Balmore Country House

Updated 25 January 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by 3 inspectors.

Service and service type

Balmore Country House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Balmore Country House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 8 November 2023 and ended on 16 November 2023. We visited the location’s service on 8 and 9 November 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection

We also contacted Healthwatch who are an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We used all this information to plan our inspection.

During the inspection

We spoke with 6 people who used the service, and 4 relatives to ask them about their experience of the care provided. We spoke with care staff, senior care staff, clinical lead, an agency nurse, domestic staff, chef, assistant manager, registered manager and operations manager. We spoke briefly with the nominated individual. They are responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included all or parts of 11 people’s care records, medication administration records and the daily notes recorded by care staff. We looked at 3 staff files in relation to recruitment and staff supervision and a variety of records relating to the management of the service, including policies and procedures and training records.

We asked the registered manager to provide us with a variety of policies and procedures and additional information after the inspection. All information was sent within the required timeframe.

Updated 25 January 2024

About the service

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.