We carried out a review of the data available to us about Balgowan Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Balgowan Nursing Home, you can give feedback on this service.
Balgowan Nursing Home provides accommodation, nursing and personal care for up to 40 older people. Accommodation is provided in an old detached building with two newer purpose-built wings. At this inspection, there were 35 people living in the home. Accommodation is arranged over two floors. Access to each floor is gained by a lift, making all areas of the home accessible to the people who live there and visitors.
People’s experience of using this service and what we found
People continued to receive safe care and support by staff who had been appropriately recruited, trained to recognise signs of abuse or risk and understood what to do to safely support people. One person said, “It’s a good place to live and the staff look after our safety,” and “There is a locked door system, so no one can get in without being checked, very safe here.” Medicines were given safely to people by trained and knowledgeable staff, who had been assessed as competent. There were enough staff to meet people's needs. The provider used a dependency tool to determine staffing levels and if extra staff were needed, these were provided. For example, if a person was unwell and needed one to one care to keep them safe. Staffing levels were regularly reviewed following falls or changes in a person's health condition. Staff were deployed in a planned way, with the correct training, skills and experience to meet people’s needs. Safe recruitment practices had been followed before staff started working at the service. Infection control was well managed and the home was well-maintained and free from hazards.
Staff knew people and their needs well and received the training they needed to meet people’s needs safely and effectively. The training matrix tracked staff training and this had ensured all staff received the training and updates needed to provide safe consistent care. The staff rotas confirmed that staff deployment was consistent and that staff skills were considered when planning the rotas. A first aider and fire officer was deployed on each shift. A plan of supervision to support staff was available and this also included competency sessions on training received. One staff member said, “We have regular supervision, handovers and staff meetings. We can go to the manager anytime we need to.” People’s nutritional and health needs were consistently met with involvement from a variety of health and social care professionals. Peoples’ weight was monitored and fortified food provided when necessary. People enjoyed the food and comments included, “Good choice and usually tasty,” and “We get a good variety and plenty of fresh fruit and vegetables.” Visitors felt the chef was “Good” and the food always ‘nutritional’ and ‘looked nice’.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Everyone we spoke to was consistent in their views that staff were very kind, caring and supportive. People were relaxed, comfortable and happy in the company of staff and we saw positive staff interactions during the inspection. Visitors told us, “Good staff, always friendly and welcoming,” and “I can’t praise the staff enough for their good humour and kindness.” People’s independence was considered important by all staff and their privacy and dignity was also promoted.
Activities reflected people’s preferences and interests. People were encouraged to go out and meet family and friends and families were welcomed in to the home. Trips out were arranged to places of interest and to the local theatre.
Staff were committed to delivering care in a person-centred way based on people's preferences and wishes.
People were involved in their care planning as much as they could be and families told us that they were involved in the well-being of their loved ones. One visitor said, “The nursing staff keep me updated with any health issues with regard to my relative and are very quick to contact the GP and practice nurse with any concerns with my relative’s health as well as other health professionals.”
People were encouraged and supported to be involved in the running of the home and there was an ambassador who was very involved in the running of the home. For example, the ambassador led the resident’s meetings and met and greeted new people to help them settle in to the home.
People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated. The provider and registered manager were committed to continuously improve. They had developed structures and plans to develop and consistently drive improvement within the service and maintain their care delivery to a good standard.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 25 May 2017)
Why we inspected:
This was a planned inspection based on the previous rating.
Follow up:
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Balgowan Nursing Home provides accommodation, nursing and personal care for up to 40 older people. Accommodation is provided in an old detached building with two newer purpose-built wings. At this inspection, there were 38 people living in the home.
At the last Care Quality Commission (CQC) inspection in 07 October 2014, the service was rated Good in four domains, outstanding on Caring domain and Good overall.
At this inspection we found the service remained Good overall.
People continued to be safe at Balgowan Nursing Home. People were protected against the risk of abuse. We observed that people felt safe in the service. Staff recognised the signs of abuse or neglect and what to look out for. Medicines were managed safely and people received them as prescribed.
Staff knew how to protect people from the risk of abuse or harm. They followed appropriate guidance to minimise identified risks to people's health, safety and welfare. There were enough staff to keep people safe. The provider had appropriate arrangements in place to check the suitability and fitness of new staff.
Each person had an up to date care plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.
Members of staff felt supported by the registered manager, however one to one formal supervisions had not regularly taken place. Not all staff had received training in such areas like diabetes and safeguarding, which would enable them to meet people's needs effectively. We have made a recommendation about this.
People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services. Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.
Staff were caring and treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs. The policies and systems in the service supported this practice.
The registered manager ensured the complaints procedure was made available to people wished to make a complaint. Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.
The registered manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support. People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.
Further information is in the detailed findings below.
The inspection visit was unannounced. The previous inspection was carried out in September 2013, and there were no concerns.
The premises are an old detached building with two newer purpose-built wings. The service provides general nursing care and accommodation for up to 33 older people. There were no vacancies on the day of the inspection.
The service is run by a registered manager, who was present on the day of the inspection visit. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Two of the people in the home had been assessed as lacking mental capacity, and there were clear records to show who their representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment.
All staff had been trained in safeguarding adults, and discussions with them confirmed that they knew the action to take in the event of any suspicion of abuse. Staff knew about the whistle blowing policy, and were confident they could raise any concerns with the manager or outside agencies if indicated.
There were clear risk assessments in place for the environment, and for each individual person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. There were systems in place to review accidents and incidents and make any relevant improvements as a result.
People spoke highly of the manager and the staff throughout the day, with comments such as, “The manager and staff are kind, caring and helpful”; and “The staff are always here to help. When I call, they come quickly.” We saw that staff were in evidence throughout the day, and responded quickly to people’s requests for help. Staff interacted well with people, and supported them in carrying out their preferences. There were effective systems in place for ongoing staff training; and for staff supervision and support.
Staff files that we viewed contained the required recruitment information. New staff were taken through a comprehensive staff induction programme which included basic training subjects. They worked alongside other staff until they had been assessed as being competent to work on their own.
Medicines were managed and administered safely. People received their medicines on time.
People were supported in having a nutritious diet. The chef was considerate and caring in ensuring that people had dishes that they enjoyed; and in providing individual dishes for people to meet their specific choices.
People and their relatives told us that they were involved in their care planning, and that staff supported them in making arrangements to meet their health needs. Care plans were amended to show any changes, and care plans were routinely reviewed and audited to check that they were up to date.
Staff were informed about people’s individual lifestyles, and supported them in retaining their independence. People said that the staff were kind and caring ,and treated them with dignity and respect.
People were given individual support to carry out their preferred hobbies and interests, such as knitting, playing games and doing crosswords. The home had been modernised to provide suitable living accommodation, and there were plans in place for on-going improvements. The premises included a garden space which was available for wheelchair users.
The registered manager maintained good links with the local community; and invited local groups into the home to provide focal points of interest and entertainment.
There were systems in place to obtain people’s views. These included formal and informal meetings; events; questionnaires; and daily contact with the manager and nursing staff. People said that the registered manager was “Always available” and she was “Friendly and approachable.” One person said “I would not hesitate to ask the manager about any concerns; and I know she would deal with anything I was worried about.”
Staff were fully aware of the ethos of the home, in that they were there to work together for the good of the people in their care. People told us that the home ran just the same at night time and at weekends; and whether the registered manager was in the building or not. This demonstrated how the registered manager fostered a positive culture within the service, and ensured that staff knew the importance of putting people who used services first.
There were systems in place for record keeping and auditing records. The audits were generally well maintained, and showed how the registered manager initiated improvements as the result of their findings. There was a culture of continuous improvement, so that people would feel increasingly well cared for; and staff would develop their own roles to the maximum of their potential. The manager had started to meet with other managers in the company’s group of homes, so that they could discuss best practice and continually look for ways to improve the services.
We spoke with four people who used the service, and three visiting relatives. People we spoke with who used the service told us that they were happy with the care and support they received. They told us that they were involved in how their care and support was provided by the staff. One person told us "It's a wonderful place, couldn't be better" and another person commented 'it's great here'. A visiting relative told us 'I can't praise this place enough; they are above and beyond helpful'.
We looked at people's care plans and saw that they were individualised and contained people's choices and preferences. Risk assessments were in place to identify and minimise risks as far as possible to people who used the service.
We spoke with people who told us they felt that staff had the right skills to care for them and support their needs appropriately. We found that staff had supervision and support from their manager and that they undertook relevant training to keep their skills and knowledge up to date. A visiting relative told us 'the staff are wonderful here; always willing to help'.
We found that the home had a range of checks and audits in place to monitor cleanliness and to help prevent cross-infection in the home.
We found that the home kept accurate records and stored them safely and appropriately, to ensure people's details and information was protected.
People told us that they felt safe and we observed that people living in the home were very relaxed and comfortable within the environment. They interacted well with the staff who worked with them and who encouraged their independence.
Relatives of people that used the service told us they had no complaints with the service. One person said 'I think it is lovely, the best care home in Hythe'.