Balmoral Court Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At the last inspection we rated this key question good. At this inspection the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

We found the provider was in breach of the legal regulation relating to person centred care and good governance.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager did not make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them. They could not explain the rationale for admissions or decisions around which units people would move into or why people had moved to different unit. Over the course of the inspection, the registered manager gave different information about how many people had different needs. Most staff we spoke with could not explain people’s needs, their conditions or tell us why they had been admitted. The assessment information did not always detail the needs of people. This meant it was difficult to determine what condition had led to their admission and if there were any triggers which might show someone was relapsing. Staff also supported people to work through reduction programmes develop for people by drug and alcohol additions services. However, the staff role in this programme was not clearly detailed in their care records.

Staff did not always plan and deliver people’s care and treatment with them. They needed to ensure the support provided was always delivered in line with legislation and current evidence-based good practice and standards. The head chef and catering staff were passionate about providing good, nutritious and wholesome food for people.The catering staff had looked closely at the recent menu and were in the process of introducing a wider range of meals. They were confident if people did not like the choices staff would ask them to provide an alternative. We observed 1 person did not like pasta, but staff took no action to get them an alternative. On some units 2 staff were providing all of the meals, which meant there was not enough staff left to assist people who needed support to eat their meals. Other staff completed the records about how much people had eaten and drank. Staff recorded the amounts of fluid people were offered and not the amount people actually drank. For example, on 1 person’s chart it stated they had 200mls of porridge, drinks, soup although they had less or more than this at times. Staff could not explain the measures even though cups and bowls were of different sizes provided different amounts of fluid. This meant staff did not have clear information about whether people were at risk or not of dehydration. We raised this with the provider and they took immediate action to change staff practices.

Staff worked well with other professionals and services to support people. Staff worked closely with other agencies and professionals such as doctors, community mental health professionals and dieticians. The visiting multi-disciplinary team spoke highly of how well the staff who attended the weekly ward round knew people and how they appropriately raised concerns. A professional said, “The staff I speak to have a good understanding of the behaviours of the residents. They always share any concerns and seek advice. I have never felt I have been an inconvenience or rushed out the door by the staff.”

The registered manager did not ensure staff effectively supported people to manage their health and wellbeing. People were not always supported to maximise their independence, choice and control. A small residential area had been set up for men on the downstairs unit, which had no communal spaces. We found the men in this area remained in their bedrooms. These people lived very isolated lives. It was unclear the rationale for the development of this unit. Also, there was a unit for working age people upstairs, which had very little communal areas and was quite confined. People living there had difficulty regulating their emotions and we found the design of the unit could contribute to arguments and disagreements, particularly as there was nowhere for people to move to if distressed. People on this unit did not have access to facilities, which would support them develop independent living skills. These people were reliant on staff to provide opportunities to engage in activities. This meant they spent long periods without meaningful engagement, which could impact their mental health. We noted 1 person’s care records stated they found it difficult to live in noisy, busy environments. However, they had been admitted to the busiest part of the service. Immediately after the inspection the provider looked at the admission criteria and design of the service. They undertook to design living area in ways which supported individuals to improve their health and well-being.

The registered manager did not ensure staff routinely monitored people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent. Staff closely worked with local healthcare professionals and sought advice when required. Staff work very effectively as a team to ensure people’s support needs were met. Visiting professionals told us staff who attended the multi-disciplinary team meetings were very knowledgeable about the people within the home, and as a team they monitored the effect of the support being provided. They found people often improved during their stay at the service. In discussions with staff we found there was an inconsistency in their understanding of people and their needs.

Staff told people about their rights around consent and respected these when delivering person-centred care and treatment. Staff understood the requirements of the Mental Capacity Act and associated codes of practice. They had received training around the Mental Capacity Act 2005 and associated code of practice. Capacity assessments and ‘best interest decisions’ were in place, but these needed extending to cover a wider range of decisions. For example, only going out with staff, management of monies, access to cigarettes and healthcare decisions. The registered manager was unclear about how to determine if relatives had enacted lasting powers of attorney (LPAs). At times relatives without enacted LPAs were making decisions on behalf of people, including determining when people got up and where they stayed in the building. The provider immediately took action to address these matters and ensured when people were deemed to have capacity they confirmed their agreement to these restrictions.

Staff worked with people who may be subject to community treatment orders and conditional discharges. Staff understood the requirements of the Mental Health Act 1983 and people’s right of appeal.