Balmoral 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 assessment we rated this key question good. At this assessment 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.

This service scored 58 (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 ensure people’s care and treatment were effective, as they did not consistently check and discuss individuals’ health, care, wellbeing, and communication needs. When people’s needs changed, these changes were not always reassessed or reflected in care plans and risk assessment, for example, after a person had fallen or required different support to move around the home.

Although staff generally knew people well, they reported that systems for communicating changes were not always effective and often relied on the knowledge of the staff team on duty.

The provider did not always plan and deliver people’s care and treatment in partnership with them or fully consider what was important to individuals.

While the registered manager reported several positive outcomes following staff support, including improvements in people’s health, mobility, and communication, there were areas for further work.

People’s weight was generally stable. One person said, “The food is good here and there is always enough.” A relative commented, “My family member has a good appetite and has not lost any weight.” Feedback about the food and meal choices was generally positive, but it was not clear that people had been involved in designing the menu. The chef adapted meals to individual preferences.

Although the provider worked with healthcare services, it was not always clear that professional advice was fully followed, for example, regarding supporting people to elevate their legs on footrests or the use of specific drinking equipment.

The provider did not always work effectively across teams and services to support people and did not consistently share assessments of people’s needs when they moved between different services.

Referrals to other agencies were made where appropriate, and the provider was fully engaged in local healthcare initiatives. However, advice from other professionals was not always incorporated into care records, although this was mitigated by staff knowing people well. The home participated in pilot projects to help relieve pressure on local services, such as taking on specific tasks delegated by the district nurse team. Clear and accurate records were not always consistently maintained, and this was hampered by difficulties connecting the electronic recording system to the internet, which affected contemporaneous record-keeping.

The provider supported people to manage their health and wellbeing in ways that promoted independence, choice and control. Staff encouraged people to live healthier lives and, where possible, reduce their future need for care and support.

People and their families felt confident that health needs were being met. One person told us, “The staff are lovely here. If I need a doctor, they will get one quickly.” During our site visit, we observed staff seeking medical attention when a person became unwell. Referrals were made when staff identified concerns, for example, people at risk of weight loss had been referred to a dietician for further assessment and advice.

However, there was limited evidence that professional advice was consistently followed. For example, where a dietician had advised that a person be weighed weekly or have their food intake monitored, this was not always taking place. Despite this, we found that people’s weights were generally stable.

The provider did not always routinely monitor people’s care and treatment to drive continuous improvement or ensure that outcomes were consistently positive and met both clinical expectations and the expectations of people themselves.

Care plans and risk assessments were not always reviewed regularly or updated following changes in need, meaning they were not always accurate. Records of daily care were not always completed in detail, making it unclear whether people with specific dietary or fluid requirements received appropriate support, whether people were supported to eat and drink enough, or whether those needing regular repositioning or bowel monitoring received this care as outlined in their care plans. Although there was no evidence that people experienced harm, largely due to staff knowing people well, there remained a risk that important changes could be missed.

The provider did not always inform people of their rights regarding consent, nor did they always respect those rights when delivering care and treatment. Consent was not clearly documented in care records, and it was often unclear whether individuals had the capacity to make decisions in specific areas. Records did not consistently show that mental capacity assessments or best interest decisions were carried out in line with the requirements of the Mental Capacity Act. Staff did not always seek explicit consent before providing support, often assuming implied consent. Where people lacked capacity and were subject to restrictions, the provider made referrals to the Deprivation of Liberty Safeguards. The registered manager understood the importance of ensuring people had access to independent advocacy.