Balmore Country House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The risks to people’s health and safety had reduced since our last inspection. People received safe care and support. There were enough staff in place to provide safe care and treatment. There had been improvements to the home environment which was now clean and tidy. There had been significant improvements to the management of people’s medicines, reducing the risk of people experiencing harm. There were enough trained and competent staff available to support people safely. Staff told us they had enough time to care for people in a safe way. Staff felt supported and received regular supervision of their role. People and their relatives were involved in their care planning. Care plans identified risks and provided staff with guidance on how to support people in their chosen way. Staff told us care records provided the information they needed to provide safe care.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us they felt able to raise any concerns or issues they may have about their or their family member’s care. A relative said, “All my contact with the home [manager] is excellent. The managers go to great lengths to answer any queries I may have.” Another relative said, “When we had some questions, and they were clearly busy at the start of a Flu outbreak they still took time to speak to us and answer the questions.”

Staff felt the support they received from management had improved. They felt involved with the development and improvement of the service. Staff felt encouraged to raise concerns, to learn from mistakes with the aim of providing high-quality, dignified care for all people. The registered manager told us they had received increased support, guidance, and training since the last inspection. They felt more confident on the expectations of their role and how to ensure they and their staff had a shared understanding of how to provide the care and support people needed. The registered manager also told us they welcomed and acted on feedback from all staff on how the service could be improved.

There were improved processes in place that ensured risks to the service were identified quickly, acted on and reviewed to prevent recurrence. Risks were not overlooked or ignored. They were dealt with willingly as an opportunity to put things right, learn and improve. Incidents and complaints were investigated and findings from those were used to improve people’s care. The registered manager worked with senior management if more serious incidents had occurred. Action was taken and their effectiveness reviewed. This helped to keep people safe. When mistakes and/or poor care had occurred the provider acted on this and apologised, explaining how they would improve. For example, following our previous inspection, the provider wrote to people and relatives apologising for the outcome and how they would make the required improvements.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives told us they were involved with care planning and were aware of the risks relating to their care. A relative told us when their family member was admitted during the COVID-19 outbreak staff found ways to ensure they were still involved with decisions about their family member’s care, which they found kind and reassuring.

Staff told us the care records provided them with sufficient information to provide people with the care they needed. They were aware that the care and support needs had been discussed with people (and relatives where appropriate) and risks to their health and safety had been identified, assessed and plans put in place. The registered manager told us they were confident that since our last inspection all people received care and support in accordance with their preferences.

We observed people being encouraged to do things for themselves such as walking around the home with a walking aid, moving from chair to chair with staff supporting people where needed. We also observed people eating their meals independently with staff offering support when asked or, if unable to ask, if people were showing signs of discomfort or distress.

Care plans contained essential information for staff to be able to provide safe care and support. Risks to people’s health and safety in areas such as personal care, moving and handling and medicines had been assessed and any actions needed by staff to reduce the risk had been recorded. Reviews of care took place with people and their relatives to ensure the current care provision continued to meet their needs. Environmental risks had been discussed with people and recorded within their care records. Agreements on how to make a person safe in an emergency had been agreed and recorded. This helped to keep the person safe.

People and relatives felt the home environment had improved since our last inspection. One relative stated they felt their family member was safer at Balmore Country House than at their own home and this had seen a reduction in the number of falls the person had experienced. Another relative said, “I have no reason to believe the environment is not safe.” Some relatives stated they did have concerns about the safety of their family members when alone in the bedrooms. Particular concern was raised about people living with dementia entering the bedrooms and staff not always being aware.

No concerns were raised by staff about the safety of the home environment. The maintenance person told us they had the time to complete all tasks to ensure people received care in a safe environment. The registered manager told they had worked with maintenance staff and all other staff to ensure that any risks to the home environment were reported immediately.

The safety of the home environment had improved since our last inspection. The home was free of clutter, unused rooms were locked, and the medicines storage procedures were improved. This helped to keep people safe. Equipment was now stored in safe places. Personal equipment was not shared amongst more than one person reducing the risk of infection and injury. Window restrictors were in place to prevent people from falling from windows or people gaining unauthorised access to the home. Plans were in place to evacuate people in an emergency. Handrails were in place to support people with moving around the home independently. Access was available to a safe and secure garden area. Access was restricted to parts of the home that could cause people harm. This included the laundry, kitchen, and sluice. People were cared for in a safe environment.

Following our previous inspection improved processes were in place to monitor the safety of the home environment. Daily walkarounds took place by the registered manager (or other suitable person) to help them to identify any immediate environmental risks. Where any risks were identified these were recorded and assigned to a specific staff member to take action. This helped to keep people safe. There were effective arrangements to monitor the safety and upkeep of the premises and to ensure facilities and equipment were well-maintained. When equipment required a service the dates were recorded, and action taken. This included servicing of the home’s lift and hoists. Equipment used to deliver care and treatment was suitable for the intended purpose, stored securely and used properly.

People were provided with safe care by consistent, well trained, competent, and experienced staff. Most relatives told us they felt there were sufficient numbers of staff in place to provide safe care for their family members. This offered them reassurance that when they were not available for their family members, staff were able to provide the care they needed. A relative said, “If I have found my [family member] requires re-positioning in bed, I have brought it to the attention of a member of staff and at least two carers have attended within minutes to change the bedding and/or re-position [my family member]. Another relative said, “There are always enough staff on duty during the weekdays and weekends.” A small number of relatives did state that although there were normally enough staff, on occasions, when call bells have been pressed there have been delays in staff coming and they have had to go and find a member of staff.” Relatives felt staff were well trained and, overall, understood their family members’ care needs.

We received mixed feedback from staff when asked if they felt there enough staff in place to provide safe care and treatment. Some staff felt there were enough in place and they could carry out their roles safely. Some felt they sometimes struggled to complete their tasks and to provide the care needed due to the numbers of staff available. Staff felt well trained, and they told us they received regular supervision of their role. The registered manager told us they felt they had sufficient numbers of staff to manage the service effectively and to provide high quality, safe care for people.

Staff responded to people’s requests for support in a timely manner. When call bells were pressed we noted these were in the majority of cases, answered within a couple of minutes. This meant people were protected from possible harm. Staff were visible in communal areas; people were not left alone for long periods of times. We saw staff visit people who remained in their bedrooms. There was a calmer atmosphere compared to our last inspection. Staff spent more one on one time with people, they did not appear rushed. Staff were focused on providing people with attentive care and were not solely ‘task’ focused. Staff appeared knowledgeable about people’s individual needs. They knew the people they were talking with. This was evidence of a confident, experienced staffing team. This resulted in positive outcomes for people.

The provider had completed a dependency assessment which helped them to determine how many staff were needed to provide safe care. We found the required number of staff were working on the day of the assessment. Staff received regular training. Staff training requirements were monitored, and any gaps or training needs addressed quickly. The provider’s policy stated staff were required to receive at least 5 supervisions and an appraisal in the calendar year. Records showed the provider was on track to meet this requirement. Poor staff performance was monitored and acted on. This will ensure people continued to receive care from well trained and competent staff. Staff were recruited safely. Checks on staff identification, right to work, past employment and criminal records were completed before people commenced their role. All inexperienced staff shadowed an experienced member of staff until they were deemed competent to conduct their role alone. These processes helped to ensure people received safe care from competent and suitable staff.

People were protected as much as possible from the risk of infection because premises and equipment were kept clean and hygienic. Most people and relatives told us they felt the home was clean and tidy. Some commented on the immediate improvements since the last inspection. A relative said, “My [family member’s] bedroom is cleaned regularly and kept tidy.” Another relative said, “We consider it clean and tidy. We appreciate it is difficult to keep a check on all toilet areas all the time when there are so many people using toilets independently and with some lack of abilities.”

Staff felt the home was clean and tidy. They understood their responsibilities to ensure people received care in a clean environment. Domestic staff felt they had sufficient time and equipment to keep the home clean. The registered manager told us they had worked with the domestic staff to agree daily, weekly, and monthly tasks. They felt these staff understood what was required of them and that there had been improvements in the cleanliness of the home since our last inspection. Our observations confirmed this.

The cleanliness of the home had improved since our last inspection. We found items such as wheelchairs, stand aids and pressure cushions were now checked daily and were visibly clean. This protected people from the risk of the spread of infection. We observed staff practice good hand hygiene, they washed hands in between supporting people with medicines and other care tasks. Personal Protective Equipment such as gloves and aprons were in good supply, readily available and used by staff when needed. We saw domestic staff working to a daily schedule that helped to keep the home clean. Care staff supported domestic staff with their duties by clean communal areas such as dining rooms when they had been used. We did note some medical dressings were stored next to a toilet which was not best practice as this could increase the risk of the spread of infection. We also noted the sheet on a person’s bed was dirty. Both issues were dealt with immediately.

Since our last inspection there had been an improved and effective approach to assessing and managing the risk of the spread of infection. This was now in line with current relevant national guidance. There were clear roles and responsibilities around infection prevention and control. All staff were made aware of what was required of them to keep the home clean and tidy. The domestic staff have had their roles reviewed and now have clear daily, weekly, and monthly tasks to be completed. These were monitored by robust infection control audits. This helped to keep people safe from the risk of the spread of infection.

People were appropriately involved in decisions about their medicines. People’s experiences with their medicines had improved since our last inspection. People were no longer placed at risk of harm due to improved medicines management. A person told us about a medicine they were taking, what it was for a how it helped them. A relative said, “The management of medications does appear to have improved since the last CQC visit.” Although they did question whether their family member would like to take medicines with their lunch which they stated happened regularly. Another relative said, “I have seen medicines distributed a couple of times via a locked trolley.”

We spoke with the nurse in charge on the day of the inspection. They told us about the improved medicines processes that were now in place, and they felt the overall management of people’s medicines was now safe and people were now protected from the risks associated with medicines. The nurse said, “We have really learnt from the process since the last inspection, its better and safer now.” The registered told us they were confident the changes and improvements that had been made since our last inspection had significantly reduced the risk of people experiencing harm. Our observations supported this view.

The provider’s approach to medicines reflected current and relevant best practice and professional guidance. This had improved since our last inspection. Improved medicines auditing processes had ensured medicines were now appropriately stored, recorded, and administered in line with the relevant legislation. Improved auditing processes meant the provider was able to identify any concerns or issues with medicines before they affected people’s health and safety. Staff were assigned clear roles and responsibilities in relation to the safe management of medicines. The registered manager checked those roles were being carried out correctly and if not, then they removed staff from administering medicines until they could be assured they could so safely. There were improved and appropriate arrangements in place for the safe management, use and oversight of controlled drugs. This helped to keep people safe from the risk associated with medicines.