Inspection on 07/06/05 for Balmore Country House Care Home

This inspection was carried out on 7th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 04/07/06

Balmore Country House Care Home 12/01/06

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 Unannounced 07/06/05 10.00am 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. Balmore Country House Care Home C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Balmore Country House Care Home Address 245-247 Loughborough Road Ruddington Nottinghamshire NG11 6NY 0115 9213006 0115 9213006 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) Ruddington Nursing Homes Ltd Angela May Dunkley CRH 54 Category(ies) of 54 0P registration, with number 4 PD of places 2 TI Balmore Country House Care Home C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31/03/05 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 C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place in one day, four staff members and four service users were spoken with. Four service users case files and other relevant records with regards to their care and the environment were examined. What the service does well: What has improved since the last inspection? What they could do better: There are several areas that may be improved thus requirements and recommendations have been set with this regard. These include the Balmore Country House Care Home C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 Page 6 preadmission process, risk assessments, service users reviews and staffing issues. 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 C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 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 Balmore Country House Care Home C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 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) 1,2,3,5 The statement of purpose and service user guide reflects the homes ethos and promotes an informed choice. Despite preadmission assessments not being fully suitable it is ensured that needs can be met prior to placement being offered. EVIDENCE: Both the statement of purpose and service user guide is given to service users and appropriate others on admission. Information available is in depth and covers the recommendations of the standards. Terms and conditions of admission are also within the guide, which outline the contract. Completed contracts were not available for inspection as these are stored at the central office. The preadmission assessment currently in use does not cover the recommendations of the standard, however the manager stated this was due to previous advice given, therefore this would be readdressed. Trial visits are not arranged unless under respite conditions, emergency admissions are not accepted. Potential service users are visited and assessed prior to entering the home to ensure their needs can be met. One service user spoken with was able to substantiated information had been received and a pre admission assessment taken had place. Balmore Country House Care Home C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 Page 9 Balmore Country House Care Home C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 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) 7,8,10,11 Assessments and plans of care are sufficient, however adjustments are required to demonstrate how needs are being met and how risk is managed. Service users health care needs are met and appropriate services accessed. Privacy and dignity of service users is maintained and preferences taken into consideration. EVIDENCE: Various assessment tools are in use to ascertain service users needs and assist in the formulation of plans of care, which are based upon the activities of daily living. Complex needs were identified with the exception of communication in one case file observed; this was implemented during the inspection. Risk agreements and assessments take place, however within one file appropriate assessments were not in place, again this was implemented during the inspection. The majority of risk assessments in place did not identify the management of the risk. Progress notes are kept as required which are supplemented with reviews of identified needs, whilst these contained sufficient information in all but one file examined these were not service user focussed and in one case not up to date. Communication sheets with regards to contact with relevant others were in depth. There is evidence of specialist Balmore Country House Care Home C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 Page 11 contacts and services being accessed and specialist equipment and aids available. One service user confirmed she had a specialist cushion. Privacy and dignity of service users is maintained by policies and practices employed. Issues with regards to death and dying are treated sensitively and required information is available to ensure this is dealt with according to needs and wishes; relatives are supported and may stay over if required. Support services are accessed and relevant equipment provided. Balmore Country House Care Home C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 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) 12,15 There are sufficient activities available to the majority of service users are enabled their expressed needs. A wholesome and preferences are taken into consideration, to ensuring risk analysis takes place. EVIDENCE: offer a structured day if required, and to achieve a lifestyle that satisfies appealing diet is on offer and however further attention is required An activities coordinator is employed and structured activities are on offer. There is an allocated budget and a resident’s fund to enable resources to be obtained. One service user spoken with stated she joins in the activities, whereas another despite complaining of boredom did not wish to. 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. Three service users stated their needs are met, staff listen to them and they are well looked after whereas one service user expressed dissatisfaction of care received and stated staff shout at him, this was investigated during this inspection. 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 with the exception of hazard Balmore Country House Care Home C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 Page 13 analysis critical control points. Staff training is up to date and on display. One service user spoken with stated meals were marvellous and were plentiful. Balmore Country House Care Home C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 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 received are taken seriously and acted upon promptly to ensure resolved. Service users are protected from abuse, however further more in depth training would further promote protection and should be considered. EVIDENCE: The complaints procedure is clear, simple and accessible. Relevant information is displayed and distributed on admission. The manger has an open door policy so she is available at all times. Records with regards to complaints were available. There is currently one ongoing complaint being dealt with, which was investigated during this inspection. The Nottinghamshire Guidelines for Adult Protection available and this is supplemented by the homes own policy. The manager delivers in house training sessions on adult abuse, however she stated she requires updating in this area. Balmore Country House Care Home C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 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) EVIDENCE: Not assessed. Balmore Country House Care Home C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 Page 16 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) 27,29,30 Whilst it is considered staffing levels are sufficient, staff needs and opinions must be considered and this issue revisited to ensure service users needs are fully met with a quality service. Recruitment policies are sufficient in ensuring the protection of service users. Staff training taken place should be consolidated to demonstrate staff are trained and competent to do their jobs. EVIDENCE: Whilst staff files observed contained relevant information, within some criminal record bureau checks and photographic identification was not available. The manger stated all staff have had criminal records checks, however records were held at head office. A new employee due to commence work has all the required documentation in place. Staff rotas were observed and the manager stated she follows the guidelines of the residential forum and feels there are sufficient staff available to meet needs of service users. Two service users spoken with substantiated this, however staff expressed concerns with regards to meeting demands of the job and needs of service users. Staff training was not able to be fully assessed as records are kept within individual files. The manager stated that all staff have received manual handling training and twenty-one staff have received first aid training. The manager stated that some staff have been issued with the General Social Care Council code of conduct, staff spoken with were not able to substantiate this. Staff spoken with stated they felt more training is required. Balmore Country House Care Home C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 Page 17 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) 31,32,33,36 The manager has sufficient knowledge and skills to ensure the smooth and continued running of the home thus promoting an effective working team. Quality assurance results are acted upon to ensure service users needs are addressed. Supervision sessions whilst offered are of no benefit if staff do not access this resource and should therefore be implemented formally. EVIDENCE: The manager has been in post for two 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. Supervisions are offered informally, however staff do not access this facility. Quality assurance audits are carried out and evidence was observed. Results are discussed with staff and improvements made if required. Staff spoken with stated the home was in general well run and good relations are maintained. They substantiated Balmore Country House Care Home C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 Page 18 supervisions are available, however these are not used. One service user spoken with however did not feel the manager is approachable and the home is well run, this is currently being dealt with, whereas three other service users spoken with stated staff were friendly and they were listened to. Balmore Country House Care Home C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 1 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 1 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 2 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 3 3 3 x x 1 x x Balmore Country House Care Home C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 Page 20 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 OP3 Regulation 14(1a,b,c d) 14(4b) 15(1) Requirement Pre admission assessments require adjustment to ensure all necessary information is obtained Risk assessments are required to demonstrate how the risk will be managed. Identified needs must have a plan of care in place to ensure service users needs are fully met. Reviews are to be service user focussed to reflect care and outcome. Further advice and guidance is to be sought with regards to food safety. Staff employed are required to have photographic identification and evidence of Criminal Records Bureau checks in place. All staff are required to be issued with the General Social Care Council code of conduct. Evidence is required to demonstrate sufficient staff training has taken place to ensure staff individually and collectively have the skills and knowledge to meet the needs of service users. Timescale for action 30th July 2005 30th July 2005 30th July 2005 30th July 2005 15th August 2005 30th July 2005 15th August 2005 15th August 2005 2. 3. OP7 OP7 4. 5. 6. OP7 OP15 OP29 15(2b,c) 13(4c) 19(1,b,i, schedule 2) 18(4) 18(1c) 7. 8. Op29 OP30 Balmore Country House Care Home C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 Page 21 9. OP36 18(2) Staff are to receive formal supervision sessions. 20th August 2005 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 OP2 OP27 OP36 Good Practice Recommendations Copies of signed service users contracts are available for inspection. Staff opinions and expressed concerns are taken into consideration with regards to staffing levels and providing a quality service. Care staff receive formal supervision at least six times a year. Balmore Country House Care Home C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Edgeley House 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 C53 C03 S26415 Balmore V232910 070605 Stage 4.doc Version 1.30 Page 23 - 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. 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