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 individua

The inspection took place on 21 and 22 September 2017 and was unannounced on the first day.

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 a

At our previous inspection on 06 November 2013 we found that the home was not following guidance from the Department of Health’s Code of Practice for health and social care on the prevention and control of infections. During our most recent visit we found that improvements had been made.

People told us “They look after us well, not just mentally but physically as well.” And “Staff are always very nice.”

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.

Karlyon Care Limited runs three homes in the Plymouth and Torpoint areas. Balmain caters for people who have mental health needs.

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.

People told us that they are encouraged to be independent and are responsible for their own laundry and keeping their rooms tidy.

All three people that we spoke with knew that a care plan existed, but said that it was up to staff what was put in them as they were not interested.

One person told us that the thing they liked best about the home was the privacy it gave them. One person told us that the best thing about living in the home was 'having company and no worries at night'. Another person said simply 'It's my home'.

People told us that they often go to the local shops, swimming, on trips over the moors and into Plymouth City centre.

People told us that the staff at Balmain were “very good” and that they got on well with them. One person told us that the staff were lovely and that there was always plenty of them about. We saw staff that were competent and we did not see any practice that gave us cause for concern.

The inspection took place on 18 and 21 August and was unannounced.

Balmain Care Home is a residential home providing care, rehabilitation and support for up to 29 people with mental health needs. At the time of the inspection 26 people were living at the home. No one was detained under the Mental Health Act or under formal supervision in the community. Balmain Care Home has 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.

During the inspection people and staff appeared relaxed, there was a calm and pleasant atmosphere. Comments included; “I feel safe here and looked after”; “Staff are very approachable and caring”; “The staff are nice” and “Staff are very good at keeping me safe.” Other people told us, “They do a better job than I did with my medicine”; “They always keep an eye on you"; “There are rules here to keep us safe, like smoking – I smoke but I do it in the garden.” People told us the food was good to “The food is good”; “The food is really good – chicken, sweetcorn and chips. I’m quite plump now!”

Care records were individualised and gave people control and reflected their choices, likes and dislikes. Staff responded quickly to people’s change in needs if they were physically or mentally unwell. People were involved in identifying their needs and how they would like to be supported. People’s preferences were sought and respected for example if they preferred female staff to support their needs.

People’s risks were managed well and monitored. The service worked closely with health and social care professionals where indicated, for example community mental health nurses. People were promoted to live full and active lives and were supported to access the community if they wished. Activities were varied and reflected people’s interests and individual hobbies.

People had their medicines managed safely. People received their medicines as prescribed and on time. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, mental health professionals (CPN’s) and social workers. People told us “I get my medicine every day, they always remember, it’s the right medicine to calm my mood.”

Staff understood their role with regards to the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Advice was sought to help safeguard people and respect their human rights. All staff had undertaken training on safeguarding adults from abuse. Staff displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

Staff described the management to be very open, supportive and approachable. . “We discuss things and work together to sort things out.” People told us the management was a visible presence within the home. Staff talked positively about their jobs telling us they enjoyed their work and felt valued. The staff we met were caring, kind and compassionate.

Staff received a comprehensive induction programme. There were sufficient staff to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively.

There were effective quality assurance systems in place. Incidents were appropriately recorded, investigated and action taken to reduce the likelihood of reoccurrence. People knew how to raise a complaint if they had one. One person said “No complaints – I’d talk to staff if I had any.” Feedback from people, friends, relatives, health and social care professionals and staff was positive; all felt listened too. Learning from feedback and inspections were used to help drive improvements and ensure positive progress was made in the delivery of care and support provided by the home.