Balmoral Court

People’s experience of using this service and what we found

The service was exceptionally well led. The provider's vision and values were person-centred to make sure people were at the heart of the service. This vision was driven by the exceptional leadership of the registered manager.

The service supported some people with complex needs. There was clear evidence of collaborative working and excellent communication with other professionals to help meet people's needs and maintain their placement wherever possible. A healthcare professional commented, “I continue to enjoy working with the team at Balmoral. The management maintains a stable staff team and communicates well with my practice.”

People's equality and diversity as unique individuals with their own needs was respected by staff. The service was flexible and adapted to people's changing needs and wishes and promoted their independence. People’s care records were well-personalised and up-to-date.

There was a strong and effective governance system in place. Processes were in place to manage and respond to complaints and concerns. People and relatives recognised that their views were valued and respected.

People and relatives stated staff were kind, caring and supportive of people and their families. Comments included, “Carers are amazing, I take my hat off to the staff” and "I like the way staff do things, they are very polite, very friendly and always have a smile.”

People were involved in decisions about their care. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People said they felt safe with the care they received. One relative commented, "Staff have a nice attitude with people, they are safe the way staff support them.” There were enough appropriately skilled staff to meet people’s assessed needs. Robust vetting procedures were in place when recruiting new staff. Staff training was up-to-date.

The service was following safe infection prevention and control procedures to keep people safe.

Medicines management procedures were in place. People did not report any concerns with their medicines.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published July 2019).

Why we inspected

This focused inspection was prompted by the notification of a specific incident, following which a person using the service died. This incident was subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about the management of people’s safety. This inspection examined those risks and we reviewed the key questions of safe and well-led and parts of effective and responsive. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the relevant domains of this report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service.

Ratings from previous comprehensive inspections for those key questions inspected but not rated were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Balmoral Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Balmoral Court is a residential care home that was providing personal and nursing care to 88 people at the time of the inspection. The service can support up to 99 people. People are accommodated in four units, including a male only and a female only unit. Care is provided to both older people and younger adults. People are supported with physical and mental health needs, including people living with a dementia-related condition.

People’s experience of using this service and what we found

The service was exceptionally well led. The provider had invested in developing an experienced and motivated management structure. The registered manager was extremely knowledgeable, proactive and driven in striving for people to receive better care. Staff were proud to work for the company. Their commitment was recognised, and their suggestions listened to. The service had excellent links with the local community and used these to enhance the lives of the people who used the service.

People told us they felt safe. The home was well maintained. There were enough staff to meet people’s needs and medicines were well managed. The home was clean.

Staff received training relevant to their role. They were given opportunities to develop their skills and were well supported. People’s care was planned and delivered to meet their individual needs. Staff had clear information about how to support people. They effectively diffused situations where people became agitated. The service was well designed to enable people to be as independent as possible.

Staff were caring and put people at ease. Relatives told us staff knew them and their family member’s well. People were valued, and their differences were celebrated. People’s dignity was respected and their independence was promoted.

People’s care was designed around their needs, choices and preferences. People could take part in activities both inside and outside the home. People and relatives were asked for their views, and these were used to drive improvements. Complaints had been well managed.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At the last inspection the service was rated good (published January 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Balmoral Court provides nursing and personal care for up to 58 mainly older people with dementia-related conditions and other mental illnesses. The home is set out over two floors, one designated for accommodating females and the other for males. At the time of our inspection there were 46 people living at the home.

The service was last inspected in August 2016 and rated as ‘Requires Improvement’. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective and well-led to at least good. At this inspection we found the necessary improvements had been made in the management of medicines, upholding people’s rights under mental capacity law, and to the governance of the service. The service had improved to good and met each of the fundamental standards we inspected.

A new manager was in post who had applied to be registered. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Systems were in place to safeguard people against the risks of harm and abuse. The home had been enhanced and the environment was clean, comfortable and equipped to meet people’s needs.

There were enough skilled and experienced staff who provided continuity of care. The staff received training and support that enabled them to care for people effectively. People were appropriately supported in maintaining their health and nutritional needs.

Staff were caring in their approach and had formed supportive relationships with people and their families. They respected privacy and dignity and encouraged people to make choices about their care. Formal decision-making processes were undertaken with the involvement of advocates, when necessary.

People’s needs were assessed and care planned, guiding staff about the care and support the individual required. A range of activities and access to the community was provided to support people in meeting their social needs. Good arrangements were made when people were cared for at the end of their lives.

The manager promoted an inclusive culture and provided leadership to the staff team. Feedback was sought and any complaints received were taken seriously and responded to. The quality of the service was continuously monitored to check that standards were maintained and improved.

Further information is in the detailed findings below.

Balmoral Court is a care home that provides nursing and personal care for up to 58 mainly older people who have dementia-related conditions and other mental illnesses. At the time of our inspection there were 41 people living at the home.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that the ongoing personal safety of people living at the home was not compromised. Appropriate steps were taken to safeguard people against the risks of avoidable harm and abuse. Measures were in place to reduce the risks associated with people’s care and to ensure there were safe working practices.

Safety-related checks were carried out and there was improved maintenance of the building. A decorating and refurbishment programme was nearing completion and more efforts were being made to enhance the environment. Accidents and incidents were suitably reported, analysed and acted on.

New staff were properly checked and vetted before they started working with vulnerable people. There was a full staff team and enough staff to provide people with safe and consistent care. Comprehensive training had been delivered to support staff in developing their skills and enable them to provide people with effective care.

Choices of meals were offered and people were given support with eating and drinking, where needed. Nutrition was assessed and, when necessary, dietetic and other specialist advice was obtained. People were supported in meeting their physical and mental health needs and accessed a range of health care services. However, the management of medicines was not fully robust and required improvement.

The principles of mental capacity law were not always being applied to make sure people’s rights were upheld. Formal processes had not been undertaken for making specific decisions about people’s care and treatment where they were unable to give their consent.

People and their representatives were provided with information about the service and had opportunities to give their feedback. We observed positive interactions and good relationships between people and the staff who cared for them. This was confirmed by people and their relatives who told us staff were caring and respectful.

Individualised care plans had been developed to guide staff on meeting people’s identified needs and preferences. Care was regularly evaluated and adapted in response to any changes in a person’s needs, though reviews of care to consult with people and their relatives had lapsed. A variety of activities were arranged for social stimulation and to help people be included in their local community.

The management team provided leadership and support to the staff. They were promoting an open culture in the service and aimed to work more inclusively with people, their relatives and staff. Any complaints raised were taken seriously and promptly addressed. A more structured approach was being taken to monitoring standards in the home, though this had not highlighted the shortfalls we found during the inspection. The governance arrangements needed to be improved to keep closer scrutiny of the quality and safety of the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to medicines management, consent and governance of the service. You can see what action we told the provider to take at the back of the full version of this report.