Balmoral Court Care 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 the last inspection we rated this key question requires improvement. At this inspection 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.

We found the provider was in breach of the legal regulation relating to medicine management, infection control, recruitment and good governance.

This service scored 41 (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 have a proactive and positive culture of safety, based on openness and honesty. They did not learn lessons or use these to identify and embed good practice. When incidents occurred, the registered manager would review them but if the event concluded outside of the home, for instance in hospital, they believed practices within the home did not need to be reviewed. This led to staff practices, which may have contributed to the incident, not being looked at to determine if any improvements could be made. Concerns raised at the last inspection in relation to medicine management, recruitment practices, risk assessments, cleanliness and upkeep of the building had not been addressed. The registered manager believed these had not occurred and the service was well-run. This meant they had had not taken the actions needed to make improvements.

The registered manager and staff did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different units within the service. Nurses in charge of units and staff were often unable to discuss people’s needs, conditions and how they were impacted by these. The management team moved people between the units. However, no one could explain why, including the staff on the unit people had moved to. Information was not always available to show why people had moved to the service. This meant staff could not be assured people were not supported in a consistent and predictable manner or their needs were always met.

The registered manager did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The registered manager sent safeguarding alerts in when concerns were raised with them However at times there was a lack of oversight, which had led to incidents that should have triggered safeguarding alerts, being missed. For example, we observed a person had sustained an unexplained injury to their face. The registered manager had not been aware of this, even though the bruising looked old, and therefore had not made an alert or investigated the cause. We raised this with the provider, and they immediately took steps to make improvements Staff had received training around what to do to make sure people were protected from harm or abuse. Staff ensured Deprivation of Liberty Safeguard (DoLS) authorisations were applied for when needed and any conditions were followed.

Staff 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. Risk assessments were in place and assisted staff identify how to mitigate risks. However, at times, the potential for distressed behaviours had not been fully assessed and there was limited information on what people’s behaviour may look like or the triggers. We raised this with the provider, and they immediately took steps to make improvements.

The provider did not 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. At the last inspection we found a wide range of issues in relation to the maintenance and upkeep of the building and equipment. When we visited the building remained in need of refurbishment. Equipment and furniture needed to be repaired or replaced. The registered manager initially stated the refurbishment of the service was complete. However, the provider confirmed this was not the case. The provider has commenced a refurbishment programme and had overhauled some bathrooms, they were addressing issues they encountered with the lifts, had purchased new furniture and were in the process of decorating one of the units. They sent us information to confirm this programme of refurbishment was ongoing. We were assured action was being taken in a timely fashion to make the improvements.

The registered manager did not always make sure there were enough qualified, skilled and experienced staff. Recruitment practices continued to fail to meet legal requirements. Full employment histories were not obtained, visas were not checked to ensure they had not expired, and measures were not in place to make sure staff who were required to work limited hours did not exceed them. The registered manager had not followed the provider’s recruitment policy. When staff were promoted internally there was no obvious recruitment process followed. When nurses with restrictions on their practice were employed there was no evidence to demonstrate consideration had been given to the impact this had upon the safe operation of the home. There had been times when there were multiple nurses on shift who needed supervision and a small number of nurses who could do this. This meant the nurses would not only be completing their work but also supervising a couple of nurses, which could be challenging particularly when staff needed to administer medicines. The deputy manager was responsible for the oversight of nurses with restrictions on their practice. The task of supporting 1 nurse subject to conditions meet NMC requirements is significant, yet the registered manager had not considered the impact on the deputy manager’s workload when they employed multiple nurses with restrictions at the same time.

Staff had received mandatory and condition-specific training. There was a comprehensive training programme in place for care staff, which included the use of physical interventions. The provider had proactively supported staff to complete qualifications to be healthcare associates and to train as nurses.

A relative said, “Oh there is always plenty of staff around and they will help.”

The registered manager did not assess or manage the risk of infection. They did not detect and control the risk of it spreading or share concerns with appropriate agencies promptly. At the last inspection we found areas of the home were dirty and had not been adequately cleaned. There were numerous examples of this, which included kitchen areas in dining rooms being unclean, chipped paint, dirty windows, unclean areas in communal rooms, bathrooms, and people’s bedrooms. There was mould in a bathroom, and we observed bathroom equipment which had areas of rust. This meant these areas could not be cleaned effectively and increased the spread of infection Although the infection control audit and registered manager’s audit suggested these had been addressed at this inspection, we found the same issues. These now included treatment rooms being extremely dirty.

The registered manager did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. At the last inspection we found medicines were not managed in a safe manner and at this inspection we found this remained the same. The treatment rooms where medicines were stored were not clean and contained out-of-date medicines and equipment. Loose tablets and capsules were found on the floor. Fridge temperatures were above the recommended range in two of the treatment rooms with no action taken to demonstrate medicines were suitable for use.

Care plans for medicines were not sufficiently detailed and some contained conflicting information.

Many people had plans in place to administer medicines covertly (hidden in food and /or drink). These were often no longer needed because these people were now taking their medicines. These had not been reviewed and removed, which meant staff were not following least restrictive practices.

Some records and guidance were missing for creams applied by care staff as part of personal care. Patch application records were not always available to demonstrate rotation in line with manufacturers’ guidance to prevent side effects.

Some pain patches and injections were not administered at the frequency prescribed. Where injections were administered the batch number and site of injection were not always detailed.

Some people were prescribed medicines to be taken on a ‘when required’ basis or with a variable dose. Guidance for how these medicines should be administered was not always person-centred and some information was missing. This meant staff at times did not have clear instructions to follow about how and when a person might need these medicines.

A basic medicine policy was in place to support the administration of medicines. Management completed audits but these were not robust and did not identify the issues we found at inspection.