Balmoral Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were safeguarded from abuse and possible harm. Staff received safeguarding training and demonstrated a clear understanding about how to recognise and report abuse and poor care. The registered manager understood their responsibility to refer any safeguarding matters to the appropriate agencies. Individual risk assessments were completed for people so that identifiable risks were managed. The service was in the process of introducing electronic care plans and a transition plan showed progress of documents transferred. People 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. Safe staffing levels were in place. Staff were supported to deliver care and treatment safely and to an appropriate standard. We shared some feedback about the recruitment procedures at the service. The registered manager took immediate action in response to the feedback.

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.

Relatives told us their family members were safe and they felt confident in the support they received from Balmoral Care Home and were confident any concerns would be appropriately responded to. One relative said, “I do also come to some of the ordinary meetings. I think they listen if you bring things up.”

Staff were aware of how to respond to accidents and incidents which included how to record and report incidents.

The provider had policies in place which were readily accessible to staff. There were monitoring systems in place to ensure that lessons were learnt from incidents such as accidents and incidents, complaints, concerns, whistle-blowing, and investigations. The registered manager confirmed that all accidents and incidents were reviewed for lessons learned including reviewing with teams on each unit and at quarterly health and safety meetings.

We saw examples of when people had received support from Balmoral Care Home following a hospital stay. The provider was responsive to meeting their needs to ensure a safe transition from hospital was facilitated and care plans updated to reflect changing needs. One family member commented, “[Name] became a resident after discharge from hospital and [Name] being no longer able to look after themselves. We are very pleased with the home. It is clean and there is nothing not to like. [Name] is very happy here.”

Staff were aware of including people in discussions about their care needs and following their care plans and risk assessments. One staff said, “I would speak to them and get to know their preferences and incorporate into the care plan whether that’s routines or choices e.g food and drink.”

We saw the provider had successfully worked with partners and had been involved in discussions with them about people care needs. We received positive feedback from partners we contacted about Balmoral Care Home. One professional commented, “Staff are really approachable and receptive.”

The provider had processes in place to monitor safe systems, pathways and transitions were maintained. This included a comprehensive needs assessment which was completed prior to support being provided.

People told us they felt safe and had no worries or concerns. People felt confident they could raise concerns if they needed to. One person said, “I have been here a while, and I am very well looked after. I am pretty independent, but the staff are here to keep me safe, and I do feel safe."

People were safeguarded from abuse and possible harm. Staff received safeguarding training and demonstrated a clear understanding about how to recognise and report abuse and poor care. One staff member said, “If any resident needed help or had any issues, I would speak to the unit manager to raise concerns.”

During our site visit we saw kind and respectful interactions between people and staff. Staff were seen to offer people choices and seek consent before supporting. The atmosphere in the home felt warm and friendly.

Staff had completed safeguarding training and the provider’s safeguarding policy guided staff about different types of abuse and how to raise a concern to ensure people were protected. Any safeguarding concerns were recorded appropriately and reviewed to ensure the relevant professionals were notified. There were monitoring systems in place to ensure that lessons were learnt from incidents.

People were involved in the assessment of their needs and the management of their risks where able. People believed staff would respond to their needs quickly and efficiently, especially if they were in pain, discomfort, or distress. One person commented, “I don’t know what they call it but sometimes they (the staff) sit with me and talk to me about how I am doing. They are all very kind and know me well.”

Staff promoted people's safety and wellbeing. People’s care plans were regularly reviewed and in response to any change in needs. One member of staff commented, “We have a handover, and changes flash up on our devices.”

Staff were knowledgeable about people’s needs and preferences and how to manage people's risks. We observed that staff were vigilant when people were moving around or undertaking activities and made sure people remained safe.

Risks were identified and were regularly reviewed and updated where there was a change in need. The home was transitioning to a new electronic recording system and had systems in place to monitor transfer of information and to inform staff when information was transferred.

People were cared for in a safe environment that was designed to meet their needs. People had a range of equipment available to use. One family member said, “They are always cleaning or vacuuming. The place is kept clean”.

The provider monitored and reduced any risks in relation to safe environments and staff were aware of safety and had received a range of training to support them keep people safe. Staff were positive about the changes implemented since the new provider took over. One staff member commented, “At the minute putting work into the home which is what is needed. When have needed something, have asked [registered manager] and then ordered and got it.”

At the time of assessment, the home was looking tired in some areas and some items of furniture needed replacing. The new provider had an action plan to update the building. This was underway with some areas already completed. Signs were available to help people to navigate around the service and personalised items and photographs were on display outside bedrooms for those people living with dementia.

There were systems in place to monitor the safety and upkeep of the premises. Regular checks were completed by the provider to ensure the environment and equipment was safe for people to use. This included checks for fire safety, legionnaires and moving and handling equipment.

People and their relatives told us staff were always available when they needed help or support. One relative told us, “[Name's] care is good. The staff are always available and they have a good rapport with [Name], who is really happy here." However, we received some feedback from relatives that the staffing levels on some units would benefit from additional staffing. One relative commented, “There does seem to be enough on [Name of unit]. There is enough for them to spend time chatting to people and giving them one to one support, whereas on [Name of unit] there is just enough to keep an eye on people rather than interact and do things with them.” We discussed this with the registered manager who agreed to review staffing levels across all units.

Staff told us they felt well supported in their role and received relevant training. Staff told us there were safe staffing levels at the service. However, some raised that although some agency staff were good, others placed additional pressure on them. One staff commented, “It’s a nice supportive team. We try and cover shifts in house, sometimes we have agency. Some agency staff are better than others and use their initiative, but not others. We have to give some reminders and it makes the day go longer. We try and use regular agency staff wherever possible.”

There were appropriate staffing levels in place. People did not have to wait for support from staff when they needed this. Staff were seen to regularly check in on people who chose to spend time in their rooms or in quieter spaces around the service to make sure people were well and to ask if they needed anything.

Recruitment procedures were in place, so people were cared for by suitably qualified staff who had been assessed as safe to work with people. However, it was noted that some areas of the process needed closer scrutiny. For example, to ensure there were no gaps in a staff member's work history. We shared this information with the registered manager who took immediate action. The supervision tracker for 2024 showed some staff had not received the number of supervisions identified by the provider policy. We discussed this with the registered manager who confirmed this would be remedied by the year end. There were enough staff deployed to meet the needs of people using the service. However, some concerns were raised by staff and families about staffing levels and agency usage. The provider was working hard to fill vacancies and reduce agency usage. Staff underwent an induction and shadowing period prior to commencing work. They had regular updates to their training to ensure they had the skills and knowledge to carry out their roles. Staff had undertaken specialist training to meet the individual needs of people using the service. For example, dementia awareness and positive behaviour support.

Feedback from people and relatives did not highlight any concerns about cleanliness and hygiene at the service or how staff minimised the risk of infection. One relative commented, “The place is always clean. The cleaner is always mopping the floor particularly after a meal.”

Staff had received appropriate training in infection prevention and control and were aware of safe hygiene practices. No concerns were raised about the availability of personal protective equipment (PPE).

Staff followed current practice when supporting people and used personal protective equipment (PPE) when required. However, in some areas the home was tired and in need of refurbishment which was impacting on overall cleanliness. Planned works were underway which should make infection, prevention, and control (IPC) measures more effective once complete.

The provider had policies and procedures in place regarding IPC and had systems in place to monitor practices. The home knew how to respond to risks and signs of infection and how to make sure infection outbreaks at the service would be effectively prevented or managed. There were arrangements in place to make sure the environment was cleaned by staff at regular intervals.

People had their medicines at the right time and in a safe way. Records of medicines administered were accurately recorded, including time sensitive medicines for certain complex health conditions. Person centred care plans were in place for ‘when required’ medicines and for people with diabetes to help make sure they were supported with their health needs and medicines. Improvements in recording were needed for one medicine, Paracetamol, that needed to be given four hours apart.

Staff informed us they had a good working relationship with the local pharmacy and told us things had improved since changing pharmacy provider. The registered manager told us, and we saw that regular detailed medicines audits were carried out and any issues identified were actioned immediately to make improvements. Staff received training in medication administration and competencies were thorough and comprehensive.

We found some improvements were needed for the recording of medicines patches and in the paperwork to support people having their medicines covertly (hidden in food or drink) administered. The manager said this would be actioned immediately. Improvements in recording were needed for one medicine, Paracetamol, that needed to be given four hours apart. Medicines were stored securely and safely. Temperature monitoring of rooms and fridges was carried out daily to make sure medicines were stored safely. However controlled drugs were not stored according to regulations, the manager provided assurance that this would be rectified immediately. Effective systems were in place to make sure people’s medicines were ordered and accurately recorded to ensure sufficient supplies of medicines were in stock. Staff administering medication were clearly identified and not interrupted by other staff. Treatment rooms and drug trolleys were clean and tidy. Staff administering medication were person centred in their interactions.