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Inspection on 06/05/05 for Balmoral Nursing Home

Also see our care home review for Balmoral Nursing Home for more information

This inspection was carried out on 6th May 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service makes sure that service users know that there needs will be met at the home, and that if they were ill they would receive the professional attention they needed. Service users were encouraged to keep in contact with their family and friends and all who visit the home were made welcome. The service users were satisfied with the meals provided and said they were asked what they wanted to eat and were given choices at each meal. When the home received complaints they did take them seriously and sort them out quickly. The service users said there was usually enough staff on duty and they were confident that staff were able to do their job well. The manager had a lot of contact with the service users and their family giving them the chance to say what they thought of the care.

What has improved since the last inspection?

Since the last inspection the home had reviewed and improved the arrangements for preventing the spread of infectious diseases. Photographs of staff and proof of criminal records checks had been added to the staff files. The service users said that improvements had been made with the menu and the food provided. The cooks said that they did talk with service users about what meals they preferred and that changes were made to provide what service users wanted.

What the care home could do better:

The home could make sure that service users or their relatives were provided with a contact that tells them the rules about staying at the home. Some changes could be made to make service users privacy better and some staff could benefit from some more training about how to speak respectfully to service users.

CARE HOMES FOR OLDER PEOPLE Balmoral 6 Beighton Road Wodhouse Sheffield S13 7PR Lead Inspector Shirley Samuels Unannounced 6 May 2005 8:00-16:00 th 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 J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Balmoral Nursing Home Address 6 Beighton Road Woodhouse Sheffield S13 7PR 0114 254 0635 0114 254 8109 None Four Seasons Healthcare (England) Limited 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) Mrs Trudi Ashmoor N Care Home with Nursing 90 Category(ies) of OP Ald Age (90) registration, with number of places Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 07 September 2004 Brief Description of the Service: Balmoral is a pupose 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. It has TV lounges and sitting rooms. There are separate dining rooms were service users are able to have meals with other service users or their relatives. Chiropodist, hairdressers and various complementary therapist attend the home. Whist the majority of the service users are permanent, the home also provides short term and respite care. Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over 8 hours from 8:0016:00. (20) service users, (5) relatives and (4) staff were spoken to find out what they felt about the service and the way the staff cared for the service users. A selection of records was checked and a tour of the building made to check on the condition of the décor, furniture furnishings and the cleanliness. What the service does well: What has improved since the last inspection? Since the last inspection the home had reviewed and improved the arrangements for preventing the spread of infectious diseases. Photographs of staff and proof of criminal records checks had been added to the staff files. The service users said that improvements had been made with the menu and the food provided. The cooks said that they did talk with service users about what meals they preferred and that changes were made to provide what service users wanted. Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 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 J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 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) 2 & 3 Each service user was not provided with a written contract or terms and conditions with the home, but was provided with a written statement of the fee to be paid. Service users did not move into the home without having their needs assessed and receiving written confirmation from the home that their needs could be met. The home did not provide Intermediate care. EVIDENCE: The manager said that the standard contract was under review and was not being issued to service users. Limiting the information provided to service users and their relatives about the terms and conditions attached to moving into the home. On each of the service user files checked, there was a copy of the assessment carried out by a social worker in addition to an assessment carried out by the homes manager prior to admission to the home. Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 Page 9 A copy of a letter sent to the service user, from the home stating that following the assessment the home was able to meet their assessed need was also seen. Providing assurance to the service user that there needs would be met. Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 8 &10 Service users health care needs were fully met by the staff at the home and other health care professionals. Service users were in the main treated with respect and their right to privacy was upheld. EVIDENCE: Records of health care needs, health care provided and the action needed and taken by staff to meet service users needs were kept on service users files. Ensuring that written information was in place for staff to read to inform themselves of service user need and what they needed to do. Relatives said that they were kept informed of any heath care issues. One relative said” I find the care given to my mother is excellent, I do find the staff are understanding and kind to myself and my family when my mum is unwell”. Another relative said” my husband is very ill at the moment, the staff are wonderful to him and to me, when needed I am able to stay over night to be with my husband, this brings us both a lot of comfort”. Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 Page 11 Observation was made of staff approaching service users with respect and promoting their privacy by knocking on doors and talking to service users about personal matters in a discreet manner. Showing respect for service users and promoting their right to privacy. Observation was made of one member of staff shouting at a service user telling them to “stop showing off” immediate action was taken by the nurse in charge of the unit and the incident reported to the manager of the home. Reinforcing to staff that this kind of approach to service users will not go unchallenged and to reassure service users that they have a right to be treated with respect at all times. Personal information describing the eating and swallowing needs of a service user was publicly posted on the wall in the dining area. Service services files and one prescription was insecurely stored. Bedroom doors were not fitted with locks and the keys to some of the lockable drawers in the bedrooms were missing. All affecting service users right to privacy. Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,14 &15 Service users did maintain contact with their family and friends and members of the local community if they wished, there were no unnecessary restrictions on visiting and visitors were made welcome. Service users were helped to exercise choice and control over their lives. Meals were provided in pleasing surroundings, and were wholesome appealing and balanced. EVIDENCE: The relatives spoken to said they were able to see their relative in private and were always made welcome. Promoting good relationships between the staff and visitors. Service users said they were able to choose who to see and who not to see. Upholding their right to make choices ad exercise control over their lives. All the service users said the food was “very Good” or “excellent”. They said they were asked what sort of meals they preferred and given two choices at each meal. Ensuring that service users dietary needs were met. Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 Page 13 Liquidized meals were provided to some service users, service users said the staff did their best to make sure these were provided in a manner which was attractive and appealing, encouraging service users to eat and enjoy their meals. The cooks said that a number of service users needed their food liquidized and that a new liquidizer had been purchased, but was too small. Resulting in a lot time being wasted as only small potions could be liquidized at a time. Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 &18 Complaints made by service users or their relatives were taken seriously and acted upon. Service users were protected from abuse, and where allegations of abuse were made immediate action was taken to protect the service users. EVIDENCE: Since the last inspection the home had received one complaint. Relating to health care information passed to the NHS on admission to hospital. This was investigated by the home and partially substantiated. The complainant received a response within the 28 days and the home reviewed the procedures to improve practice and to ensure the safety and welfare of the service users. The relatives and service users said that they were satisfied with the way comments and concerns were dealt with by the home. Promoting confidence in the homes complaints procedures. The manager carried out unannounced out of hour’s visits to the home. During one of these visits (since the last inspection) a member of staff was overheard being verbally abusive to a service user. This individual was suspended immediately and following an investigation dismissed, and has been referred to POVA. Reducing the risk of further abuse of service users, and sending a clear message to all staff that abusive practice will not be tolerated and reassuring service users that they will be protected. Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 Page 15 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 The environment was safe reasonably maintained clean and hygienic. All areas used by service users were accessible. The décor and flooring in some areas of the home was below the required standard and in need redecorating and replacement. EVIDENCE: There was a handy person employed at the home who had responsibility for repairs and maintenance ensuring that repairs and maintenance was carried out quickly. Service users said they were satisfied with their bedrooms the furniture and the décor providing a comfortable and pleasing space to spend time In if they wished. The staff and service users said faults and general housekeeping problems were soon sorted out, reducing the risk accidents. Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 Page 16 The carpets and floor coverings particularly in the communal areas including corridor areas were stained and worn, some wallpaper was damaged faded and paintwork was chipped and shabby creating an impression of neglect Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 Page 17 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 Service users needs were met by the number and skill mix of the staff, who received the training and guidance they needed to do their job, and training was ongoing. Service users were supported and protected by the homes recruitment policies and procedures. EVIDENCE: The staffing levels agreed at the time of registration were being maintained in line with the ratio of staff to service users. Ensuring that there was enough staff on duty to respond to the needs of the service users. Service users said there was usually enough staff and they did know how to look after them and said, “when ever I need help I ring my buzzer and they always come straight away”. Observations were made of staff attending promptly to the needs of the service users. For those being nursed in bed regular checks were made and records kept detailing the care given along with dates and times, demonstrating staff competence. The manager said that they had problems with the NVQ training, but added that the problems were being sorted out. Ensuring that the remainder of the staff would be trained to NVQ level 2 in care. Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 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) 31,33,35 & 38 The home was run in a way that promoted the best interest of the service users, with their financial interest being safeguarded. In general the health safety and welfare of the service users and staff was promoted and protected. EVIDENCE: The line manager of the home carried out regular visits to the home spoke to service users and staff about the service received and the management of the home, ensuring that their view were sought and acted upon. Service users said they were satisfied with the financial arrangements in place, making sure their best interests were safeguarded. Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 Page 19 The manager was working though the NVQ level 4 in management, to achieve the standard required for registered managers. Staff were observed using safe moving and handling methods, ensuring the safety of both service users and staff. There was a heated, unattended food trolley in the downstairs dining area creating a safety hazard for service users, should they tamper with it. Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 2 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 3 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 x 3 x 3 x x 2 Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation 5 Requirement Each service user must be provided with a written contract/statement of terms and conditions with the home.(pevious timesale of,10/1/05 not met) To ensure that service users privacy is upheld personal information should not be publicly displayed and files should be securly stored. Arrangements must be made by further training or by any other measures to pevent service users being harmed are being placed at risk of harm or abuse. All areas used by service users including and floor coverings and the decor must be well maintained and in good condition. (previous timescale of,10/1/05 not met) All parts of the home to which service users have acces must be as far as possible, free from hazard to their safety. Timescale for action 10/10/05 2. 10 12 10/6/05 3. 18 13 10/6/05 4. 19 16 10/10/05 5. 38 13 6/5/05 as instructed on the day of the inspection. Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 Page 22 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. Refer to Standard 10 28 31 Good Practice Recommendations To promote service users right to privacy, locks should be fitted to bedroom doors and keys provided for the lockable drawers in the bedrooms. A minimum ratio of 50 of the care staff must be trained to NVQ level 2 in care by 2005. in addition to the qualified nurses. By 2005 the manager in addition to being a qualified nurse must also have the NVQ level 4 in management and care, or its equivelent Balmoral J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection Ground Floor, Unit 3 Waterside Court Bold Street Sheffield, S9 2LR 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 J55 21767 Balmoral V218854 04.05.05 UI Stage 4.doc Version 1.20 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!