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 our last inspection we rated this key question requires improvement. At this inspection the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff did not always ensure people’s health, care, wellbeing and communication needs were fully assessed, reviewed and recorded in a way that consistently supported effective care. They completed pre-admission assessments and reviewed people's needs during their stay. Care records contained more information than at the previous inspection and staff demonstrated a good understanding of people's histories, preferences and support needs. The new manager had introduced measures to improve staff knowledge of people and had worked with staff to develop more person-centred care records. However, records were not always sufficiently detailed, accurate or consistent. We found some care plans were contradictory, difficult to navigate and lacked clear guidance about how staff should support people. The new manager recognised these shortfalls and took immediate action to review records and improve their quality. Staff spoke positively about the improvements made to care planning and said people and relatives were involved wherever possible. One staff member told us, “Residents are involved as much as possible and care plans are now updated.”

Staff did not always ensure care and treatment were delivered in line with current evidence-based guidance and best practice. Care records relating to physical interventions, positive behaviour support and restrictive practices did not always clearly demonstrate how interventions should be used or reviewed. Records lacked sufficient detail to demonstrate staff were consistently following best practice guidance or evaluating the effectiveness of interventions used. Medicines were not always administered safely. For example, prescribed medicines had not been administered as intended, placing people at risk. Since the last inspection the provider had invested in staff training and competency development, including positive behaviour support, dementia care and specialist clinical training. External professionals described improvements in staff knowledge, engagement and practice. Staff now understood people's nutritional needs and preferences and worked to provide care which promoted positive outcomes. Catering staff were knowledgeable about adapted diets and people were complimentary about the quality and choice of food available. Healthcare professionals reported there were no concerns regarding nutrition and hydration and described the manager as proactive in seeking specialist support when required. A visiting professional told us they found staff; “Always seem to find the time to support me with getting the information required.”

Staff worked well with other professionals and services to support people. Staff worked closely with a range of healthcare professionals including GPs, dietitians, mental health teams, behaviour support teams, pharmacists, district nurses and specialist services. The service had established regular multidisciplinary team meetings to review people’s physical health, mental health and emotional wellbeing and to coordinate support. People experienced continuity of care because staff shared information appropriately when people's needs changed and when they moved between services. Staff described positive working relationships with healthcare professionals and professionals consistently praised communication, responsiveness and engagement from the service. Staff also worked collaboratively within the service. The manager had focused on improving teamwork, staff engagement and communication following concerns about the culture inherited from the previous management team. Staff told us communication was much better, morale had improved and they felt supported to raise concerns. One staff member said, “Communication is so much better.” Another told us, “It’s not a closed culture anymore.”

Staff ensured people were consistently supported to achieve the best possible health and wellbeing outcomes. They encouraged people to maintain their health and wellbeing and worked with healthcare professionals to ensure people received timely support. People had access to GPs, dietitians, mental health professionals, opticians, podiatrists and other specialists. Staff recognised the importance of social engagement and community involvement and supported people to access activities, local facilities and social opportunities. The new manager had introduced initiatives to improve people's quality of life, including meaningful one-to-one engagement, community activities, wellness outings, access to a hair salon and opportunities to maintain relationships and interests. We observed positive interactions and meaningful engagement between people and staff.

The provider and new manager had made significant progress in addressing previous breaches and improving the culture of the service. Staff morale, communication and engagement had improved and external professionals reported positive changes within the home. The new manager monitored people's care and outcomes and had made significant improvements to quality assurance systems, although further work was required to fully embed these arrangements. They had completed a comprehensive review of the service and implemented a wide-ranging improvement programme. Systems had been introduced to monitor care quality, staff performance, incidents, accidents and people’s experiences. Staff described learning from incidents, audits and feedback and felt involved in service improvement. The new manager had identified many of the wider improvements were still required and was taking action to strengthen oversight arrangements.

Staff told people about their rights around consent and respected these when delivering person-centred care and treatment. Staff understood the principles of the Mental Capacity Act 2005 and associated codes of practice. They sought people’s consent before providing care and support. During our observations staff offered people choices, respected their decisions and involved them in day-to-day decisions about their care. Staff had received additional training, and improvements had been made to Mental Capacity Act practice. Capacity assessments and ‘best interest decisions’ were in place. Some restrictions relating to community access had been implemented following assessments by external professionals and commissioners to support people to access the community safely. However, records did not consistently demonstrate the necessary consent, capacity assessments or best-interest decisions to support these arrangements. We also found people who had capacity had not always signed records to demonstrate they had consented to restrictions that affected them, such as requiring staff support when leaving the service. The new manager acknowledged these issues and undertook immediate action to address them.