Inspection on 04/07/06 for Balmore Country House Care Home

This inspection was carried out on 4th July 2006.

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.

Other inspections for this house

Balmore Country House Care Home 08/04/09

Balmore Country House Care Home 01/08/08

Balmore Country House Care Home 06/07/07

Balmore Country House Care Home 12/01/06

Balmore Country House Care Home 07/06/05

Balmore Country House Care Home 31/03/05

Balmore Country House Care Home 25/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Balmore Country House Care Home 245/247 Loughborough Road Ruddington Nottinghamshire NG11 6NY Lead Inspector Karmon Hawley Key Unannounced Inspection 4th July 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.V302755.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. Balmore Country House Care Home DS0000026415.V302755.R01.S.doc Version 5.2 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.V302755.R01.S.doc Version 5.2 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 12th January 2006 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. The current fees for the home, which are made available on the point of enquiry are as follows: residential shared room £291, residential high dependency £319, nursing basic starts at shared £343 up to single £625; prices are dependant on the room size and facilities on offer. Balmore Country House Care Home DS0000026415.V302755.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the site visit an analysis of the performance of the home over the previous year took place in line with the key national minimum standards. The evidence gained was assessed and thus the site visit planned in accordance with further evidence required to demonstrate compliance with the national minimum standards. The unannounced site visit took place in three and a half hours and was performed by one inspector. The main method of gaining evidence during the site visit 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. Four service users were spoken with, one relative and one visiting professional so as to give the inspector 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 manager assisted in the inspection process and two members of staff were spoken with. Staff were able to demonstrate an understanding of service users needs and the core values and principles in relation to their job role. What the service does well: A kind and caring ethos was prevalent throughout the home and a good rapport was evident between staff, service users and relatives. Service users spoken with expressed satisfaction with life within the home and care received, one service user stated the home was excellent and another stated that staff are respectful, always listen to needs and are available as needed. Both the relative and the visiting professional spoke highly of the home. Staff spoken with were able to discuss service users needs and the core values and principles, it was evident that service users quality of life was of a priority.’ Balmore Country House Care Home DS0000026415.V302755.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Develop service users plans of care to reflect individuality, choices, preferences and equality and diversity to ensure service users needs are fully met. Develop service users reviews to ensure they are service user focussed in order to reflect service users current conditions and care required. To ensure that safe systems are in place with regards to the administration and recording of medication to fully protect service users continues to be developed. All staff employed are required to have all items listed in schedule 2 available for inspection to ensure service users are fully protected. To continue to develop the quality assurance systems in place to fully demonstrate that the home is run in the best interest of service users. Balmore Country House Care Home DS0000026415.V302755.R01.S.doc Version 5.2 Page 7 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.V302755.R01.S.doc Version 5.2 Page 8 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.V302755.R01.S.doc Version 5.2 Page 9 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): 3 The quality rating for this outcome area is good this judgement was made using evidence available including a visit to the service. 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.V302755.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality rating for this outcome area is adequate this judgement has been made using evidence available including a visit to the service. Service users health, personal and social care needs are set out in a plan of care, however to ensure service users equality and diversity is fully recognised these are required to be further developed in order to reflect personal choices and preferences, reviews are also required to become service user focussed in order to reflect service users care and condition appropriately. Service users health care needs are fully met. Whilst improvements with respect to the homes medication policies and procedures are acknowledged, minor improvement are still required to ensure they are fully protected. Service users feel they are treated with respect and their rights to privacy is upheld. 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. A new manual Balmore Country House Care Home DS0000026415.V302755.R01.S.doc Version 5.2 Page 11 handling risk assessment, which is clear and simple to use, is now in place. Appropriate plans of care were in place in regards to highlighted needs. Plans of care were a combination of pre-printed and handwritten plans; individuality had been considered briefly however not all plans fully reflected choices, preferences and how the equality and diversity of service users is to be recognised and enhanced. Reviews were observed to be taking place however in the main these were not service user focussed to reflect service users current care and condition. Relevant risk assessments were in place for identified needs. Progress notes and communication sheets recorded significant events. Service users spoken with expressed staff were kind and caring and their needs were met. Staff spoken with were able to discuss the core values and principles and service users needs. There was evidence of specialist contacts and services being accessed and specialist equipment and aids available. One service user spoken with stated that they may request to see the doctor at any time. A new medication procedure had been implemented recently; there was evidence available to demonstrate that this had been fully discussed with staff along with improvements that were required. Medications checked against the prescription corresponded. An appropriate contract for the disposal of medicines is in place. All records were satisfactory with the exception of the hand written entries on medication charts, as these had not been signed by two members of staff to demonstrate that these were correct. Staff continue to be instructed in maintaining service users privacy and dignity at all times. Staff were able to discuss these issues and service users spoken with substantiated that privacy and dignity is maintained. Balmore Country House Care Home DS0000026415.V302755.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality rating for this outcome area is good this judgement was made using evidence available including a visit to the service. There are sufficient activities available to offer a structured day if required, and the majority of service users are enabled to achieve a lifestyle that satisfies their expressed needs. 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. A wholesome and appealing diet is on offer and preferences are taken into consideration. EVIDENCE: An activities coordinator is employed and structured activities are on offer. Seven service users were observed to be joining in activities on the day of the visit and a number were sitting out in the gardens. Records are kept of activities undertaken. Staff spoken with stated that activities take place and these are of benefit. A physiotherapist also visits the home twice a week and carries out one to one or group sessions. A church service is also held in the home on a monthly basis should service users wish to attend. Balmore Country House Care Home DS0000026415.V302755.R01.S.doc Version 5.2 Page 13 The routine of the home is stated to be flexible and service users spoken with substantiated this and stated they are able to make decisions as to how they spend their day. 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. Visitors as required have access to the door code so as to ensure they can gain access without restraint. One relative spoken with stated that they are always made welcome when they visit. Service users are enabled to maintain contact with the community as required. 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 and one service user spoken with substantiated this. Service users may access their records should they desire. In respect to equality and diversity the manager stated that this is respected and care is carried out accordingly, however she felt this could be improved upon in the plans of care now it had been raised. Staff spoken with were able to discuss the relevant issues with regards to ensuring service users equality and diversity is respected and maintained. A rolling menu is followed and offers a variety of choice, special diets are catered for and staff spoken with were knowledgeable in this area. There is a list detailing individual likes and dislikes and service user requirements. Appropriate records were noted to be in place. Staff training is up to date and on display. All service users spoken with spoke highly of the menu and meals on offer. Balmore Country House Care Home DS0000026415.V302755.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The quality rating for this outcome area is good this judgement was made using evidence available including a visit to the service. Service users and relevant others may be assured their complaints will be listened to taken seriously and acted upon. Whilst service users are protected from abuse this will be further enhanced once training has been completed. EVIDENCE: An appropriate complaints procedure is in place and service users and relatives may approach staff at any time should they have any concerns. There have been no complaints received since the previous inspection. Service users and the relative spoken with expressed no complaints. All staff have current criminal record bureau checks in place. The manager has commenced ensuring records of these are available on the premises. Whilst a number of staff have undertaken training in adult protection there are still a number who are to complete this training, plans are in place to introduce this in the induction programme and to up date all staff. Staff spoken with were able to discuss the relevant issue in regards to adult protection. Balmore Country House Care Home DS0000026415.V302755.R01.S.doc Version 5.2 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 the following standard(s): 19,26 The quality rating for this outcome area is good this judgement has been made using evidence available including a visit to the service. Service users live in a clean, pleasant, safe and well-maintained environment. EVIDENCE: An ongoing maintenance plan continues of which there was evidence available to substantiate this takes place. The manager is currently looking into having CCTV installed to improve the security of the home, however this is in the preliminary stages at present and consultation with appropriate others is due to take place. Following a recent visit from the fire authority a risk assessment has now been introduced. The gardens remain well maintained and a new summerhouse has been installed for service users use. Several service users stated that they may sit out in the garden when they wish which was very pleasant. The home was clean, pleasant and hygienic in all areas and appropriate equipment and facilities were in place. Balmore Country House Care Home DS0000026415.V302755.R01.S.doc Version 5.2 Page 16 Balmore Country House Care Home DS0000026415.V302755.R01.S.doc Version 5.2 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 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): 27,28,29,30 The quality rating for this outcome area is adequate this judgement was made using evidence available including a visit to the service. The number and skill mix of service users meets service users needs. Service users are in safe hands at all times. Minor improvements are required to ensure service users are fully protected by the homes recruitment and selection procedures. Staff are working towards ensuring they are trained and competent to do their jobs. EVIDENCE: The duty rotas were observed which demonstrated that sufficient staff are employed. Skill mix is taken into consideration when planning the duty rota. Staff spoken with sated there were sufficient staff available to meet service users needs, one service user spoken with substantiated this. The current level of staff trained to the national vocational qualification level two or above is 51 the induction programme is supplied by an outside agency and is in depth, there are plans to include the adult protection training in the induction. Four staff files were observed, three files did not contain all required information and documentation as listed in schedule two, the manager stated that she had discussed this with the sister home that morning so information Balmore Country House Care Home DS0000026415.V302755.R01.S.doc Version 5.2 Page 18 may be transferred as it is held there. Several copies of references were faxed through to the home during the visit. A training matrix has been completed this demonstrated that a wide and varied programme is planned. There were gaps in mandatory training however there were plans in place to address these. Service users, the relative and the visiting professional spoken with all stated that staff were kind and caring and maintained good quality care. Balmore Country House Care Home DS0000026415.V302755.R01.S.doc Version 5.2 Page 19 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): 31,33,35,38 The quality rating for this outcome area is adequate this judgement was made using evidence available including a visit to the service. The home is run and managed by a person who is fit to be in charge, of good character and able to discharge her responsibilities. There was evidence available to demonstrate that the home is working towards ensuring the home is run in the best interest of service users, however it is recommended that current systems in place are further developed to fully substantiate this. Service users financial interests are safeguarded. The health safety and welfare of service users and staff are promoted and safeguarded. EVIDENCE: Balmore Country House Care Home DS0000026415.V302755.R01.S.doc Version 5.2 Page 20 The manager has been in post for three years and is able to demonstrate experience and knowledge in her specialised area. She ensures she remains up to date with practices through training. An open door policy is maintained so staff, service users and relatives feel she is supportive and approachable. She ensures she works along side staff to maintain relations. She has now completed the registered managers award and has also updated her manual handling trainers course. Staff spoken with spoke highly of the manager and stated they were supported in their job roles. Questionnaires are no longer sent due to a poor response, therefore relatives meeting are held to gain feedback. Minutes of the previous meeting were observed, these demonstrated issues that were discussed, however did not fully reflect the outcomes for service users, this was discussed with the manager who is now intending to develop this further. 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. Maintenance and servicing certificates were observed and were satisfactory. Balmore Country House Care Home DS0000026415.V302755.R01.S.doc Version 5.2 Page 21 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 2 8 3 9 2 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Balmore Country House Care Home DS0000026415.V302755.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 12(2) 15(1) Requirement Develop service users plans of care to reflect individuality, choices, preferences and equality and diversity. Develop service users reviews to ensure they are service user focussed in order to reflect service users current conditions and care required. 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. This requirement has been partly met, outstanding issues must now be addressed to fully comply with this requirement. All staff employed are required to have all items listed in schedule 2 available for inspection. Timescale for action 05/10/06 2. OP7 15(2,b) 05/10/06 3 OP9 13(2)sche dule 3(2) 05/08/06 4 OP29 19(1,b,I) 05/08/06 Balmore Country House Care Home DS0000026415.V302755.R01.S.doc Version 5.2 Page 23 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 OP33 Good Practice Recommendations To continue to develop the quality assurance systems in place to fully demonstrate that the home is run in the best interest of service users. Balmore Country House Care Home DS0000026415.V302755.R01.S.doc Version 5.2 Page 24 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 © 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 Balmore Country House Care Home DS0000026415.V302755.R01.S.doc Version 5.2 Page 25 - 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. 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