basis. The record of fire drills did not state the duration of the fire drill. We talked to the manager about recording the actions that staff took Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 27 during a fire drill for example what went well and any learning points. This would be a valuable learning process. A fire risk assessment had been completed. A number of action points had been identified as necessary. As the home cares for people with dementia the risk assessment should have highlighted what particular precautions were in place to keep people with dementia safe. Following an incident at the home the coroner wrote to us raising concerns about: • • Staff training/guidance in assisting with a clinical procedure. Staff training in restraint. The coroner’s inquest is completed. The provider must, without delay, give full consideration as to the prevention of similar incidents happening in the future. We must be informed of any remedial action that has taken place as a result of the evidence presented at the coroner’s inquest. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 28 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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 29 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 OP8 Regulation 13 Requirement So that peoples health, safety and welfare is promoted: Turning charts that record a persons pressure care must be fully completed. So that peoples health, safety and welfare is promoted: Observation charts must be completed accurately and truthfully. To ensure peoples health and welfare, MAR sheets must be fully completed and signed at the time of medication administration. Timescale 08/10/07 not checked at this inspection therefore new timescale given. (Previous timescale of 01/07/08 not met). Suitable arrangements and appropriate action must be taken to ensure that people’s privacy and dignity is respected. The results of the quality assurance surveys must be made available to anyone with an interest in the home. Any actions that have been taken DS0000021767.V364349.R01.S.doc Timescale for action 15/07/08 2. OP8 13 15/07/08 3. OP9 13 15/07/08 4. OP10 12 (4) (a) 15/07/08 5. OP33 24 01/10/08 Balmoral Nursing Home Version 5.2 Page 30 6. OP38 13 7. OP38 12 13 must be documented so that people can see that the home is run in the best interests of people. So that people are kept safe the fire risk assessment must highlight any particular precautions that need to be in place for people that have dementia. So that peoples health, safety and welfare are protected: Following the coroner’s inquest the provider must, without delay, give full consideration as to the prevention of similar incidents happening in the future. We must be informed of any remedial action that has taken place as a result of the evidence presented at the coroner’s inquest. 01/10/08 01/10/08 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. 3. 4. 5. 6. Refer to Standard OP1 OP7 OP7 OP7 OP12 OP19 Good Practice Recommendations The Statement of Purpose and Service User Guide should be reviewed and updated. Streamlining of the care plans should be considered so that they are less cumbersome. Care plans should be written in a more person centred way. When a care plan has been reviewed and updated this should be clearly recorded. So that people will benefit and engage socially, activities provided should be suitable to people’s individual needs and preferences. Toilets and bathrooms should be made to look more homely and appealing. DS0000021767.V364349.R01.S.doc Version 5.2 Page 31 Balmoral Nursing Home 7. 8. 9. OP26 OP28 OP38 Staff should undertake training in infection control. 50 of care staff should be trained to NVQ level 2 in care. So that fire drills are a valuable learning process the actions taken by staff should be recorded. The duration of the fire drill should also be recorded. Balmoral Nursing Home DS0000021767.V364349.R01.S.doc Version 5.2 Page 32 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. 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