Inspection on 04/10/07 for Balmoral Nursing Home

This inspection was carried out on 4th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Balmoral Nursing Home 22/11/06

Balmoral Nursing Home 13/03/06

Balmoral Nursing Home 14/07/05

Balmoral Nursing Home 01/12/04

Balmoral Nursing Home 24/08/04

Balmoral Nursing Home 10/02/04

Similar services:

Ruskin Lodge

Dystlegh Grange

The Good Companions

Springfield Cottage

Cuerden Grange Rest Home

Cornmill Nursing Home

Vitalise Sandpipers Centre

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 Janet Ranson Unannounced Inspection 19th September 2007 10:00 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.V349152.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 DS0000025428.V349152.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Balmoral Nursing Home Address 29 Old Road Mottram Hyde Tameside SK14 6LW 01457 765879 F/P 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.V349152.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. No service user may be admitted into the establishment who is under 55 years of age. 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. Date of last inspection 22nd November 2006 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 extension 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. The range of weekly fees charged by the home at this time was £331.75. to £481.77. Additional fees are charged for hairdressing, podiatry, personal newspapers and some entertainment and trips out in the community. Balmoral Nursing Home DS0000025428.V349152.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection, which included an unannounced visit to the home, was carried out on 4 October 2007. We (the commission) arrived at 10:45 and stayed until 18:30. The manager had previously sent us an annual quality assurance assessment (AQAA) and a data set that gave us certain information about the service. From these details a selection of service users and their relatives were invited to complete a small survey so they could have the option to provide information about the service they receive. We also took a random tour of the building and looked at a selection of residents and staff records as well as other documentation including duty rotas, medication records and staff recruitment process. What the service does well: What has improved since the last inspection? The home continues with the redecoration and carpeting of individual bedrooms. All the bedroom doors have been fitted with closures. This means that they now shut properly providing a seal in the event of fire. This was a requirement from the last inspection. The manager told us that they had reduced the amount of agency staff over the past 12 months. This is due to recruiting staff with caring and nursing skills. Balmoral Nursing Home DS0000025428.V349152.R01.S.doc Version 5.2 Page 6 All newly appointed care staff now have a period of induction that meets with the Skills for Care standards. 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 DS0000025428.V349152.R01.S.doc Version 5.2 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.V349152.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 intermediate care is not provided.) Quality in this outcome area is good. The residents have an assessment of need carried out by a senior member of staff before they move into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined a selection of resident’s files. They showed us that an assessment of need had been completed prior to them being offered a place in the home. The manager confirmed that a senior member of staff usually visited the potential resident at their current place. The purpose of the visit was to introduce themselves and explain what the home had to offer. In the case of a person being admitted from hospital the manager told us she would take time to read the nursing notes and clarify any issues identified at this time. She Balmoral Nursing Home DS0000025428.V349152.R01.S.doc Version 5.2 Page 9 also told us that she would not offer a place to a person if she did not think her staff could meet their needs. A visitor said that his relative had looked around the home before making the decision to move in. He also told us that his relative had received written information about the home and the services they could offer. A resident told us he had looked around the home, “liked what he saw” and decided to move in. Balmoral Nursing Home DS0000025428.V349152.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. The residents’ individual health and social requirements are identified and met through the care planning process. The care plans provide the carers with action to be taken so that the residents to benefit from the individual care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at four care plans in detail from admission to the present day. They were all quite detailed and showed where health care professionals had also been involved in the individual care. The care plans set out the action to be taken each day to meet with the individual care needs. They were detailed, evaluated and placed the person at the centre of the care so their direct wishes and preferences are clearly documented. We were also able to track the outcomes of certain actions to a satisfactory conclusion. Balmoral Nursing Home DS0000025428.V349152.R01.S.doc Version 5.2 Page 11 We saw that in each case a social history had been obtained giving details of previous occupations, interests and hobbies. This is good practice and helps the carers to have a better understanding of the individual. We found that accident records were maintained. There was not enough detail in the records to provide a clear picture of what had happened and what the outcome had been for the injured party. The manner in which the records were kept was not in accordance with the Data Protection Act. A pharmacist from the Primary Care Trust (PCT) had recently (May 2007) carried out an inspection at the home. The resulting report showed the medications were managed and stored in the correct manner. The PCT gave a result of 85 on the report, which is considered to be good. Based on observation and discussion with the residents and their visitors, we can conclude that individual dignity and respect for privacy is promoted within the home. Balmoral Nursing Home DS0000025428.V349152.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 &15 Quality in this outcome area is good. The residents are helped maintain their links with families and friends, and are provided with a balanced and nutritional menu. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A relative told us that, “Social activity is good, although (due to condition) my relative cannot always join in.” A resident told us about a recent trip he had been on, and how much this had been enjoyed. He also said he enjoyed a sing along and Quizzes. The garden to the side of the building was fully accessible and secure. We were told that a resident had been helped to put plants into the various pots and hanging baskets. Balmoral Nursing Home DS0000025428.V349152.R01.S.doc Version 5.2 Page 13 We were told that the residents were invited to meetings where they could contribute towards where they would like to go or what they would like to do. A resident described how he was looking forward to going out of the home independently during the day with the Ring and Ride transport service. The manager said that the initial registration had been organised for the resident by the home. The resident told us that he intended to phone the Ring and Ride to make his own arrangements for his future journeys. Visitors could be seen in the home throughout the day. One person told us that they were always made welcome and offered light refreshments when they visited. They also said the initial visit to look around the home was good and they liked the informal atmosphere. We were told that some people visited at meal times to assist their relatives with their meal. The cook told us that there was always a choice of menu at each mealtime. She was familiar with individual specific dietary requirements. A menu was shown to us and it was also displayed in the hallway. A resident said he enjoyed his meals and that an alternative was always available. Another resident told us that the cook would make him something different and according to the way “he liked it”. Arrangements for the residents to practice their individual religion were detailed with in the care files. The manager told us that there are regular services held within the home. Balmoral Nursing Home DS0000025428.V349152.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. Residents and relatives felt comfortable in raising any concerns they may have which means that they are listened to, and responded to. Staff training in the protection of vulnerable adults ensured residents are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaint procedure was displayed in the entrance hallway and included in the service users guide. One relative told us that they would feel able to make a complaint (to the manager) if there was a need. This person also said they had a copy of the procedure in with “the other paperwork” he had been given. A relative wrote in the survey form, “Occasionally (twice) I have made a complaint regarding my relatives care. Remedial action by the nursing home was taken very quickly to my satisfaction.” Balmoral Nursing Home DS0000025428.V349152.R01.S.doc Version 5.2 Page 15 We looked at the homes complaints records and noted that they were disorganised. The content varied in detail and failed to show the outcomes of any investigations undertaken. We spoke with the manager about this and agreed that she would make sure the staff used a page for each complaint making sure it was dated with the name of the complainant clearly written. This will make auditing and analysing easier. The commission had received one complaint in the form of an anonymous letter, since the last inspection. The home also received the letter the contents of which were subject to a safeguarding adults investigation by the local authority. The outcome of the investigation resulted in disciplinary action. The home acted in the approved manner by making sure the residents were safe at all times. We saw that the majority of staff have received specific training in the recognition of adult abuse. A carer told us what she would do if she thought abuse had taken place. Balmoral Nursing Home DS0000025428.V349152.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. In the main the home provides a reasonable standard of accommodation and hygiene for residents. So that the safety and comfort of residents can be assured, certain areas within the home require attention. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We could see that the rooms in the new extension provided a high standard of comfort and style. The majority of bedrooms were bright, comfortable and personalised with pictures, photographs and ornaments. This gave them a homely appearance. We were told that the bedrooms continue to be refurbished and decorated. We saw that the floor covering in the communal bathrooms and lavatories was poor. In one area it was beginning to lift up from the floor. This could become Balmoral Nursing Home DS0000025428.V349152.R01.S.doc Version 5.2 Page 17 a tripping hazard. Also where a toilet pan had been replaced the floor covering had not been changed so that there was a gap around the base of the toilet. This has the potential for cross infection. Both of these issues have been brought to the homes attention during previous site visits. The manager told us that she had been let down by a company who had agreed to replace the floor covering in these areas. Another company had been contracted to carry out this work. She said it was due to be done in the next few weeks. We were told that a general maintenance person was employed at the home to carryout day-to-day repairs. He was not on duty during the site visit. This was unfortunate, as the flush mechanism was not working in the staff toilet throughout the site visit. We thought that some cosmetic improvements could be made to the general environment such as repainting woodwork that was showing signs of being knocked by wheelchairs. We were also told that the bedroom doors had been fitted with special fittings so they now close properly. This was required at the last inspection. Domestic staffing levels had improved since the last site visit. We saw that the home looked clean with no offensive smells. Balmoral Nursing Home DS0000025428.V349152.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. Staff were trained and competent to carry out their duties. The reduction of trained staff during the afternoon and evenings could be detrimental to the residents well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager told us in the AQAA that the home had reduced the number of agency staff. This was because there continued to be a successful recruitment campaign. Over the past 3 months 5 nurses had been employed from a specialist agency. A staff meeting took place during the afternoon of the site visit; the agenda showed that working with agency staff was to be discussed. The manager told us that the carers felt strongly that the agency staff were not able to work to the standard required in the home. The home tried to use the same agency and where every possible the same person so as to provide continuity of care. We observed an agency carer interacting with residents whilst the regular staff attended the staff meeting. She did not appear to have the skills or knowledge of how to care for people with dementia. This situation was discussed with the manager. Balmoral Nursing Home DS0000025428.V349152.R01.S.doc Version 5.2 Page 19 We also discussed the issue of staffing levels in general. Judging from the duty rota we could see that the ratio of nursing staff reduces in the afternoon from 2 (1 on each floor) to 1 over all. As the residents needs do not change during these hours it was difficult to understand why there was a reduction at this time. The manager referred us to the “staffing notice.” The manager was reminded that the “staffing notice” issued by the previous regulatory body (the health authority) at the time of the original registration, was obsolete. We told her that the home should be staffed with enough people who have the skills and training to meet individual needs. The manager told us she recognised this and was considering creating a post of senior carer to provide a better supporting structure. A resident told us the staff were “very good, they’d do anything for you.” We recognise that the outcomes for the residents are at present are positive. However we could see that some of the residents nursing needs were very great. Should this situation continue there could be the reduction of trained staff could begin to have a detrimental effect. We were told that half of the staff in the home had achieved a National vocational Qualification (NVQ) at level 2 with a further 5 carers working towards this. Additional training was also provided including moving and handling, falls prevention, dementia awareness and food hygiene. The manager told us that the staff were expected to attend some training in their own time, so they were not always paid. We thought this was not acceptable and it was recognised that this was an area where the home could improve. The induction programme met with the Skill for Care standards. We checked a selection of staff files. We saw that they contained the required records and showed that the home had taken up references and had made checks with the Criminal Records Bureau (CRB) and with Protection of Vulnerable Adults (POVA) registers before the person began to work unsupervised at the home. This means that the residents are safe and protected from potential harm. This was an improvement on the situation at the last inspection where the records were disordered and appropriate checks had not been carried out. A newly appointed carer was interviewed. She told us she had previous experience of working in a care home and her experience at Balmoral was favourable. She said she felt supported by the management and was looking forward to starting her NVQ at level 2. Balmoral Nursing Home DS0000025428.V349152.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. The manager of the home has the skills, experience and qualifications to run the home in the resident’s best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is a qualified registered nurse with many years experience in care. She told us that she is about to complete her NVQ 4 (Registered Managers Award). She keeps her skill and knowledge up to date by attending courses in line with the residents needs. The manager has worked at Balmoral for 9 years. Balmoral Nursing Home DS0000025428.V349152.R01.S.doc Version 5.2 Page 21 We saw that staff meetings take place and there is a programme of formal supervision. The manager told us that supervision had become not as regular as she would like but she had plans to get it back on course. We were told that residents meetings were held at regular intervals and it was apparent that both the residents and visitors knew the manager by sight and by name. At the last inspection there was a recommendation that the registered managers supernumerary hours were increased. This recommendation remains as we think the registered manager should have time to improve and develop the service in line with current thinking and legislation. We could see that improvements had been made to staff practice when moving the residents in wheelchairs. Where the residents had refused to have footplates in use on the wheel chairs the reasons (and associated risk) had been fully documented on the care plans. Staff training in Health and Safety, falls prevention, moving and handling and first aid had taken place. We were told small amounts of money held on behalf of residents were securely and appropriately stored and records maintained by a person who is employed as an administrator. Balmoral Nursing Home DS0000025428.V349152.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 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 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Balmoral Nursing Home DS0000025428.V349152.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 OP8 Good Practice Recommendations The accident recording should be improved to clearly document the accident and the outcome for the injured party. The records should also be kept in accordance with the Data Protection Act. The complaints record should clearly document the name of the complainant, details of the investigation and the outcome for the residents. So that any risks to cross infection is minimised, the floor coverings in the communal bathrooms and toilets should be replaced. A review of staffing numbers and competences should be carried out so that the resident’s needs are fully met. The registered person should ensure that the manager’s supernumerary hours are reviewed and increased to ensure sufficient time to carry out their duties. 2. 3. 4. 5. OP16 OP19 OP27 OP38 Balmoral Nursing Home DS0000025428.V349152.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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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