Balmoral Court Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At the last inspection we rated this key question inadequate. At this inspection the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

We found the provider was in breach of the legal regulation relating to good governance.

This service scored 57 (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 and new manager had been working with staff to ensure they had a clear shared vision, strategy and culture that was fully embedded across the service. The management team had made significant progress in addressing the poor culture that had existed under previous management and were actively working to create a more open, person-centred environment. Staff, people and professionals consistently described improvements in culture, communication and morale since the appointment of the new manager. Staff told us they felt more supported and reported a greater understanding of people's needs, preferences and life histories. The new manager had introduced a range of initiatives to improve staff engagement, including regular supervision, staff meetings, manager walkarounds and opportunities for staff to contribute ideas for improvement. People and relatives were positive about the new manager, describing them as approachable and responsive. We observed staff interacting with people respectfully and demonstrating a better understanding of their individual needs. Although improvements were evident, the provider and new manager acknowledged further work was required to ensure these cultural changes were consistently embedded and sustained across all areas of the service.

The provider was taking action to ensure fully effective leadership arrangements were in place. The management team had driven significant improvements since the last inspection. The new manager was highly visible within the service and was viewed positively by people, staff and external professionals. They were in the process of applying to become the registered manager. Staff consistently described the new manager as approachable, supportive and willing to listen. The new manager had undertaken a thorough review of the service and implemented a range of measures to improve staff engagement, care quality and organisational culture. They demonstrated an understanding of the challenges facing the service and had developed clear improvement plans. Staff reported improved morale, communication and support and described leadership as more visible than previously. However, leadership arrangements were not always fully effective. The delegated oversight provided by clinical leads had failed to identify significant medicines concerns and other areas requiring improvement. The management team had recognised these shortcomings and had begun taking steps to strengthen management capacity through the appointment of a deputy manager and additional clinical oversight. While the manager demonstrated the qualities of a capable and compassionate leader, leadership systems were not yet consistently effective at all levels and further work was required to embed sustainable improvements.

The provider had developed a culture where people and staff increasingly felt able to speak up and share concerns. Leaders recognised that a closed culture had existed under previous management and had taken proactive steps to address this. Staff described feeling more confident raising concerns and making suggestions and told us they no longer feared negative repercussions. The manager had introduced a range of mechanisms to encourage openness, including an open-door policy, regular staff meetings, HR clinics and whistleblowing training. Staff consistently told us their views were listened to and that leaders responded positively to feedback.

The provider promoted equality, diversity and inclusion within the workforce and had implemented systems to support staff from diverse backgrounds. Staff completed equality and diversity training and leaders demonstrated an understanding of their responsibilities under equality legislation. The management team employed a diverse workforce and had arrangements in place to support staff with protected characteristics, including pregnancy risk assessments, reasonable adjustments and access to support from line managers. Staff told us they felt respected and valued by leaders and reported improvements in workplace culture. The management team had worked to ensure workloads were allocated fairly and staff described a more inclusive and supportive working environment.

The provider’s governance systems still needed to be improved. Governance concerns identified at previous assessments had not been fully addressed. Although the management team had implemented a range of new quality assurance and auditing processes, these had not always identified significant risks and poor practice. We found continued concerns relating to medicine management which had not been identified through the provider's auditing systems. Clinical leaders had failed to identify missed medicines which had occurred over several months, inaccurate medicines records and concerns regarding covert administration practices. Governance systems had also failed to identify areas where care records, capacity assessments, best interests’ decisions and behaviour support documentation required improvement. The management team had not critically reviewed inconsistencies in incident reporting or recognised that some staff were not consistently reporting restrictive interventions. The provider and new manager recognised these failings and had taken immediate action when concerns were raised but the new oversight arrangements were not yet embedded and fully effective.

Staff understood their duty to collaborate and work in partnership, so services worked seamlessly for people. Staff worked effectively in partnership with external organisations and professionals to support people's care and improve outcomes. Professionals consistently described positive working relationships with the service and praised the manager's willingness to engage, seek advice and implement recommendations. Staff participated in regular multidisciplinary meetings which supported coordinated decision making and enabled timely access to specialist advice. Professionals told us staff communicated effectively and provided the information required to support assessments and treatment. People were supported to maintain connections with their local community and participate in activities outside of the service. The management team recognised the importance of community integration and had increased opportunities for people to access local amenities, social events and community resources. Staff demonstrated a collaborative approach and understood the importance of partnership working in achieving positive outcomes for people.

While leaders had made significant efforts to learn from previous concerns and implement change, systems to evaluate and embed learning were not yet always effective. The new manager had introduced a range of initiatives aimed at improving staff confidence, competence and engagement. Staff reported receiving regular training, supervision and development opportunities and described a stronger focus on learning than had previously existed. The management team actively sought support from external professionals and used this to inform service improvements. Training had been expanded and staff were encouraged to reflect on practice, seek advice and develop new skills. The new manager had undertaken extensive work to improve care planning, engagement, infection prevention and organisational culture. Staff described a commitment to continuous improvement and reported that leaders encouraged ideas and suggestions. However, lessons from incidents were not always fully embedded. Governance systems had failed to identify some significant medicines concerns and leaders had not consistently analysed incident reporting trends to understand why recording practices varied across the service. Although there was clear evidence of an improving learning culture, further work was required to ensure learning was consistently translated into sustained improvements in practice and outcomes.