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

People’s care plans reflected their physical, mental, emotional, and social needs. This included any protected characteristics under the Equality Act 2010. Where people were assessed as lacking capacity to make a particular decision, the provider followed best interest processes to protect people's rights. People had been referred to other health professionals as required such as the district nursing service. The provider assessed and reviewed people’s health, care, and wellbeing with them. Staff worked across teams and services to support people. People were supported to understand their right to consent and empowered to make their own decisions when involved in planning how their care and support was provided. Staff understood the importance of ensuring people understood what they were consenting to and obtaining people’s consent before they delivered care. People’s communication needs were assessed, and staff interacted appropriately with people according to their needs.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed responses from relatives about their involvement in the assessment and review of the care of their relative. One commented, “There is a new care plan as it was done last time [person] came back from hospital.” Another said, “I am not sure if there is a care plan but assume so as I know the staff update things during the day.”

Staff were involved in developing care plans and reviewing and updating them as necessary. Staff were aware of the importance of involving people in all aspects of their care and ensuring they were meeting people’s assessed needs. The registered manager described how the senior team involved residents and families in gathering information prior to support and the benefits of the new electronic recording system. The registered manager commented, “With the new system one nominated relative will be able to have access. It’s not available at the moment but it is in progress.” Staff spoken to were positive about the new electronic recording system. One staff said, “It’s easier to look up information. The information is there on our devices instantly.”

The service had recently moved to a new electronic recording system. This included a new comprehensive assessment, which included consideration of people’s clinical needs (including pain relief), mental health, physical health and wellbeing, and nutrition and hydration needs. Care plans were developed and written in line with people's assessed needs, for example if a need was identified, care plans included ways in which staff could support people to achieve their outcomes.

People received care, treatment and support that was evidence-based and in line with good practice standards. We observed lunch being served on all 3 units. The main meal of the day at Balmoral is in the evening. We observed a calm atmosphere with warm rapport between staff and residents. Staff asked people what they would like to eat or used show plates for some people to support them to make a choice. Staff were seen to support people discreetly and respectfully and where supporting people one to one with their meal did so at the person’s pace. We received mostly positive responses regarding food served. One person commented, “The food is good. I like everything but they’ll do specials if I ask for them.” However, one person said, “The food is all right but sometimes it’s rubbish. I’m not sure if I can ask for something different.” We discussed this with the registered manager who agreed to ensure all residents were aware they could request alternatives to the menu in place.

Staff that we spoke with had received the relevant training and were confident in carrying out assessments of people's needs using evidence-based standards, which was in line with good practice. Staff were aware of people who needed a specialised diet and how to support them to ensure their needs were met. Staff were aware of the importance of involving people in all aspects of their care and ensuring they were meeting people’s assessed needs.

People's preferences and dietary needs were assessed and accommodated. In people's care records there was evidence of involvement from other health care professionals where required, and staff made referrals to ensure people’s health needs were met. The provider’s systems ensured that staff were up to date with national legislation, evidence-based good practice and required standards. Standard, industry recognised assessments were used to assess people's support needs. These included Waterlow to assess the risk in relation to pressure sores and the Malnutrition Universal Screening Tool (MUST).

People using the service and their relatives told us they had access to health professionals for their ongoing healthcare support needs. They received care and support that was coordinated, and services worked well together. One relative said, “I am fully involved and engaged in [Person’s] care and any medical issues”.

All relevant staff, teams and services were involved in assessing, planning, and delivering people's care and treatment and staff worked collaboratively to understand and meet people's needs.

Overall, we saw the provider had successfully worked with partners and had been involved in discussions with them about people care needs. One professional commented, “[Registered Manager] manages to keep on top of everything given the size of the home and is quick to respond to reportable issues.”

Information was shared between teams and services to ensure continuity of care, for example when tasks were delegated or when people were referred between services. Evidence of joint working with partners was available, including the wider community and volunteer services.

People were involved in regularly reviewing their health and wellbeing needs where appropriate and necessary, including health assessments and checks with health and care professionals. People using the service, and their relatives, told us they had regular access to their GP and other professionals. One relative said, “They are very good at keeping us informed about [person’s] condition and will get the doctor or nurse as needed and keep us in the loop.”

Staff, including the registered manager, told us they had a good relationship with health and care professionals which meant that people got the support they required, quickly. Staff could describe how they supported people to remain healthy and what action they would take if someone’s health changed, or they required additional support. One staff member said, “Lots of professionals come in, we see them often. They pass information onto us, and the unit manager inputs it (on the system).”

In people’s records we found evidence of involvement from other professionals such as nurses, social workers, and doctors. Where people needed additional support, we saw involvement of relevant professionals to ensure people received the appropriate level of support.

People using the service experienced positive outcomes in line with their level of need and the provider carried out assessments and reviews to ensure they were regular monitored for any changes. Overall we received positive reviews from relatives about the support received from staff. One relative told us, “The impact on [person] has been amazing. [Person’s] mental and physical health are better. [Person] is eating better, and all aspects of [Person’s] life are improved." However, one relative said, “I don’t think there are enough staff as I don’t think they are spending enough time giving the passive care they are supposed to.” We discussed this with the registered manager who agreed to continue to monitor staffing levels across all units.

The registered manager and senior staff told us they worked alongside staff to ensure there was effective monitoring of people’s care and treatment and their outcomes. The provider regularly asked people to give them feedback on their experiences of the care they were receiving. They listened to their responses and tailored the care they gave where this was needed.

The quality and service that people received was routinely monitored by managers and staff through a range of different methods. This included care plan reviews, audits and obtaining feedback. Audits were used to identify issues and themes and to learn lessons to provide positive outcomes for people. Action plans were used to address issues and make improvements to the service where needed. For example, during our inspection, the registered manager immediately actioned an issue we identified.

People, and their relatives, understood their rights around consent to the care and treatment they were offered. People's capacity and ability to consent was taken into account through mental capacity assessments, and they, or a person lawfully acting on their behalf, were involved in planning, managing and reviewing their care and treatment. One person said, “I am always treated with respect, and they knock on my door and ask if it’s ok to come in.”

Staff demonstrated a good understanding of the principles of the Mental Capacity Act (MCA) and people were supported wherever possible to make their own decisions. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Staff understood the importance of obtaining consent before they delivered care or treatment. They were aware of the need to ask people and offer them a choice when it came to decisions around personal care, dressing and meals. One staff member said, “I always make sure to knock on the door. I always talk them through (what I am doing) and make sure it is alright with them for example when supporting with personal care.”

The provider had suitable policies and procedures in place regarding consent to care and treatment and staff had received training on MCA. The registered manger was aware of the mental capacity act and associated legislation and DoLS applications had been submitted and renewed where applicable.