Care Home: Balmore Country House Care Home

What the care home does well Potential service users have their needs assessed prior to admission, which means staff, will be able to plan for their individual needs and know how to care for them. Service users have the opportunity to participate in recreational activities within the home and maintain social contacts. Service users receive a nutritious and appetising diet with individual preferences and needs being met. Staff demonstrated that they are knowledgeable in relation to safeguarding adults and how to safeguard service users at the home. The home provides a clean well maintained environment that meets the needs of service users. Service users are supported by competent and qualified staff and are protected by the home`s recruitment policies and practices. There is evidence that the home is run in the best interests of service users and that the registered manager supports a team of staff to deliver safe and effective care. What has improved since the last inspection? The Registered manager demonstrated that all the registered nurses employed at the home now have an up to date registration number to show that they are registered to practice. Window restrictors have been installed to the service users bedroom on the first floor to ensure the safety of service users is promoted. The care plans for service users at the home are currently being re-evaluated to ensure they are person centred and highlight service users needs. Medication procedures and practices promote service users safety. Observed staff practices promotes service users dignity and respect. Service users feel able to raise concerns and complaints and the registered manager demonstrated that systems are now in place to record and investigate concerns and complaints. Staff undertake fire drills and emergency lighting tests are undertaken. What the care home could do better: The registered provider should ensure that consent to the content of the care plans is obtained from the service users or a representative of theirs. The registered provider should ensure that the all the service users care plans are reviewed as planned to ensure they are person centred. The registered provider should ensure that the care planning reformatting process ensures that out of date information is archived. Key inspection report Care homes for older people Name: Address: Balmore Country House Care Home 245/247 Loughborough Road Ruddington Nottinghamshire NG11 6NY     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: Steve Keeling     Date: 0 9 0 4 2 0 1 0 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 29 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Balmore Country House Care Home 245/247 Loughborough Road Ruddington Nottinghamshire NG11 6NY 01159213006 F/P01159213006 ruddhomes@talk21.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ruddington Nursing Homes Limited Name of registered manager (if applicable) Ms Julie Dawn Ward-Daft Type of registration: Number of places registered: care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 46 The registered person may provide the following categories of service only - Care Home with Nursing - 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 Physical Disability - Code PD Dementia - Code DE Date of last inspection Brief description of the care home Balmore Country House Care Home provides nursing and personal care for up to 50 older people. Balmore is a converted and extended property set in pleasant and Care Homes for Older People Page 4 of 29 Over 65 0 46 0 46 0 46 0 8 0 4 2 0 0 9 Brief description of the care home extensive grounds in Ruddington village, near Nottingham. There is a welcoming atmosphere for people using the service and relatives as well as professionals visiting the home. There are several sitting rooms and a private sun room offering sufficient space for people using the service. There is a passenger lift providing access to the upper floor and there is access for wheelchairs throughout the home. The current fees for the home, which are made available on the point of enquiry range between £355 to £550 per week. These fees do not include chiropody services, hairdressing services or newpapers. Care Homes for Older People Page 5 of 29 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: The focus of the inspection undertaken by the Quality Care Commission is upon outcomes for people who use the service (service users) and their views on the service provided. The process considers the providers capacity to meet regulatory requirements, minimum standards of practise, and focuses on aspects of service provision that needs further development. One inspector conducted the unannounced visit. The main method of inspection used is called case tracking which involves selecting service users and looking at the quality of care they receive by speaking to them, observation, reading their records and asking staff about their needs. Care Homes for Older People Page 6 of 29 The registered manager and members of staff were spoken with as part of the visit and records relating to medication management was also inspected to form an opinion about the quality of care provided. A partial tour of the building was undertaken which included service users bedrooms and communal areas they frequent to make sure that the environment is homely and safe. A review of all the information we have received about the home since the last key inspection was performed on the 08.04.2009 was considered in planning this visit which included the Annual Quality Assurance Assessment (AQAA) which was provided by the registered manager on the 12th February 2010. We also used the nine responses we have received from the fifteen Have Your Say service users pre inspection questionnaires and the eleven responses to the fifteen Have your Say staff surveys which were distributed at the home prior to the inspection process. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The registered provider should ensure that consent to the content of the care plans is obtained from the service users or a representative of theirs. The registered provider should ensure that the all the service users care plans are Care Homes for Older People Page 8 of 29 reviewed as planned to ensure they are person centred. The registered provider should ensure that the care planning reformatting process ensures that out of date information is archived. 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 29 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 29 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. Potential service users have their needs assessed prior to admission, which means staff, will be able to plan for their individual needs and know how to care for them. Evidence: Information provided by the registered manager in the Annual Quality Assurance Assessment states We regularly review and update our Statement of Purpose and Service Users Guide. Service user assessments are undertaken by the manager and clinical lead nurse. We have good communication with outside services such as general practitioners, occupational therapists, the district nursing team and social workers. The Have your Say pre inspection questionnaire asked service users Did you receive enough information to help you decide if this home was the right place for you before you moved in. Five respondents stated Yes and four respondents stated that their relatives arranged their admission for them. Care Homes for Older People Page 11 of 29 Evidence: Records showed that the case tracked service users had undergone a needs assessment before gaining residency and additional information from Social Services Department is incorporated into the evaluation process when available. Staff confirmed that the needs of all new service users are discussed at staff handovers, that the needs assessments are always available for reference and guidance and said that this helps them to be confident that they can meet the service users needs. Intermediate care services are not provided at the care home. Care Homes for Older People Page 12 of 29 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. Service users have care plans in place, which are currently undergoing a review process, to enable staff to deliver the appropriate care.Medication procedures and practises promote service users safety and service users are happy with the quality of care they receive. Evidence: Information provided by the registered manager in the Annual Quality Assurance Assessment states The requests and needs of service users are dealt with without fail. The staff work well as a team to achieve the best possible outcomes for the service users. The Have your Say pre inspection questionnaire asked staff Do you feel you have enough support, experience and knowledge to meet the different needs of the service users, nine respondents stated Always and two respondents stated Usually. The Have your Say pre inspection questionnaire asked service users Do you receive the care and support you need and Do you receive the medical support you need, Care Homes for Older People Page 13 of 29 Evidence: all nine respondents stated Always. Service users spoken with on the day of the inspection confirmed that they are able to see their General Practitioner on request and records showed that service users had received additional interventions from community based specialist nurses, chiropody services and opticians as required. The case tracked care plans contained useful information to inform staff of the needs of service users and that reviews of the care plans have been undertaken to address service users changing needs. It was noted that the care plans examined on the day of the inspection were very bulky and contained documentation which would require archiving. In addition the care plans did not show that consent to the content of the care plans had been obtained from the service users or a representative of theirs. The registered manager stated that these issues would be addressed as all the care plans are currently being amended and reviewed to make them more person centred, which is good practice. Staff spoken with on the day of the inspection confirmed that care plans are readily available throughout the 24 hour period should they be required for reference and guidance. It was confirmed by the registered manager and members of staff that medications are only administered by qualified nurses. A medication round was briefly observed, the Medication Administration Records (MAR) were maintained effectively and a qualified nurse was administering service users medication in a safe and competent manner. All service users spoken with confirmed they receive their medication as prescribed and expressed no concerns relating to medication management. Information provided by the registered manager in the Annual Quality Assurance Assessment states Staff are aware of the issues relating to privacy and dignity and continue to do their best to apply these to practise. The staff use the service users preferred mode of address and are friendly, ensuring that service users feel needed whilst promoting a homely atmosphere. Service users are treated as individuals and their independence and choice is encouraged every day. All service users spoken with on the day of the inspection said that all the staff are very are caring. Service users confirmed that their respect and dignity is always promoted by the care staff and expressed no concerns. Service users confirmed that the routine in the home is flexible in meeting their needs which further promotes their respect and dignity. A service user commented I can do what I want, I like to sit up quiet late and watch TV in my room and its great to have breakfast in bed the next morning. Care Homes for Older People Page 14 of 29 Evidence: A visitor confirmed that the staff are welcoming and respectful at all times, and said This is a really nice place, the staff are very good, I have no concerns. Throughout the day we observed interactions between the care staff and service users, it was evident that staff were supportive and promoted a relaxed, caring environment thus affording the service users with dignity and choice at all times. Care Homes for Older People Page 15 of 29 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. Service users have the opportunity to participate in recreational activities within the home and maintain social contacts. Service users receive a nutritious and appetising diet with individual preferences and needs being met. Evidence: Information provided by the registered manager in the Annual Quality Assurance Assessment states We provide two activities coordinators working five day per week who offer a wide range of activities throughout the home such as group activities, trips out and one to one sessions. We provide flexible activities and routines depending on the preferences of the service users. Weekly activities sheets are displayed but these activities can be changed at any time to meet the needs of our service users and promote their choices therefore we are able to offer individualised daily activities. We encourage family involvement in entertainment and outings. The Have your Say pre inspection questionnaire asked service users Does the home arrange activities that you can take part in if you wish, Seven respondents stated Always and two respondents stated Usually We discussed the provision of social activities with the service users on the day of the Care Homes for Older People Page 16 of 29 Evidence: inspection. The service users confirmed that the home arranges activities that they can take part in if they want to and service users stated were very satisfied with aspect of service provision. Service users and visitors to the home confirmed that their family and friends can visit the home at any time and that visitors are made very welcome. A visitor to the home stated that he had been visiting his mother for six months and had never witnessed anything that gave him cause for concern and praised the home in providing a good standard of care for his mother. The Have your Say pre inspection questionnaire asked service users Do you like the meals provided, two respondents stated Always and seven respondents stated Usually. Through discussion with the Chef if was determined that Menus are provided on a four weekly cycle and service users are given additional choices and if they want something different to what is on offer on the menu of the day. It was noted that the kitchen facility was maintained to a high standard and the Chef informed to us that the home has recently been awarded a four star rating from Rushcliffe Environmental Health Department. The Chef also confirmed that meat, fresh fruit and vegetables are locally sourced and an examination of the food stocks within the home evidenced that food supplies were plentiful and varied. Records showed, and staff confirmed that, specialist diets are catered for and systems are in place to ensure that staff are fully aware of the specialist dietary needs of the service users. On the day of the inspection we asked service users if they enjoyed the meals provided at the home, comments included The food is very good we have lots of choice and Its very nice. Service users also confirmed that drinks are readily available. It was observed that service users who required support from care staff during mealtimes were assisted in a sensitive and discrete manner thus ensuring their respect and dignity is maintained. Care Homes for Older People Page 17 of 29 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. Service users feel able to raise concerns and complaints and can be confident that the registered manager will act on them. Staff know how to safeguard service users. Evidence: At the last key inspection a requirement was issued to ensure that all concerns and complaints are logged to demonstrate that they have been fully investigated and resolved.The registered manager provided us with a complaints and concerns folder which showed that the requirement has been addressed. Information provided by the registered manager in the Annual Quality Assurance Assessment states The complaints policy is offered in several formats when requested. It is displayed on the notice board and is included in the Service Users Guide and employees handbook. We encourage the service users, visitors and staff to make a complaint which will be dealt with effectively. We ensure that any complaints or safeguarding issues are dealt with efficiently in a professional manner and inform relevant agencies immediately. The manager operates an open door policy 365 days a year and she is contactable via a mobile phone if not on duty. Protection of Vulnerable Adult checks, Criminal Record Bureau Checks, are undertaken and no one is employed without these checks. The Have your Say pre inspection questionnaire asked service users Is there someone you can speak to informally if you are not happy, all nine respondents Care Homes for Older People Page 18 of 29 Evidence: stated Yes although two respondents stated that they did not know how to make a formal complaint. The Have your Say pre inspection questionnaire asked staff Do you know what to do if someone has concerns about the home, all eleven respondents stated Yes. We asked a health care professional if she was confident that if she had any issues of concern or complaints they would be addressed effectively, her response was Yes, the manager is very approachable. A service users relative confirmed that he had received the homes complaints procedure when his relative gained residency at the home and when asked if he felt confident in highlighting any concerns or complaints, his response was Yes I have every confidence in the manager, any issues will always be sorted out. Since the last key inspection was performed we have been notified of several issues of concern which have either been investigated by the home or referred to local Safeguarding Adults teams. We discussed these issues with the registered manager who provided us with records which showed that satisfactory conclusions have been achieved. Records showed, and staff confirmed, that training in Safeguarding Adults has been provided within the induction process with additional refresher training being provided on an annual basis. We spoke to members of staff to determine their level of understanding in this area. The members of staff demonstrated a good level of knowledge and competency in this area and stated they were aware of the revised Nottinghamshire Safeguarding Adults procedure. Staff stated they would ensure the safety of the service user is maintained, document any concerns and complaints, refer to policies and procures, report the issues to the registered manager or nurse in charge. Staff also said that if they were not satisfied with the management of the concern or complaint they would refer the issue to the Local Safeguarding Adults team or the Care Quality Commission. Care Homes for Older People Page 19 of 29 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 provides a very clean well maintained environment that meets the needs of service users. Evidence: Information provided by the registered manager in the Annual Quality Assurance Assessment states Balmore provides a safe clean and well maintained environment. We undertake regular checks of the equipment and the homes environment. Infection control issues are acted on quickly and effectively. Service users are encouraged to personalise their bedrooms. The Have your Say pre inspection questionnaire asked service users Is the home fresh and clean, seven respondents stated Always and two respondents stated Usually. On the day of the inspection we asked service users if they are satisfied with the standard cleanliness in the home, comments included Yes very satisfied, its always clean and Its lovely and clean all the time, my bedroom is cleaned on a daily basis. Service users bedrooms and the communal areas that service uses frequent were inspected. All areas were well maintained, clean and fresh. Care Homes for Older People Page 20 of 29 Evidence: At the last key inspection an immediate requirement was issued to ensure that appropriate risk assessments and management plans are in place with regard to upstairs windows that had no restrictors in place. On the day of the inspection it was confirmed by the registered manager and the homes maintenance technician that the issue has now been addressed as all service users windows on the first floor now have appropriate window restrictors fitted. Care Homes for Older People Page 21 of 29 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. Service users are supported by competent and qualified staff and are protected by the homes recruitment policies and practises. Evidence: At the last key inspection an immediate requirement was issued to ensure that the qualified nurses have an up to date registration number to show they are registered to practice. During this inspection the manager provided evidence to show that she has initiated a system to monitor the expiry dates of all the qualified nursing staff Personal Identification Numbers (PIN) and records showed that all PIN numbers were in date. Information provided by the registered manager in the Annual Quality Assurance Assessment states Balmore continues to keep all long serving staff. Prospective employees are given a full interview process followed by reference checks, Protection of Vulnerable Adult checks, Criminal Record Bureau Checks and a mentoring system is in place. Prospective employees are introduced to service users and visitors and any comments made by service users are taken into account. We undertake a first day induction and all staff are provided with an induction course and are placed as extra on shift through out the induction period. The Have your Say pre inspection questionnaire asked service users Are staff available when you need them, five respondents stated Always and four Care Homes for Older People Page 22 of 29 Evidence: respondents stated Usually. The Have your Say pre inspection questionnaire asked staff Are their enough staff to meet the needs of all the service users four respondents stated Always and seven respondents stated Usually. The staffing levels at the home have been recently amended and increased to meet the needs of the service users. On the day of the inspection 37 service users were accommodated at the home being supported by two trained nurses, six care assistants, catering staff and domestic staff. The manager confirmed that she is not expected to provide direct care to the service users so as to be in a position to effectively manage the service. On the day of the inspection we asked service users and a visitor to the home if staff are available when needed, responses included Yes, the staff are very good and always available and I dont use my call button very much but when I do they [staff] are always available. We examined two staff recruitment files and it was evidents that they contained, Protection of Vulnerable Adult checks, Criminal Record Bureau Checks, an application form, two written references and proof of identity together with supervision notes. On the day of the inspection staff confirmed that an induction process was provided when they commenced employment and the registered manager confirmed that the induction process is based on Skills for Care common induction standards. A staff training matrix showed, and staff confirmed, that they are provided with additional refresher training to ensure they have the competency and skills to meet the needs of the service users. Care Homes for Older People Page 23 of 29 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 run in the best interests of service users and the registered manager provides effective support to ensure the team of staff can deliver safe and effective care. Evidence: The manager has been in post at the home since September 2009 but has over 14 years experience in managing care homes. She has a recognised degree level qualification in Management and has recently attended an interview at the Care Quality Commission where she demonstrated the skills and knowledge to manage Balmore County House Care Home. It was evident that the registered manager has invested considerable time and effort in addressing the concerns identified at our previous inspection and demonstrated a commitment to improve service provision at all levels. Records showed that the service users, their representatives and all grades of staff are Care Homes for Older People Page 24 of 29 Evidence: encouraged to contribute to developments within the home via service users and staff meetings which are performed on a regular basis. The Have your Say pre inspection questionnaire asked staff Does your manager give you enough support and meet you to discuss how you are working, ten respondents stated Regularly and one respondent stated Often. The Have your Say pre inspection questionnaire asked staff What do you think the home does well, comments included Balmore County House is excellent when it come to care, the staff are all trained to meet the needs of the service users,The management is responsible enough to give training to the staff and ensure they are updated on any new guidelines, The new manager listens if you need to say anything and the home caters well for all the service users and The home provides good training opportunities and promotes service users choice and dignity within a pleasant working atmosphere. On the day of the inspection staff confirmed that staff supervision is performed on a bi-monthly basis which gives them the opportunity to discuss any issues of concerns relating to the service provision. A member of staff commented I love working here, the care we provide is very good and I have no concerns at all. The Have your Say pre inspection questionnaire asked service users What do you think the home does well, comments included The home provides good care and the staff are friendly and reassuring and The home is very clean, they [staff] look after and care for me and are very friendly. On the day of the inspection we asked service users if they were confident in the registered managers abilities in relation to managing the service, comments included Yes she is very good, I have every confidence in her and I feel she is doing a good job. Through discussions with the registered manager it was determined that service users are provided with the opportunity to have small amounts of spending money securely stored within the home. We examined the financial records relating to financial transactions and it was shown that all transactions are recorded and receipts are obtained to ensure that service users are protected from financial abuse. The manager stated and staff confirmed that the homes policies and procedures are readily accessible to all staff and information provided within the Annual Quality Assurance Assessment shows that the policies and procedures are updated. Care Homes for Older People Page 25 of 29 Evidence: Service users health, safety and wellbeing is promoted by the provision of effective routine maintenance which includes electrical circuit safety tests, the maintenance of hoists and lifts, gas appliance tests and fire fighting equipment. Care Homes for Older People Page 26 of 29 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 27 of 29 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 7 The registered provider should ensure that consent to the content of the care plans is obtained from the service users or a representative of theirs whenever practically possible. The registered provider should ensure that the care planning re-formatting process ensures that out of date information is archived. The registered provider should ensure that the care plans are reviewed for all the service users to ensure they are all person centred. 2 7 3 7 Care Homes for Older People Page 28 of 29 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. 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