Care Home: Balmoral Court

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What the care home does well The home has a skilled and competent manager who has a good knowledge of the people living in the home including both their care needs and as individuals . The staff working in the home also know the residents well and use the knowledge to good effect when providing care to them. There are good social activities being offered to the people living in the home and this is offered in a way that takes into account their needs, choices and previous lifestyle. The home has a "bar" and a "team room" which is very effective in offering the residents a stimulating environment to have social event, spend time and enjoy each others company. The manager has a good relationship with visiting professionals and she makes sure that she seeks advice and support from them to make sure that any actions taken on behalf of a resident are made in their best interest. The home has a very pleasant atmosphere and visitors are made welcome when visiting their friends or relatives. A number of relatives spoken to during the visit were positive about the care being delivered and those residents who were able to express their opinions were complementary about the staff and the way they are supported an example being the "staff are lovely". The home has a number of residents who are very dependent and present challenging behavior. This is managed well by the staff on a day to day basis and the staff were observed being kind and patient during all of the care delivery and in the contact they have with them throughout the day. The home provides a good standard of food which is well prepared and offers choice and variety. The food served during the visit was well received by the residents. Those of them who were asked all said that they enjoyed it and that the food was "always lovely". They felt that they always had lots to eat and that they could have alternatives if the choices on the menu was not to their taste. Those residents not able to express themselves verbally were eating enthusiastically and were being supported in a kind and respectful way. The manager is continuing to work at making the improvements identified as a result of the quality assurance process and is looking at "best practice" advice to improve the specialist nature of the service they provide. What has improved since the last inspection? Significant improvements have been made since the last inspection these include the meeting the requirements identified. There are now sufficient staff on duty at all times this makes sure the safety of residents is maintained at all times. The way that complaints are managed are now effective and the records include details of any action taken as a result of the investigation and the response given to the person making complaint. The home is now odour free and there are good procedures in place to make sure that it remains so. Adequate signage is now in place in areas such as corridors and bedroom doors. This helps residents to find their way around the home. There are now good training records in place which are centrally held and updated regularly to ensure they are current and accurate. More than 50% of the staff have now achieved NVQ level 2 or above. What the care home could do better: No requirements were made as a result of this inspection. One recommendation was made, this is that the ongoing work to further improve the environment with signage go ahead as planned. Key inspection report Care homes for older people Name: Address: Balmoral Court Ayton Street Byker Newcastle Upon Tyne Tyne & Wear NE6 2DB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Suzanne McKean     Date: 1 5 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Balmoral Court Ayton Street Byker Newcastle Upon Tyne Tyne & Wear NE6 2DB 01912652666 01912652777 balmoral@ladhar.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Baldev Singh Ladhar care home 62 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Aged 55 and above on admission The maximum number of service users who can be accommodated is: 62 The registered person may provide the following category of service only: Care Home with Nursign - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 1 Dementia Code DE, maximum number of places 62 Date of last inspection Brief description of the care home Balmoral Court is a purpose built home providing nursing and social care to people suffering from Dementia. It is a large home providing 62 beds. The home is in Byker close to local shops and other public amenities. There are good transport links. The home is within easy reach of the busy Shields and Chillingham Roads. The home Care Homes for Older People Page 4 of 25 Over 65 0 1 62 0 Brief description of the care home adjoins Kensington, a general nursing care home owned by the same proprietor. Both homes share joint laundering and catering facilities. The fees range from #376 - #496 per week depending on whether social or nursing care is provided. Information brochures are available and the last inspection report is always available. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken Summary: This is an overview of what the inspector found during the inspection. How the inspection we carried out:- Before the visit we looked at, the information we have received since the last visit on 17th June 2008. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The views of people who use the service and their relatives, staff and other professionals. Care Homes for Older People Page 6 of 25 The visit: An unannounced visit was made on 15th June 2009 and the visited lasted six and a quarter hours. The visit was undertaken by the link inspector for the home. During the visit we: Talked with people who use the service, relatives, staff, the manager and visitors. Looked at information about the people who use the service and how well their needs are met. Looked at the records which must be kept. Checked the staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building and parts of the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last visit. We told the Manager what we found. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? Significant improvements have been made since the last inspection these include the meeting the requirements identified. There are now sufficient staff on duty at all times this makes sure the safety of residents is maintained at all times. The way that complaints are managed are now effective and the records include details of any action taken as a result of the investigation and the response given to the person making complaint. The home is now odour free and there are good procedures in place to make sure that it remains so. Adequate signage is now in place in areas such as corridors and bedroom doors. This Care Homes for Older People Page 8 of 25 helps residents to find their way around the home. There are now good training records in place which are centrally held and updated regularly to ensure they are current and accurate. More than 50 of the staff have now achieved NVQ level 2 or above. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a comprehensive assessment carried out by the staff prior to admission, which forms the basis for the development of the care plan. The home does not offer intermediate care. Evidence: There is a good brochure which gives information to prospective residents. All residents have access to a copy of the statement of purpose and service user guide for the home. Pre admission procedures remain the same and are comprehensive and detailed. The care files all have a pre admission assessment which contain the necessary information to make sure that they can make the judgment to offer a place in the home. The assessments identify the needs of the potential residents and this means that the place can be offered on the basis their needs and the category of care they Care Homes for Older People Page 11 of 25 Evidence: require. Care Homes for Older People Page 12 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good care planning and review processes make sure that staff are clear how they should meet the health, personal care and mental health needs of residents. This is done in a way that respects their views and supports them to retain control over the way they live their lives. Evidence: All residents in Balmoral Court have an individual plan of care which is created using the information collected in the pre. The format of care files is good, with information being easy to find and well organised. Residents and relatives are invited to read care plans, and sign that they have seen and agreed with them. Where residents are unable to sign, this has been recorded. The daily records and evaluations were up to date. The care plan interventions are detailed and contain personally relevant information care plans are person centered and individualised. Moving and handling care plans are generally good, with one example (which was Care Homes for Older People Page 13 of 25 Evidence: noted at the last visit) stating The assistance offered is by no means always necessary, and staff must allow (resident) the opportunity to mobilise independently while making it clear help is available if needed This is an example of good practice as it gives staff a very clear instruction about what is required while acknowledging a judgment must be made on their part. Similar entries have been made in the more recently written care plans. Behavior care plans are also very good, with detailed analysis of potential triggers to challenging behavior, and how staff might prevent occurrence or deal with it if it does happen. The health needs of residents are being met and residents are well cared for. Staff were attentive and friendly, they were knowledgeable about the way that each resident can be best supported and planned the routines of the day around their needs. The health of residents is carefully monitored. Regular assessments of their physical state such as nutrition, pressure ulcer risk and weight are carried out. All residents under 50kg are automatically placed on more stringent observation, and care plans are put in place. Residents in the home are treated with respect, and their dignity is maintained. Staff were seen to knock on residents bedroom doors before entering and net curtains provide additional privacy in overlooked bedrooms. Care Homes for Older People Page 14 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are very well supported to maintain social contacts and be involved in activities in the home so that they can live active and fulfilled lives in line with their abilities, choices and previous lifestyles. Evidence: There has been an activities coordinator appointed since the last inspection. Care records show that personal interests have been taken into account to use when planning activities. One care file contains pictures of the residents favorite places to visit. A record is kept where possible of their favorite things such as film star, pet etc. Notice boards display what events are happening and there are newsletters around the home. The notice board also records who has a birthday that month and links it to famous birthdays in the same month. There are a number of activities being offered to the people living in the home these are well organised and offer a number of choices. They are also flexible enough so that the people living in the home can make decisions as to what they wish to participate in. The residents are supported to live active and fulfilled lives. During the visit the residents were enjoying a number of activities including carpet bowels and Care Homes for Older People Page 15 of 25 Evidence: discussion groups. Some were spending time in their bedrooms and others in the communal spaces. The staff were spending time with the residents and were very patient and supportive. The lower ground floor has a room which has been made into a lounge/bar and has tables and chairs and a bar with bottles etc to simulate a public house. This is enjoyed by a number of the residents who use it for social activities. There is also a tea room on the same floor which residents spend time having tea a cakes. The hairdressing room is also on the same floor and this has been decorated and equipped effectively to give the impression of a hairdressers. Visitors are encouraged to visit the home at any reasonable time, and there were a number of visitors at the home during the inspection. Most are happy with the care provided, with the exception of the food. Visitors are able to visit in private. Care Homes for Older People Page 16 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good complaints and adult protection procedures result in the residents being protected and their concerns being dealt with in an effective way. Evidence: The home has a clear complaints procedure which is displayed in the home and is made available in the service user guide. This is easy to follow which means that the staff, residents and their relatives can understand how it is used if they have any concerns. A detailed list of complaints is available, and the follow up information is also available. A response is usually initially in writing, with an estimated time for completion of the investigation into the complaint given. Where this might take longer, another letter is sent indicating this. There have been some adult protection issues in the home since the last inspection which have been reported appropriately and dealt with by the home and relevant external professionals. Staff have received training in safeguarding adults issues and procedures. Care Homes for Older People Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and well maintained and there are design features in place to assist people who live in the home around their dementia care needs. Evidence: The home is a purpose built building with a large car park area to the front. The home has three floors and the entrance is on the middle floor as the building is on a slope. The lower floor is currently being used mainly as a social area and it has the services such as laundry and the kitchen. There is an ongoing redecorated programme in place and since the last inspection there has been a number of areas which have been redecorated and furnishings replaced. Bedrooms are nicely personalised and lounges are very homely and tastefully decorated. The work to introduce environmental changes that will help to provide more interesting spaces for people with dementia to explore, and also provide visual clues as to their whereabouts is ongoing. This has been effective. Corridors have been improved so that they no longer all look the same and there has been an increase in the use of signage to show residents where the toilet is. Bedroom doors have signage or clues as to who the room belongs to. Care Homes for Older People Page 18 of 25 Evidence: The top floor has been decorated with murals, to add interest and contrast between areas. These include meadows and snowy mountain scenes, seating at intervals along the corridor are popular with residents and they were moving around the areas. One resident was asked, what do you think of the decoration and he replied, I think we have done a really good job of it, its lovely. The home is generally clean and tidy. All remote kitchen areas are very clean and communal lounges bedrooms and dining areas are all clean. En suite bathrooms are clean and tidy. The Operations Manager regularly monitors the standard of cleanliness in the home, as part of her monthly visiting and reporting. Care Homes for Older People Page 19 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient numbers of safely recruited, well trained staff on duty to meet the needs of the people who live in the home. Evidence: On the day of the inspection, the staff on duty was, the Manager, two qualified nurses (one of which was the deputy) seven carers, two domestics, two laundry assistants, four staff in the kitchen, the handyman, administrator and the activities co-ordinator. Recruitment procedures are good. Two staff files were checked and found to contain all of the required information including criminal record checks and references. The training file and information about training completed was well organised and there was evidence in staff files that training has been carried out in food hygiene, infection control, health and safety, nutrition, dementia awareness, conflict resolution, safeguarding adults and fire awareness. The manager confirmed that fire safety training has been carried out by day and night staff, with night staff receiving it at the required three monthly intervals. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run in the interest of the people living in the home, protecting their rights and interests and safeguarding them by effective policies and procedures. Evidence: The home has a new manager, Linda Gonzalez, who has been appointed since the last inspection. She is not yet registered with the Care Quality Commission but she has however been register with us for two other care homes in the past. She has been qualified as a Registered Nurse for 20 years and has a background in both specialist acute nursing and in care of the elderly. She has worked as a care home manager for the past four years and prior to that had experience in other roles within the sector. Mrs Gonzalos has achieved the Registered managers award as well as having a Diploma in Health and Social Welfare and having a specialist training award in health promotion. The home is generally run in the best interests of service users. There are good Care Homes for Older People Page 21 of 25 Evidence: quality monitoring procedures and there are regular audits carried out by the senior managers. There is a programme of meetings arranged by the manager to make sure that everyone is kept informed about what it happening and have the opportunity to participate in the planning of the service. Records of staff meetings are in place for May 2009 and July 2009 and there was resident and relatives meetings in March and May 2009. The financial procedures have not changed since the last inspection. A random check was carried out on the balance of residents accounts and found to be correct. A written record of all transactions is maintained, and money is stored in the safe. Regular audits are carried out. Regular safety checks are carried out by maintenance staff and outside contractors. Hoists are checked twice a year and the lift is also serviced regularly. Regular maintenance checks are carried out, including fire alarms, emergency lighting, bed rails, boiler, fire blankets and window restrictors. There were no safety concerns identified during the inspection. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 19 It is recommended the manager continues to make the improvements necessary to provide the specialist dementia environment necessary for this client group. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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