CARE HOMES FOR OLDER PEOPLE
Balmore Country House Care Home 245/247 Loughborough Road Ruddington Nottinghamshire NG11 6NY Lead Inspector
Karmon Hawley Unannounced Inspection 12th January 2006 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 Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 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. Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Balmore Country House Care Home Address 245/247 Loughborough Road Ruddington Nottinghamshire NG11 6NY 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) 01159213006 01159213006 Ruddington Nursing Homes Limited Angela May Dunkley Care Home 54 Category(ies) of Old age, not falling within any other category registration, with number (54), Physical disability (4), Terminally ill (2) of places Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Within the total number of beds a maximum of 2 beds may be used for the category TI Within the total number of beds a maximum of 4 beds may be used for the category PD with 3 of those for 59 years and above 07/06/05 Date of last inspection Brief Description of the Service: Balmore Country House Care Home provides nursing and personal care for up to 54 older people. Balmore is a converted and extended property set in pleasant and extensive grounds in Ruddington village, near Nottingham. There is a welcoming atmosphere for service users and relatives as well as professionals visiting the home. There are several sitting rooms and a private sun room offering sufficient space for service users. There is a passenger lift providing access to the upper floor and there is access for wheelchairs throughout the home. Regular church services are held within the home and there is also an activities coordinator who provided structured activities. Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place in three and a half hours and was performed by one inspectors. The main method of inspection was case tracking, this is a method of sampling the records of four randomly selected service users to ascertain if the needs of service users are appropriately assessed and identified needs are being catered for by the home to maintain optimum health and wellbeing of the service user. Five service users were spoken with so as to give the inspectors an insight into the conditions and standards within the home. Those spoken with were happy with the staff, care received and the standards within the home. The registered manager assisted in the inspection process and two members of staff were spoken with. Staff were able to demonstrate a good understanding of service users needs and the core values and principles in relation to their job role. The focus of this inspection was to concentrates on the remaining core standards not assessed and the requirements made at the previous inspection. What the service does well: What has improved since the last inspection?
There have been many improvements since the previous inspection. An vice administration assistant has now been employed and is making significant
Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 Page 6 progress in reorganisation of the filing systems, thus ensuring continuity of care for service users and a more organised working environment. Care plans have also continued to improve; ensuring identified needs are met and supported. Further attention has been given to risk assessments ensuring service users are fully protected. The manager has discussed the need for service users reviews to become more service user focused and it is the intention that as well as monthly reviews relevant others will be invited to join in reviews on a quarterly basis to enable this process. Liaison has taken place with the environmental health officer with regards to hazard analysis ensuring food safety is maintained. Photographic identification and criminal records bureau evidence is now in place further protecting service users. All staff are issued with the General Social Care Council Code of Conduct ensuring professionalism is maintained. Staff training records demonstrated that staff received satisfactory training in mandatory areas, thus enabling service users needs to be fully met. Staff now receive supervisions in order to develop their practice. 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. Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 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 Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users can be assured their needs will be assessed and met prior to entering the home. EVIDENCE: Preadmission assessments cover the requirements of the standard. All service users are assessed prior to admission into the home and needs are discussed with the service users and relatives to ensure these can be met. Informal visits to the home can be arranged prior to admission. Evidence was available to substantiate these findings. Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9 Service users health, personal and social care needs are set out in an individual plan of care. Medication procedures require minor attention to ensure the safety of service users. EVIDENCE: Four service users case files were examined which demonstrated that service users undergo various assessments such as the activities of daily living, pressure area care, manual handling, falls, infection and nutrition. Information from these assessments forms the basis of the plan of care. Plans of care in place were a combination of pre-printed and handwritten plans; they demonstrated that individuality had been considered, as alterations were made as necessary. Care plans reflected choices and preferences. Relevant risk assessments were in place for identified needs. Evidence was available to demonstrate that the multidisciplinary team and other specialist services are accessed as required. Progress notes and communication sheets recorded significant events. Medications examined on the day of inspection demonstrated not all service users had photographic identification in place, nor on plans of care.
Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 Page 10 Handwritten entries did not have two signatures to demonstrate it had been checked as correct. In one instance the medication record did not correspond with the prescription. Relevant policies were in place, new contacts are currently being finalised due to the changes in legislation and the disposals of medicines, the policy is due to be changed imminently to reflect this. Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14 Service users are enabled to exercise choice and control over their lives and maintain contact with relevant others and the local community as they wish. EVIDENCE: There are no restrictions placed upon visiting times and visitors may be received in private in the sunshine room or service users own rooms should they wish. Service users spoken with substantiated this. A door code has been put on the main door due to current service users needs, however so as not to place restrictions upon visitors or service users, should the need arise the code is given to enable access/exit. Community contacts are maintained with the local church who visits the home on a monthly basis, choirs also visit on special celebrations. Service users are also enabled to maintain contact via trips out with relatives. If able service users are facilitated to maintain control over their personal finances and in order to protect these or any belongings rooms all have locks on the doors. Service user are able to bring in personal possessions should they wish in order to make their room more homely, this was observed during the tour of the home. Service users may access their records should they desire. Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users are protected from abuse. EVIDENCE: Not fully assessed during this inspection. In accordance with the previous requirement set evidence with regards to photographic identification and criminal records disclosure checks was observed. Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Service users live in a safe, satisfactory maintained environment, which is clean, pleasant and hygienic. EVIDENCE: A maintenance man is employed who ensures all maintenance work is carried out routinely; records were observed which demonstrate this. Decoration is at a satisfactory standard, there are minor areas that require slight attention, the manager stated this is done when there is the facility to accommodate service users in alternative rooms. The garden was pleasant and well maintained. The fire officer has visited the home and requirements set have been actioned. The environmental health officer has also visited the home in December of last year, the letter was not available for inspection however the manager stated a new freezer as required had been purchased. Sufficient domestic staff are employed to maintain the cleanliness of the home. Relevant aids adaptations and equipment was noted to be in place during the tour of the home.
Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 Page 14 Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 Service users are in safe hands at all times. EVIDENCE: All staff undergo a recognised training programme during the induction period, evidence of which was observed. A total of fifteen staff out of 31 are qualified at the National Vocational Qualification level two or above, therefore approximately 50 percent has been achieved. Staff spoken with were able to demonstrate understanding of service users needs and the core values and principles, one had attained a qualification whereas the other was hoping to commence level two training. Staff showed a genuine compassion and understanding of service users needs and this was observed during practice. Service users spoken with express that safe were kind and thoughtful and they felt settled and safe within the environment and their needs are met. Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35,38 Service users personal finances are protected. Whilst the health, safety and welfare of service users is protected this may be compromised due to the lack of documentary evidence available to demonstrate relevant servicing has taken place. The minor deficits within the safe administration and recording of medications may also compromise service user safety. EVIDENCE: The home does not deal with service users personal finances. Should assistance be required a court of protection or power of attorney is applied for and dealt with by either relatives or solicitor.
Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 Page 17 Maintenance and servicing certificates were observed and were satisfactory with the exception of the mains electrical check which was out of date, advise was sought with regards to this on the day of inspection and plans are in place to carry out this work. The gas certificate was also not available for inspection. Staff training demonstrated that staff are trained to a satisfactory level in all mandatory training. Minor deficits were noted in the medicines procedure as noted in standard 9. Accident records were observed and relevant information was available. Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 Page 18 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 2 Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 Page 19 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. 1. Standard OP9 Regulation 13(2) schedule 3(2) Requirement The responsible individual is required to ensure that safe systems are in place with regards to the administration and recording of medication to fully protect service users. A photograph of each service user is required to aid the identification process. The responsible individual is required to provide evidence of the maintenance and servicing certificates identified have taken place. Timescale for action 20/01/06 2. OP38 23(1) 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Balmore Country House Care Home DS0000026415.V267678.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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