De Baliol

De Baliol provides nursing care and accommodation for up to 59 people. At the time of the inspection, 50 people were living at the home. Accommodation for people who were living with a more advanced dementia condition was on the first floor. Staff referred to this area as the ‘dementia care unit.’

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

People were complimentary about living at the home. We asked people how they would describe De Baliol for members of the public who were looking to choose somewhere to live for either themselves or a relative. One person told us, “I would tell them, I love it here, there are lots of people around. The staff are very nice and you can do what you like and have your freedom. I had a first home and this was my second home, by now I think of this as my first home and I love it.”

Systems were in place to safeguard people from abuse. People told us they felt safe. People were cared for by a consistent and stable staff team who knew people well.

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.

People and relatives spoke positively about the caring nature of staff. One relative told us, “Sometimes when I come in, I can see her through the window of the door and I see staff comforting her which is really nice to see. It makes me feel they do care about my relative.”

We observed that some staff were more confident and skilled when communicating with people who were living with dementia than others. Further dementia care training was planned.

People were supported to continue their hobbies both within and outside of the home. We spoke with the registered manager about further meaningful activities which staff could undertake with people in the ‘dementia care unit’ to help promote their engagement and wellbeing.

The home had a mini bus and people went out on trips to help ensure they remained involved in the local community where many of them had lived. Staff recognised the importance which animals, children and being outdoors had on people’s wellbeing. One relative told us, “There is a lovely big garden and when the weather is better you can go out into the garden. There is also a play area for visiting grandchildren which is nice.”

There was a cheerful atmosphere and positive culture at the home. Staff told us they felt valued and enjoyed working there.

A range of audits and checks were carried out to monitor the quality and safety of the service. The ‘dementia care unit’ was still relatively new and was developing. We discussed with the registered manager about ensuring their quality monitoring system included checking the experiences of people who had a dementia related condition. This was to make sure that best practice guidelines were followed.

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 24 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.

The inspection took place on 20 April 2017 and was unannounced. This meant the staff and the provider did not know we would be visiting. At our last inspection of this service in January 2016 the provider was found to be in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to safe care and treatment. We found that the provider was not fully complaint with fire safety regulations at that time.

At this inspection, we found that the provider had acted to make the necessary fire safety improvements. Regular fire safety training and drills were carried out.

Risks to people had been assessed, and steps taken to mitigate these. Staff had received training in the safeguarding of vulnerable adults and knew what to do in the event of concerns. Specialist equipment was provided for the comfort and safety of people where necessary.

Suitable procedures were in place for the management of medicines, and staff received regular training and checks of their competency to administer these.

Infection control procedures had been updated following an inspection by the local authority last year which highlighted issues to be addressed. We found that appropriate action had been taken and the home was clean and well maintained. Staff were aware of infection control procedures.

The service was working within the principles of the Mental Capacity Act 2005 (MCA) and applications had been made to the local authority in line with legal requirements. People were supported to make decisions about their care and treatment.

Staff received regular training, supervision and appraisals and placements were provided to student nurses. Nursing staff received support to maintain their professional registration.

People's nutritional needs were met, and they had access to a range of health professionals.

Staff were caring, courteous and friendly during our inspection. We saw numerous examples of caring interactions and there were several references to the close knit community and the connection which therefore existed between people, relatives and staff.

Care plans were in place which recorded people's individual needs and preferences, and work was taking place to standardise these as they varied in detail. People and their relatives were involved in care planning and reviews of their care.

People had access to a range of activities, including group and individual sessions. A minibus had been secured for the sole use of the home to increase the number of trips.

A complaints procedure was in place and was displayed in the home. There had been no recent complaints received by the service.

A new manager was in post, who was in the process of registering with CQC. They had previous experience of managing a care home, and were also a registered nurse. A deputy manager was in post and the manager and deputy told us they felt well supported by the provider and regional manager.

There were systems in place to audit the quality and safety of the service, and to gather the views of people, relatives and staff. Procedures were in place to show how these would be acted upon.

Staff told us they enjoyed working in the home and morale appeared good. The provider was praised by staff for their responsiveness to requests for new equipment or refurbishment to improve the quality of the facilities and service offered to people.

Further information is in the detailed findings below.

The inspection took place on 13 January 2016 and was unannounced. The service was inspected in June 2014 and met all of the regulations we inspected at that time.

A new manager was in post and was in the process of registering with the Care Quality Commission (CQC). 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.

Safety concerns were identified following a fire safety audit. The provider was sent a report by the fire safety officer which highlighted some areas for improvement. They had begun addressing some of these issues during our inspection and were aware of the action that needed to be taken to ensure the safety of people staff and visitors.

People told us they felt safe, and there were suitable safeguarding policies and procedures in place. Staff had received safety training, and risk assessments in relation to the care needs of people and premises and equipment had been carried out. Records of accidents and incidents were appropriately maintained.

We found that there were suitable numbers of staff deployed and checked staffing rotas to confirm this. A small number of concerns were expressed by staff and relatives, that at times staffing numbers appeared low. We have made a recommendation that the provider keeps staffing under review in light of these concerns.

There were safe procedures for the storage and administration of medicines although we found gaps in a small number of records. The nurse and manager assured us that these would be addressed and we made recommendation about this.

The home was clean and there were no malodours. Appropriate infection control procedures were in place.

People were happy with the care they received. Staff had received regular training including training specific to their role. We found gaps in training and supervision records which meant that staff were not adequately supported with their performance and development needs.

People had access to a range of health care professionals. We saw that people were referred promptly in the event of any concerns about their health and visiting professionals spoke highly of the effectiveness and responsiveness of staff. The Mental Capacity Act was applied appropriately and capacity assessments had been completed.

Nutritional needs were assessed, and people were supported well with eating and drinking. Dietary concerns were addressed appropriately by referring people to the appropriate professional such as GP or dietician.

People looked well cared for and were comfortable. Staff spoke kindly with people and treated them with respect, and also promoted choice and independence. When a person was distressed we saw that staff supported them skilfully and with warmth.

The service engaged well with the local community and supported people to maintain outside interests.

Pre admission assessments were carried out to ensure the service could meet the needs of people. Person centred care plans were in place and were reviewed regularly. A varied programme of activities was available. A complaints procedure was in place and people knew how to make a complaint if they needed to.

A number of routine audits and checks were carried out to ensure the safety and quality of the service. People, staff and relatives had regular opportunities to share their views about the running of the service. These included questionnaires and meetings.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to safe care and treatment and staffing. You can see what action we told the provider to take at the back of the report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

We found the premises were designed to provide a safe environment and arrangements were in place to ensure the home was maintained to protect people from the risks of unsafe or unsuitable premises. The gardens were attractive and designed to suit people's needs and we saw the new patio area was well used.

The provider had in place effective systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others. We saw an assessment of people's care and support needs had been completed and care plans were in place. They included risk assessments specific to the needs of each person and included areas such as going out, moving around the home, falls and personal care.

The staff we spoke to were all aware of the complaints, safeguarding and whistle blowing procedures. All of the staff we spoke with were able to describe the appropriate procedures to be followed in the event of someone raising an issue with them.

We looked at records and saw, where necessary, mental capacity assessments and best interests decisions were in place for people who were unable to make decisions for themselves. Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) is a legal process that protects people who are unable to make decisions for themselves.

Is the service effective?

People's health and care needs were assessed with them and they were involved in this process. We saw one person had contributed to a document named 'This is my life' which contained information about their life, their preferences, family background and any activities or hobbies they have a particular interest in. We saw that particular care needs were identified in individual plans for example, dietary needs or dementia care.

Staff training was provided that took account of the needs of the people in the home. For example, we saw training in dementia and administration of medicines had been provided.

Is the service caring?

We saw staff responded kindly and promptly to people. Care workers were patient and encouraging to people as they assisted them. We saw people engaged in activities with staff and they were supported effectively according to their level of need. We saw staff checked regularly with people to make sure they were all right and did not need anything for example, a drink.

People's preferences, interests, aspirations and diverse needs were recorded and we saw staff were aware these during the inspection. We noted people's privacy was respected and people were afforded choices about where and how they spent their time.

Is the service responsive?

We saw evidence that the care staff identified changes in people's needs and acted to make sure they received the care they needed. For example, there was evidence that care plans had been amended when a person returned from hospital and when someone had lost weight.

People told us they were aware of the complaints procedure and staff could describe how they would assist a person to make a complaint. We saw there were systems in place for dealing with and recording complaints.

People told us there were plenty of activities and they could choose whether or not they attended. One relative told us, 'There are lots of different activities and they do baking regular which X enjoys.'

There was evidence people were consulted about the food, activities, the d'cor and furnishings and outings on a regular basis. People told us they were asked if they wanted to raise anything at the meeting. They said they felt satisfied staff listened to and acted upon their views.

Is the service well led?

The service had a quality assurance system in place that included the use of surveys from people who used the service. Audits of care records, medicines, health and safety, infection control and premises were carried out monthly. Where it was identified there were shortfalls in a specific area the action needed was identified and there was a record to show when this work was completed. We saw any shortfalls were addressed promptly.

Staff had regular supervision, appraisals and staff meetings which meant they were able to feedback to the management of the home their views and suggestions. Staff we spoke with confirmed their views were listened and account was taken of them. They said they felt well supported by the management of the home.

We found people's needs were assessed and care was planned in line with their needs. One relative told us, "We are very happy with the care and support X gets." Care plans were regularly updated and contained clear information about individuals' care.

People were protected from the risks of inadequate nutrition and dehydration. One person told us, "The food is good."

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People told us, "I don't worry."

At the time of this visit there were enough qualified, skilled and experienced staff available to meet people's needs. Staff responded promptly to requests for assistance. One person told us, "The staff are kind and helpful."

People were asked their views about the service provided and these were taken account of. People were aware of the complaints procedure. We saw the provider had a complaints policy and procedure in place and people told us they would confidently raise any concerns they had with the manager. People told us, "I only have to say and things get sorted" and "The staff listen."