About the service: Balmoral House is a residential care home that can accommodate up to 60 people. The service was providing personal care to 54 people older people at the time of the inspection.

People’s experience of using this service: People were safe and protected from the risk of harm and abuse. Staff had received safeguarding training and there were policies and procedures to guide staff on what to do if they had concerns. Staff were recruited safely and there were sufficient staff to meet people’s needs. People received their medicines as prescribed. The service was very clean and tidy.

The provider acted within the law when people lacked capacity to make their own decisions or when they were deprived of their liberty. People's health and nutritional needs, including religious observances, were met and understood by staff. Staff received induction, training, supervision and support to enable them to feel confident when supporting people.

People and their relatives described staff as kind and caring. We saw staff were patient and friendly, and people's privacy and dignity was maintained. Staff supported people to communicate their needs effectively. Staff were aware of the need for confidentiality and personal records were held securely.

People had assessments of their needs completed and care plans developed to guide staff in how to meet them in ways they preferred; the care plans were updated when people’s needs changed. The care plans highlighted what people could do for themselves and included a social profile, which indicated their important relationships, previous interests and work. People could remain at Balmoral House for end of life care. The provider was responsive to complaints and concerns.

The service was well-led; there was an open and supportive culture. People who used the service and their relatives knew the registered manager’s name and said they could speak to them if needed. There was a quality monitoring system to ensure any shortfalls could be identified and addressed. People could make suggestions in meetings and surveys. The management team had developed good working relationships with other people and agencies.

More information is in the full report.

Rating at last inspection: Requires Improvement; last report published on 20 February 2018. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected: This was a planned inspection based on the rating of the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection took place on 19 and 23 January 2018 and was unannounced. At the time of our inspection, 56 people were using the service. Balmoral House 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.

Balmoral House is registered to provide accommodation and care for up to 60 older people, some of whom may be living with dementia. Balmoral house is a purpose built residential home and provides care over two floors accessed by a lift. There are five large communal spaces including lounge areas and dining rooms, and a secure garden area. All bedrooms are single rooms with en-suites.

We found people’s care records were not always contemporaneous and did not always reflect their full and current needs. Two people had no care plans and risk assessments and three people’s care records were not always fully completed, or completed in a timely manner.

The provider did not have effective quality assurance systems in place and the provider’s own policies and procedures were not always followed. Care plans were not reviewed according to the provider’s policy and these shortfalls were not identified through audit.

You can see what action we told the provider to take at the back of the full version of the report.

A condition of the provider’s registration was for the service to be managed by a registered manager. There was a manager who was responsible for the day-to-day running of the service and we saw they had applied to become registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC 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.

The manager and staff had a good understanding of mental capacity legislation and their responsibilities under this. The manager had submitted notifications to CQC and safeguarding authorities as required. 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.

The service was safe, clean and tidy. People told us they felt safe and there were systems in place to safeguard people from abuse and avoidable harm. Staff accommodated people’s individual needs to enable them to feel safe in their surroundings. There were personal emergency evacuation plans (PEEPs) which informed staff and other professionals in how to meet people’s needs in emergency situations. Staff were trained in infection control and used personal protective equipment (PPE) as necessary. The environment was suitable for people who may be living with dementia. The premises were purpose-built and safely maintained. Any maintenance requests were recorded and carried out in a timely manner.

People’s health and nutritional needs were met. Food looked healthy and nutritious. People saw healthcare professionals as required. Medicines were managed well and people received them as prescribed.

There were appropriate activities for people to participate in if they wanted and attendance at community events was encouraged.

There were sufficient staff to meet people’s individual needs and staffing levels were reviewed weekly. Staff were recruited safely. Records showed staff had completed a thorough induction, which was linked to the Care Certificate and they received supervision and appraisal as required. Staff skill and knowledge was good. They had completed a range of training and many were completing further qualifications.

People told us staff were caring, respected their privacy and dignity, and promoted independence. People were offered choices and tr

The inspection was carried out by one inspector. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service caring?

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. People told us they were happy with the care provided at the service.

Risk assessments were completed which ensured staff knew how to keep people safe. People had been involved with the formulation of their care plans and where people needed support to make informed decisions this had been provided. Health care professionals, for example doctors and district nurses, had been consulted and their advice sought when people needed more specialist care and attention.

Is the service responsive?

The service had a complaints procedure which people could access. People were therefore assured that complaints were investigated and action would be taken as necessary. The provider consulted with people about how the service should be run and any issues were addressed. People were consulted about their care needs.

Staff followed instructions from visiting health care professionals for example doctors and district nurses. This ensured people received the care and attention they required to meet their needs.

Is the service safe?

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly, therefore not putting people at unnecessary risk.

The manager sets the staff rotas, they took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure people’s needs were met.

The provider had policies and procedures in place for staff to follow to report any abuse they may witness or become aware of. Staff also received training about how to keep people safe.

Is the service effective?

People’s health and care needs were assessed with them and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People were provided with a wholesome and nutritious diet and their dietary needs were monitored. Health care professionals were consulted if required.

Is the service well led?

The provider consulted with people about how the service was run and took account of their views. People who had an interest in the care and attention people received had also been consulted and their opinions taken into account about how the service was run. Staff received training which equipped them to meet the needs of the people who used the service. The provider also gave staff the opportunity to gain further qualifications.

What people who used the service and those that matter to them said about the care and support they received.

People told us they were satisfied with the care they received. Comments included, “The staff are really kind and caring, they help me stay independent”, “The girls come and help me get up in a morning” and “I just have to press my buzzer and they come and help me.” People were involved in their care. They told us, “I have meetings about my care plan and my daughter comes as well.”

People we spoke with told us they liked the staff and felt they were well looked after. They said, "The staff are very pleasant" and "The carers are very good."

People who used the service were satisfied with the quality and quantity of food they received. Comments included, “The food is fantastic, it’s all home cooked”, “I can have a choice of meals, it’s all nice”, “The cook makes sure we are all well fed” and “We had a really nice tea last night.”

Relatives we spoke with were complementary and about the quality of care the service offered. Comments included, “I know my mother is safe here and I trust the care staff” and “We can go home safe in the knowledge she will be well looked after.”

We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People we spoke with were very satisfied with the care they received. They told us “The care is exemplary, there is always someone coming to check on you, you can’t fault it."

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 that they felt safe living in the home and felt comfortable speaking to staff if they had any concerns.

We found medicines were given to people appropriately, were kept safely and were safely administered and disposed of.

The building was completed in the summer of 2012. We found the building provided comfortable, accessible and well planned accommodation. All the bedrooms were for single occupancy and had ensuite level floor showers/wet room and toilet facilities. People told us they were able to have their own possessions with them to personalise their rooms.

There were enough qualified, skilled and experienced staff to meet people’s needs. People we spoke with were very complimentary about the staff. They told us "I can't fault the staff" and "The staff are excellent."

The views of people who used the service were sought and questionnaires were sent to people at the end of any short stay. These showed that they were satisfied with the service provided.

We undertook this unannounced inspection over two days on 26 and 27 November 2015. The service was last inspected on 14 April 2014 when it was found to be compliant with the regulations inspected.

Balmoral House is situated close to the centre of Scunthorpe. It is registered to provide care and accommodation for up to 60 people. The service predominately provides care for older people, some of whom may be living with dementia. The service was purpose built and opened in August 2012. At the time of our inspection there were 50 people using the service.

There was a registered manager for the service. 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. The service also had an acting manager who had been recently appointed and was due to take over the direct management of the home. We saw evidence they had submitted an application to the Care Quality Commission for this post and were currently awaiting an interview to enable their skills and competencies for this post to be formally assessed.

We saw that staff had received training to ensure they could recognise and report potential abuse and had been recruited safely, to ensure they did not pose a risk to the people who used the service. Staffing levels had been assessed to ensure suitable numbers of staff were available to meet the needs of people who used the service. People’s needs had been assessed and staff knew how to manage known risks which enabled them to keep people safe from harm. People’s medicines were administered safely and checks of the building were regularly carried out to ensure it was well maintained.

Staff were provided with a range of training to enable to them to effectively carry out their roles. Regular supervision and appraisals of staff skills were carried out to ensure individual staff performance was monitored and they were able to develop their careers. Staff engaged with people in a kind and courteous way to ensure they were in agreement with decisions made about their support. Best interest meetings were held when people lacked the capacity to make important decisions for themselves.

A range of healthy and nutritious meals were provided for people and their intake was monitored with the involvement of relevant community health care professionals when required. People and their relatives were involved in the planning of their support which was reviewed on a regular and ongoing basis.

A variety of opportunities were provided to people to enable them to participate in meaningful activities. Staff demonstrated a positive understanding for the promotion of people’s personal dignity, whilst protecting their privacy. People’s records and information were maintained in a confidential manner.

A complaints policy was in place to ensure people could raise concerns about the service. Regular management checks were carried out to ensure the quality of the service was assured and enabled the identification of changes when this was required.