Balmoral Rest Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Incidents were not always shared with the local authority or Care Quality Commission. There had been 2 incidents that required statutory notifications that had not been submitted. Following feedback, the registered manager took action to submit the appropriate notifications retrospectively.

Records relating to incidents clearly detailed actions taken and lessons learnt. Staff could explain how they would respond to incidents and accidents, and confirmed details were discussed in handover meetings. People knew who to raise concerns with and felt listened to by management.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Systems were in place for the pre-admission assessments taking place before people moved into Balmoral Rest Home.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

There were appropriate policies and procedures, and staff completed safeguarding training. People were supported by staff who knew why and how to raise safeguarding concerns. Staff told us they would report concerns to the registered manager, Care Quality Commission and local authorities if they had concerns . One allegation hadn't been fully investigated by the RM who said they would investigate it.

People told us they felt safe living at Balmoral Rest Home. When asked why they felt safe one person told us, “It’s warm, its comfortable and the staff are nice.”

Where people needed to be deprived of their liberty to keep them safe, the provider ensured a deprivation of liberty safeguard (DoLS) was applied for through the relevant local authority.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them .

Records we reviewed showed risks were assessed and reviewed regularly. Care plans were in place to manage identified risks and reflected people’s choices and individual needs. However, while staff had the required knowledge, not all care plans and risk assessments held information on how to respond to some people’s underlying health conditions or lifestyle choices. The registered manager acted and updated these documents.

People were informed about any risks and were confident staff knew how to support them to mitigate risk. One person told us staff were worried about them falling commenting, “Staff tell me not to get up unless I tell them, they’re worried about me falling and hurting myself. I take no notice and scoot off.” During our visit we saw [person] being reminded to use their walking frame and staff walking with them. We also observed a second person who was at risk of falling walking around the home completing tasks they valued. Staff monitored their movements and ensured they used their walking frame and wore appropriate footwear.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

During a tour of the building, we notice several potential risks to the environment. Not all radiators had covers to improve safety by creating a barrier against the hot surface. Following feedback, the registered manager took immediate action to update the environment and mitigate risk.

Staff had good knowledge of fire safety procedures, and every person had a personal emergency evacuation plan (PEEP). The purpose of a PEEP is to ensure that all people can evacuate the building safely and promptly in the event of an emergency, regardless of their level of mobility or other health conditions. However, evacuation measures included procedures some staff were not trained in. The registered manager told us the required training had been scheduled for all staff.

Equipment and technology were available and well-maintained, used for their intended purpose and consistently supported staff to deliver safe and effective care. The environment was well maintained, free from trip hazards with exit doors locked where necessary.

The provider made sure there were enough skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. However, recruitment processes needed reviewing to include applicants’ full employment history. The registered manager acted immediately so recruitment documentation requested this.

While staff received training suitable for their role, not all staff had completed mandatory learning disability and autism communication training. The registered manager told us they had received a suitable training package from the local authority and staff were in the process of completing this.

People experienced continuity of care, for example being supported by a regular staff team, and care being delivered through their agreed routines. One person told us they had a buzzer in their room and if they pressed that, staff would come. They said, “There’s staff here day and night and I’ve got a buzzer that I can press if I need them. They always come.”

Observations showed there was enough staff in each area of the care home to keep people safe and attend to people’s needs. Observations also showed staff supported people in ways, such as moving and handling, that indicated they were well trained in their roles.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Balmoral Rest Home had a food hygiene rating of 3. This meant hygiene standards were generally satisfactory. The registered manager told us they had taken action to improve their rating. Observations showed the kitchen was clean.

We observed there to be good standards of cleanliness throughout the service, and housekeeping staff were available to support the team. The provider was working towards refurbishing and updating the home.

The provider made sure that medicines and treatments met people’s needs, capacities and preferences. However, we found that 1 topical cream was not stored safely. The recording of some medicines did not follow best practice. Documentation related to ‘as and when required’ medicines did not always guide staff on when to administer them. The registered manager acted quickly speaking with staff, reviewing and updating documentation to ensure procedures and records were robust.

We observed the staff member made the administration of medicines a positive experience for people, engaging in conversation. This gave people time and suitable oversight.

People received their medicines as prescribed. Processes were in place to ensure people got their medicines at specific times. This included their ‘as and when required’ medicines.