Archived: Balmoral Care Home

Updated 10 January 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was carried out by an inspector, a Specialist Advisor and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Balmoral Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission at the time of our inspection visit however an application had been made. The manager was registered shortly after our inspection visit had taken place. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service, including Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all of this information to plan our inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

During the inspection

We spoke with 13 people who used the service and 12 relatives about their experience of the care provided. We spoke with six members of staff including the regional manager, the resident experience manager, the home manager, the deputy manager, the clinical lead, and a cook.

We reviewed a range of records. This included three people’s care records and various medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service were reviewed.

After the inspection

We spoke with three care staff and the local authority. As requested, the manager provided policies, staffing rotas, dependency tools, maintenance plans and regional manager oversight following our visit.

Updated 10 January 2020

About the service

Balmoral Care Home is a residential care home providing personal and nursing care to 68 people at the time of the inspection. The service can support up to 75 people. Accommodation is provided over three floors and three separate units. The Hampton unit is on the ground floor and can support up to 20 people with residential needs. The Chatsworth unit is on the first floor and can support up to 29 people with nursing needs. The Windsor unit is on the first and second floor and can support up to 26 people living with dementia.

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

Systems were in place to protect people from abuse. Risks were assessed to ensure people were supported safely and their freedom was respected. Care observed was unrushed, and whilst people and relatives felt staff levels were low this was not the general view of staff. Medicines were administered safely. Infection control procedures were in place and were followed, however some areas of the home weren’t entirely clean and some areas needed maintenance to take place.

People’s needs and choices were assessed in line with current legislation and guidance. 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. Staff received regular training, and new staff were inducted however not all staff had received the required updates to their moving and handling knowledge. The manager had a plan for this to be completed. People were supported to eat and drink and maintain a balanced diet. Records showed good interaction and communication between staff and other professionals to support good quality care. People were involved in the running of the home; areas of the home were personalised and homely. Consent to care was sought and recorded.

Observations showed kind and caring interactions between staff and people. People were supported to express their views and be involved in their care and support. People’s privacy and dignity were respected and their independence promoted.

People’s care plans were personalised to their individual needs however some aspects of people’s social inclusion had not been considered and people’s views on activity provision was poor. People’s concerns and complaints were recorded and actions taken, where applicable, to improve care quality. People were well-supported at their end of life.

The home had developed an open culture. There was a governance framework in place to review and assess quality of care and risks. People, relatives and staff were involved in the service, however for people and relatives this was limited. We have made a recommendation about people and relatives attendance at meetings. The service used feedback to learn and improve. The service worked in partnership with other agencies to support people appropriately.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 10 December 2018) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.