Balmain Care Home

People living at the service had capacity, understood the risks of Covid 19 as well as their collective responsibilities to each other and staff. Since the start of the pandemic people living at the service had chosen to limit their interactions to keep each other safe and form in effect their own household bubble.

Whilst the registered manager and staff told us they were doing everything they could to support, encourage and enable people to socially distance. It was evident from our observations that some people living at the service did not always choose to follow their guidance

We found the following examples of good practice.

Systems were in place to help manage the risks and prevent the spread of COVID-19.

There was a clear system in place for visitors to ensure they followed the current guidance on the use of personal protective equipment (PPE) and social distancing.

Instructions were easily accessible on arrival at the service to ensure visitors understood the services infection prevention and control protocols and what they needed to do to keep people and themselves safe.

All visitors to the service were asked to walk through a ‘Sanitising Tunnel’, wear PPE, have their temperature checked, wash their hands and complete a verbal health declaration before they would be allowed to enter the main part of the building.

Staff had received additional training in infection prevention and control and the use of PPE including masks, gloves, aprons and hand sanitiser.

There were sufficient stocks of PPE available and staff were seen to be wearing PPE appropriately.

People and staff took part in regular COVID-19 ‘whole home’ testing. People and staff who tested positive followed national guidance and self-isolated for the required amount of time.

Cleaning schedules and procedures had been enhanced to include more frequent cleaning of touch points such as handrails and light switches.

The provider had developed specific COVID-19 policies and procedures which had been reviewed and updated where necessary in line with the latest guidance.

Balmain Care home, hereafter referred to as Balmain, is a care home that is registered to support up to 29 people. At the time of our inspection 27 people were living there, 12 of whom were having support with their personal care, mental health and wellbeing. 15 people required support with their mental health and wellbeing but did not require support with personal care.

Balmain is in the coastal city of Plymouth and is four houses knocked through to create one large building. There are three floors, two lounges, dining areas, and smoking and non-smoking garden areas.

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

People were protected from abuse and avoidable harm by staff that knew their needs well and had been provided with safeguarding training. Risks that people faced were assessed and staff had a good understanding of people’s health conditions and unique behaviours and how to support these.

Staff were safely recruited and there were enough staff on shift to be visible and meet the needs of people. People enjoyed the food and could also go out to buy their own food if they wished to.

Staff were kind and caring and interacted with people in a friendly way, we heard banter and saw people responded well to staff when they entered a room.

People were supported as much as they wanted to be, to encourage further independence and develop their life skills. Some people came and went as they pleased, and others were supported in a more structured way to access local community facilities.

People said they could approach staff if they wished to make a complaint, and complaints were recorded.

There was a registered manager and deputy manager who oversaw the day to day running of the service. Quality assurance checks were taking place for building safety, care provision and records.

Professionals we spoke with told us of the unique nature of this service supporting some people who had historically disengaged from all services. The service understood that people chose how much support they wished to have and offered safe challenge and positive risk taking as part of their support.

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.

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 9 January 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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 of Balmain Care Home (“Balmain”) took place on the 22 and 23 November 2018 and was unannounced. When we last inspected in 2017, we judged the service to be Requires improvement as there were safety concerns and décor issues in respect of the premises. We did not find breaches of the Regulations at the last inspection but highlighted where progress could be made in the service being safe, effective and well-led.

Balmain is registered with us to provide accommodation and care for up to 29 people. People have a mental health diagnosis or history of such a diagnosis. They may have other needs associated with their mental health and a high level of complexity.

Balmain is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care is provided across four homes that are linked together. There were communal places or/and quiet spaces where people could choose to spend their time. People had individual bedrooms that they could personalise.

A registered manager was employed to manage the service locally. 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. They were supported in their role by a deputy manager.

We found some improvements were needed with the management and auditing of people’s medicines to ensure they were safe

Balmain works with people who are at varying stages of their journey with their mental health. Each person has some level of complexity and can have other issues such as alcohol dependency as part of why they need extra support. People had often exhausted support services and lost their tenancy or had been living homeless when they came to stay. Balmain does not give up on people easily and therefore worked in an atmosphere that could be challenging for other people, staff, the community and external agencies such as the police. They managed this well with staff that cared deeply about people and were always looking for new ways to meet their needs.

As a service they actively advocated for people living in the community with mental health issues. They acted as a safe house for vulnerable people to be referred to for emergency support and help. They used their place on various forums to support people to be better received into hospital, for example.

People living at Balmain were encouraged to set achievable goals and take steps to reducing the need for support. Staff knew people well and used this to support people to move on in their lives and manage dependencies, for example, to live a safer life. Goal setting was backed up by good risk assessments and management behaviour plans. We found some inconsistencies in people’s records and the detail of what staff knew about people was not always in their records. We discussed this with the registered manager who was responsive to feedback.

Balmain was considered as part of the multi-disciplinary team; able to seek support from other agencies and professionals as well as actively take part in discussions about planning people’s care.

The registered manager, the deputy manager and provider were highlighted as being approachable, responsive and willing to act on feedback, ideas and concerns. Staff, people and professionals linked with the service gave positive feedback on how the service is led. Everyone felt they could be supported if needed.

People received effective care from staff who had the skills and knowledge to meet their needs. Staff monitored people’s health and well-being and made sure they had access to other healthcare professionals according to their individual needs. People’s food and drinks were monitored to ensure people were kept healthy.

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

People said they would feel comfortable making a complaint and were confident action would be taken to address their concerns. The registered manager and provider treated complaints as an opportunity to learn and improve.

People felt safe at the home and with the staff who supported them. There were systems and processes in place to minimise risks to people. These included a clear recruitment process and making sure staff knew how to recognise and report abuse. There were adequate numbers of staff available to meet people’s needs in a timely manner.

We have found two breaches of regulations. You can see the back of the full report to see what action we have asked the provider to take.

Balmain Care Home (known as Balmain) is a residential home providing care, rehabilitation and support for up to 29 people with complex mental health needs. The home accommodates people across four joined houses. People have access to communal bathrooms, lounges, dining areas, a therapy room, a quiet area and an outside garden.

At this inspection there were 25 people living at the service.

At the last inspection in August 2015, the service was rated Good. At this inspection we had concerns about the internal and external environment which may put people at risk. The provider addressed these concerns promptly to ensure the service was safe, but the environmental concerns affected the rating.

The service had a new registered manager in post. They were one of the providers and had been appointed in March 2017. 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.

On the day of the inspection staff were relaxed, and there was a calm, quiet atmosphere. Everybody had a clear role within the service. Information we requested during and after the inspection was supplied promptly, records were organised, clear, easy to follow and comprehensive.

People were comfortable with staff supporting them and we observed positive interactions. Care records were personalised and gave people control over aspects of their lives. However, some care plans required updating and further detail about how staff supported people, for example people with diabetes. Staff responded quickly when they noted changes to people’s mental or physical well-being by contacting the appropriate health professionals for example people’s mental health nurses. People or where appropriate those who mattered to them, were involved in discussing people’s care needs and how they would like to be supported. People’s preferences for care and treatment were identified and respected.

Staff exhibited a kind and compassionate attitude towards people. Staff were mindful of equality and diversity and respected people. Positive, caring relationships had been developed and practice was person focused and not task led. Staff had appreciation of how to respect people’s individual needs around their privacy and dignity and individual behaviours. Feedback we received from people, relatives and professionals were excellent.

People’s risks due to their mental health needs were managed well and monitored. People were promoted and encouraged to live full and active lives. Positive risk taking was encouraged so people’s human rights and freedom of choice was respected. Staff were thoughtful in finding ways to overcome obstacles that restricted people’s independence.

People had their medicines managed safely. People received their medicines as prescribed, received them on time and understood what they were for. People were supported to maintain good health through regular access to health and social care professionals, such as GPs, mental health nurses, social workers, occupational therapists and physiotherapists.

People we observed were safe and they told us they felt secure at Balmain. During the inspection we raised concerns about aspects of the internal and external environment which could pose a risk to people at Balmain, these risks were addressed promptly and systems were put in place quickly to reduce the likelihood of a reoccurrence. An ongoing maintenance schedule was in place with planned work being undertaken.

Areas were uncluttered and clear for people to move freely around the home. Where people had behaviours which might put them and others at risk, staff liaised with external professionals such as the fire service in a timely way to address risk. All staff had undertaken training on safeguarding vulnerable adults from abuse, they displayed good knowledge about how to report any concerns and described what action they would take to protect people against harm. Keeping people safe from harm within the service and local community was at the forefront of staffs minds.

People were supported by staff that confidently made use of their knowledge of the Mental Capacity Act (2005), to make sure people were involved in decisions about their care and their human and legal rights were respected. The service followed the processes which were in place which protected people’s human rights and liberty.

People were supported by a staff team that had received a comprehensive induction programme, training for mental health conditions and ongoing support from the registered manager, deputy manager and assistant manager.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment. Volunteers from external agencies supporting people at the service were also appropriately checked.

The service had a policy and procedure in place for dealing with any concerns or complaints, however, no written complaints had been made to the service in the past twelve months.

People described the management team to be supportive and approachable. Staff talked positively about their jobs. The provider / registered manager were supported by a deputy manager and an assistant manager.

There were quality assurance systems in place but they had not identified the areas of concern we found with the environment. Following inspection feedback, audits and checks on the environment and cleanliness of the service were adapted and made more robust to reflect the needs of the people living at Balmain. Incidents were appropriately recorded and analysed for trends. Learning from incidents, concerns and feedback raised was used to help drive improvements. The staff team were reflective and listened to advice from professionals. Inspection feedback was also listened to which further enhanced the quality of care.

During out visit to Balmain we met with five people who used services, spoke with staff on duty and reviewed four care records and four staff files. We found people were involved in decisions about their care and treatment and staff understood the principles of the Mental Capacity Act (2005) which ensured people's human rights were respected.

Care and treatment was provided in accordance to people's needs. There was evident in the care records which considered people's physical, mental health and social needs. Evidence of health and social care professional's involvement was apparent. Risks were assessed and updated if people's needs changed. People were able to participate in community activities as they wished.

We saw that people living in the home were supported to keep their own living area clean and tidy but in the remainder of the home cleanliness was not maintained to a suitable standard which could put the people living in the home at risk of infection.

There were robust systems in place to ensure that before staff began working in the home that they were safe and trained to look after the people.

There was a system in place to manage complaints and the people living at Balmain and the staff were confident complaints would be taken seriously and investigated.

The people we met had a diverse range of needs. One person who used the service told us "they look after us well here'.

During a tour of the home we saw staff treated people with respect and were quick to respond to their needs. People who used the service were asked if we could look in their rooms. Each person had a key to their door and all doors had knockers on so staff and people who used the service could knock on the doors before being invited in.

We saw people who used the service were included in decisions made about the running of the service by being included in the recruitment process.

We saw people who used the service were included in developing and reviewing their care plans. We saw they had access to a wide range of activities in and outside of the home.

The medicine ordering, administering and storage systems in place were satisfactory. We saw regular audits of the system were carried out to ensure the systems were safe.

We saw systems in place to support staff. Staff we spoke with said there was an on call system so there was always somebody to contact if they had any concerns. Staff told us they enjoyed working with the people who used the service and felt the staff all worked well together as a team.