Balmore Country House

Balmore Country House is a residential home providing personal and nursing care to up to 76 people. The service provides support to older people, some of whom may be living with dementia. At the time of our inspection there were 44 people using the service.

People’s experience of using this service and what we found

People’s medicines were not managed safely. There were concerns about the way medicines were stored, used, and disposed of. This placed people at significant risk of harm. Areas of the home were not clean. This placed people at risk of the spread of infection. Some parts of the premises were not safe, equipment was left in people’s bedrooms and not stored safely. This placed people at risk of harm.

There were sufficient staff in place; however, we had concerns about some of the staff and their approach and attitude to providing safe and compassionate care for people.

The home was not well managed. The provider had not ensured the registered manager had sufficient support to carry out their role effectively. Staff performance was inconsistent and poorly monitored. Some staff carried out their roles well, others, did not. This has impacted people’s health and safety. Quality assurance processes were ineffective. They had not highlighted most of the significant concerns we have identified during this inspection. This has placed people at risk of harm.

Staff had received the training the provider had deemed required for them to carry out their role effectively. However, staff performance was not appropriately monitored. Some poor staff actions have placed people at risk of harm. The premises was not always monitored for risk that could impact people’s safety. People did not always receive care and support in accordance with their assessed needs.

Some people felt lonely with limited interactions with staff and other people. We found people’s dignity was not always respected. Staff did not respond quickly enough to people who required their support to lead a dignified life. At times inspectors had to step in to reassure people and to seek the help they needed. Independence was not always encouraged and at times we witnessed staff actively discouraging a person’s attempts at independence.

Staff were not always responsive to people’s needs. Staff did not always call people by their preferred name. At times when we raised concerns with some staff they were reluctant to accept our findings.

We did observe some positive interactions between staff and people. Some staff were kind and caring with their approach and people liked this. Accidents and incidents were investigated and reported appropriately.

People were supported to have maximum choice and control of their lives and staff supported did them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 23 April 2020).

Why we inspected

The inspection was prompted in part due to concerns received about the provider’s management of incidents that affected the safety of people living at the home. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

Although we found no evidence during this inspection that people were at risk of harm from this concern, we did find significant failings in other key areas of care and governance.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Balmore Country House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to governance, medicines, premises and equipment and the provision of dignified care at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Balmore Country House is a care home providing nursing and personal care to 36 people at the time of the inspection. The service operated within an adapted building and specialised in supporting older people, people with physical disabilities, and people who are living with dementia. The care home could support up to 46 people and was undergoing building work at the time of the inspection.

People’s experience of using this service and what we found

People were protected from acquiring health infections. Staff used appropriate personal protective equipment such as gloves and aprons. People’s living environment was generally clean, however due to undergoing building work some areas of the home required better cleaning processes. The home ensured good staffing levels to meet people's needs. People received their medicines when they needed them from staff who were trained and had their competency regularly checked. People were safeguarded from the risk of abuse.

Pre-admission assessments were completed before people moved into the home to ensure staff could meet their needs. People’s needs and choices were assessed and evaluated regularly. People were supported by staff who were skilled, experienced and knowledgeable. People's dietary needs were met, and healthy eating was promoted. People lived in an environment which had been adapted to meet their needs.

People were supported by staff who treated them with kindness and compassion. The staff provided care in ways which maintained people's privacy, dignity and supported them to maintain their independence where possible. People were offered choices of what to eat and drink; and expressed their wishes about how they wanted to receive care. People told us they enjoyed the food that was provided.

People had comprehensive care plans in place, detailing individual needs and preferences, however, end of life care required updating to ensure accurate and detailed information was recorded. Systems were in place to gain and record people's consent. People were supported to take part in activities that were socially and culturally relevant to them.

The registered manager understood their responsibilities for being open and honest when something went wrong; and ensured the necessary notifications were made to the CQC and other relevant authorities. The provider had systems in place to monitor the quality of care provided. Staff were happy working for the service and felt supported by the registered manager. Partnership with health and social care professionals and various community services ensured people received joined up care.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 13 September 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.

We carried out our unannounced inspection visit on 25 July 2017. We returned announced on 1 August 2017.

Balmore Country House provides nursing and personal care for up to 46 older people and people with dementia and physical disabilities. On the day of our inspection there were 38 people using the service. At our last inspection we rated the service requires improvement overall. The provider had made the necessary improvements to the service people received.

The service had a registered manager. 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 2008 and associated Regulations about how the service is run.

Action had been taken following accidents or incidents to prevent further occurrences. Risks associated with people’s care needs and the environment had been assessed and measures put in place to prevent avoidable harm.

People were supported by staff who understood how to keep them safe and could raise concerns if they needed to. There were enough staff to meet people’s needs. The provider followed safe recruitment practice.

People received their medicines as prescribed by their doctor. People were supported to maintain their health and had access to health professionals.

People were supported by staff who had received training and support to meet their needs. Staff felt supported and their competency in their role was checked.

People were supported to have enough to eat and drink. Where people had dietary requirements, these were met and staff understood how to provide these.

People were supported in line with the requirements of the Mental Capacity Act. People’s mental capacity to consent to their care had been assessed where there was a reasonable belief that they may not be able to make a specific decision.

Staff at all levels treated people with kindness and compassion. Dignity and respect for people was promoted. People were supported to maintain their independence.

The care needs of people had been assessed and were regularly reviewed to ensure they continued to be met. Staff had a clear understanding of their role and how to support people who used the service.

People had access to activities so that they could follow their interests and remain active if they wanted to.

The registered manager had sought feedback from people and their relatives about the service that they received. We saw that they had taken action based on this feedback.

Staff felt supported. Where necessary the provider’s disciplinary procedures had been implemented.

People and their relatives felt the service was well led. They felt the registered manager was approachable and that they would deal with any concerns they may have. The registered manager had a good over sight of the service.

Systems were in place to monitor the quality of the service being provided and to drive improvement. Where systems had identified areas of concern action had been taken to address these in a timely manner.

The registered manager was aware of their responsibility to report events that occurred within the service to CQC and external agencies.

Balmore Country Home provides nursing and accommodation for up to 46 older people. It is registered for a maximum of 46 people. There were 34 people living at the home at the time of our visit.

On the day of our inspection there was a registered manager in place. 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 2008 and associated Regulations about how the service is run.

People told us they felt safe at the service. They were supported by staff who understood how to report allegations of abuse. The provider took a protective approach to respect the people’s human rights when necessary. Risk assessments were in place, but did not always identify or reduce the risk to people’s safety. There were enough staff to keep people safe and medicines were stored and handled safely.

People were supported by trained and knowledgeable staff. People received effective suitable care that met their individual needs, preferences and choices.

People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink, but did not always have a good experience at meal times. Some people were not fully supported when eating their meal. People had access to other healthcare professionals and received care that was relevant to their needs.

People were encouraged and supported to keep positive caring relationships with each other, staff as well as their family and friends. People were treated with kindness and compassion and spoke highly of the staff. Staff interacted with people in a friendly and caring way. People’s privacy and dignity was protected and they felt able to contribute to decisions made about their care. Arrangements were in place for people to receive support from an independent advocate if they needed one.

People’s care records focused on people’s wishes and respected their views. Staff responded to people’s needs promptly. They encouraged people to participate in activities that were available in the home which reflected their needs. A complaints process was in place and staff knew how to respond to complaints.

People, relatives, staff, and healthcare professionals all complimented the registered manager. The registered manager actively sought people’s views and acted on them. There were systems in place to monitor and improve the quality of the service provided. The service was led by a registered manager who had a clear understanding of their role and how to improve the lives of some of the people at the service. They had a robust auditing process in place that identified the risks to people and the service as a whole and any issues were dealt with quickly and effectively.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

We observed staff speaking to people in a polite and respectful manner. The manager told us they had been working with staff to ensure they used appropriate language when supporting people with personal care, eating and drinking.

We found the provider had commenced reviews and was in the process of updating all care plans to ensure people were safe and their individual needs were met.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff understood when an application should be made, and how to submit one.

We saw staff had attended training and refresher courses. The manager told us they were in the process of booking for further training such as medication, infection control, health and safety, dementia and the mental capacity act.

Is the service effective?

Equality and diversity was acknowledged and understood. We saw people's specific needs were recorded in their care plan.

We looked at five care files and found three files had been reviewed and updated. The plans of care were detailed and included appropriate information to ensure staff was able to care for people's individual needs.

People told us they were happy with the care they received. It was clear from our observations and speaking with staff that they had good knowledge and understanding of people's individual needs and knew how to support them. One person told us it was their choice to come and live at the home. Another person said, 'The staff are lovely. I am pleased with everything.'

We spoke with the activities coordinator who told us they provided a variety of activities and encouraged people to get involved, if they wished to do so.

Is the service caring?

Staff had good knowledge of how people who use the service should be treated. We saw dignity and care training was completed in April 2013. One staff member told us they assisted people when required to help to meet their needs.

People were supported by kind an attentive staff. We observed staff used appropriate equipment to support people, we saw the staff were patient and gave encouragement where needed. We observed staff interacted with people who used the service and gave them choices with day to day activities, such as where they would like to sit. Staff were proactive to gain consent before they provided any care such as assisting people to the toilet. One person who used the service said, 'They [the staff] spend time with me.'

Is the service responsive?

People's needs were assessed before they came to live at the home. We found records confirmed that people's preferences and experiences were taken into consideration. Staff we spoke with told us they acquired information on how to meet people's needs and preferences from their care plan. People were encouraged to have contact with family and friends. We observed staff responding to people's needs in a timely manner.

Is the service well-led?

The managers named in this report were not the managers at the home at the time of our visit.

Staff told us there had been a lot of improvements to the service since the new manager had been employed. People who used the service and their family gave positive comments about the staff and the service they received. We found the quality of the service was monitored on a monthly basis by the provider and outside professionals visited the home. We saw staff meetings along with resident and relative meetings were taking place regularly. The staff told us management consulted with them before implementing changes to the management of the home and they felt their views were taken into consideration.

The person in charge told us there had been a lot of changes in the home and different ways of working. We saw improvements had been made since our visit in September 2013.

We found people gave consent to their care and treatment and received care and support that met their needs. A person told us, 'Everyone is very well looked after, I would say first class.'

We found the premises were safe and suitable and repairs that were needed were planned to take place. A relative told us the home was, 'Very clean and well maintained.'

We found the provider had taken steps to ensure there were sufficient and suitable staff available and people's comments and complaints were acted upon. One person told us, 'If I say there is something I don't like they (staff) will sort it.'

The service had not always completed Mental Capacity Act 2005 (MCA) assessments or associated Best Interest Decision forms for people who may lack the capacity to make individual decisions.

We spoke with a person who used the service who told us, 'I've got no problems with anything.'

We found that care plans and associated risk assessments had not always been completed.

We saw evidence in people's care plans that external health care professionals were involved in the planning and delivery of care to meet people's identified needs.

One staff member told us, 'We contact GPs for people and they visit the home every Thursday to see some of the people here.'

During our inspection, we observed that effective systems were not in place to reduce the risk and spread of infection which meant that people may not always be cared for in a clean, hygienic environment.

Appropriate arrangements were not in place in relation to the storing, recording and safe handling and administration of medicines.