Ballards Ash

Ballards Ash is a residential care home which is registered to provide a service for up to 10 people. People living at Ballards Ash had diagnosed needs including a learning disability, mental health disorders and some people were on the autistic spectrum. At the time of our inspection seven people were living in the home and one person was in hospital.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This was a focused inspection and did not cover all areas of the Right support, right care, right culture during this inspection. People had limited access to external activities and reduced social contact due to the current government guidelines around the pandemic.

Improvements had been made in documenting and reviewing incidents within the service. Care plans had detailed information around identified risks. Medicines were being managed safely and staff had received appropriate training. Improvements had been made to infection control measures to ensure the service followed safe practices.

Staff feedback was mixed around the support they received and how the management team dealt with raised concerns. Staff felt the morale continued to need work and that some documentation was more of a tick box exercise than an actual review of practice. During this inspection we received two whistle-blowing concerns which have been safeguarded and raised with the management to investigate.

Quality systems were in place and actions set where improvements were identified. Additional management support was in place to oversee and drive improvements. Staff felt mixed on changes within the service, some felt good improvements had been made and others felt that the high staff turnover impacted negatively on the skill mix in the service and wasn’t being considered by the management team.

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 8 July 2020).

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. We have made one recommendation for the provider around reviewing the management of raised concerns.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service is Requires Improvement. This is based on the findings at this inspection.

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

Follow up

We will continue to engage 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.

Ballard's Ash is a residential care home which is registered to provide a service for up to ten people. People living at Ballards Ash had diagnosed needs including a learning disability, mental health disorders and some people were on the autistic spectrum. At the time of our inspection eight people were living in the home. One person was currently being supported at another of the provider's homes and there was one vacancy.

The service has not developed in line with or consistently applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The service is larger than recommended by best practice guidance. There were environmental factors that reduced the likelihood of being able to provide complete person centred care and maximise independence, choice, control and involvement in the community.

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

The risk of harm to people and staff had not been safely or effectively assessed and mitigated. There were people whose behaviours at times placed them, the staff and others at risk of harm. We had some concerns and observed that staff's approach to people's needs was not consistent, or always in line with people's care plans. There was a failure to review methods, amend measures and support staff to learn and develop their responses to keep people safe. Staff told us they felt a high staff turnover impacted their ability to support people well due to people displaying high levels of aggressive behaviour. The systems in place would not have prevented an infection from spreading and increased the risk of exposure for people.

The culture within the service did not promote a positive environment for the people living there or the staff who supported them. Staff told us they felt worn down and there was a lack of proactive actions taken to improve outcomes for people. Staff gave mixed feedback about the support they received from the registered manager. Prior to this inspection there had been allegations that documentary evidence was being falsified and backdated. From our inspection this was in part substantiated. People in the home had the opportunity to attend service user meetings and provide feedback through a survey. Some professionals expressed concerns that implementation of advice was inconsistent.

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 27 December 2017).

Why we inspected

The inspection was prompted in part due to safeguarding and whistleblowing concerns received about increased incidents of physical abuse between people in the service, lack of management support, incomplete or back dated documentation and a lack of suitable staffing levels. The Local Authority are currently reviewing some safeguarding’s that have been made about this service. As a result, we undertook a focused inspection to review the key questions of safe and well led only. We did not inspect the other key questions at this time. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

The provider has shared details of their action plan to address the concerns raised. The provider has assured us they will not be accepting any new placements at this time whilst they focus on improving the service. We have had a meeting with this provider to discuss our concerns and how they will implement change and improvements. We will work with the local authority to monitor progress and 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.

Ballard’s Ash is a residential care home which is registered to provide a service for up to ten people with learning disabilities. People had other associated difficulties such as behaviours that may cause distress to themselves and/or others and some people were on the autistic spectrum.

At the last inspection, on 23 September and 3 October 2016, the service was rated as requires improvement in the effective and responsive domains. This meant that the service was rated as overall requires improvement. At this inspection we found the service was good in all domains and therefore overall good.

There is a registered manager running the service. 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.

People, staff and visitors were protected from harm and the registered manager ensured the service remained as safe as possible. Safety was maintained and promoted by staff who had been trained in safeguarding vulnerable adults and health and safety policies and procedures. Staff understood how to protect the people in their care and knew what action to take if they identified any concerns. General risks and risks to individuals were identified and appropriate action was taken to reduce them, as far as possible.

People benefitted from adequate staffing ratios which ensured there were enough staff on duty to meet people’s diverse, complex, individual needs safely. Recruitment systems were in place to make sure, that as far as possible, staff recruited were safe and suitable to work with people. People were supported to take their medicines, at the right times and in the right amounts by trained and competent staff.

People were assisted by well-trained staff who were supported to make sure they could meet people’s varied well-being and complex needs. Staff worked very hard to deal effectively with people’s current and quickly changing health and emotional well-being needs. The service worked closely with health and other professionals to ensure they were able to meet people’s special needs.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible. The policies and systems in the service support this practice.

People were supported by a caring staff team who were committed to meeting people’s needs with patience and kindness. The staff team were attentive and were able to communicate with people by using detailed individual communication systems.

The service was extraordinarily person centred and responsive to people. Staff had made very positive impacts on people’s feelings of well-being. Support planning was highly individualised and regularly reviewed which ensured people’s needs were met and their equality and diversity was respected. People were provided with varied activities to enable them to lead as fulfilling a lifestyle as possible.

The registered manager was highly respected and ensured the service was well-led. She was described as open, approachable and supportive. The registered manager and her team were committed to ensuring there was no discrimination relating to staff or people in the service. The quality of care the service provided was constantly assessed, reviewed and improved, as necessary.

Ballards Ash provides care and accommodation for up to 10 people with a learning disability. At the time of our inspection there were nine people using the service.

There was a registered manager in place at the home. 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.

Procedures were in place to manage and dispense people’s medicines safely. Medicines audits were also undertaken. Stock levels that we checked were correct.

There were risk assessments in place to ensure that staff received guidance in how to support people safely. These were reviewed and updated accordingly when necessary.

Staffing levels were assessed and a minimum number of staff required on duty had been set. However, on some days this number fell below the number set by the provider. A recent recruitment drive had resulted in several new members of staff being employed.

Some families and professionals told us they did not feel that people were always supported to make choices around their preferences for participating in individual hobbies and interests.

Staff received support through supervision and training and felt supported by the management team.

Some aspects of the Mental Capacity Act 2005 were not being adhered to and some people were not fully supported by the company appointee to choose how they spent their money.

People received care which was responsive to their individual needs. People were able to follow their own preferred routines during the day, for example by getting up and going to bed when they wished. Staff worked with healthcare professionals to ensure professional advice was sought when necessary.

Staff were kind and caring and treated people with respect. People were encouraged to maintain relationships with other people that were important to them.

The service was well led by the registered manager. Staff reported feeling well supported and able to raise any concerns or issues. There were systems in place to monitor the quality and safety of the service. This included a programme of audits that included: medicines, the environment and people’s care plans.

People were provided with choices of food and drink to meet their diverse needs. We found that the cook knew the individual nutritional requirements of people contained within their care plans. The cook bought fresh produce and made home cooked meals. We observed these were presented in an appetising way to encourage people's enjoyment.

We found that staff and people who used the service or their representatives understood the safeguarding process and how it applied to them. This meant that people were protected from abuse and their human rights were respected.

Staff told us there was a good team spirit at Ballards Ash, cultivated by an experienced and approachable manager and deputy. We found that training in core subjects was up to date and that staff thought that this equipped them to fulfil their roles effectively.

The provider had a clear system for handling and responding to complaints, although there had been none recorded since the last inspection.

We saw the people were supported to go out at different times of the day. One person was supported to go Christmas shopping. We saw staff asking people throughout the day what they wanted to do and what support they needed.

People's needs were assessed and care was planned so that they experienced care, treatment and support that met their needs and protected their rights. There were suitable arrangements for obtaining, administering, recording and storing medicines so that people received the right medicines at the right time.

Before staff started to work with people they had strict recruitment checks and they provided information about their employment history, qualifications and experience. The manager and staff made sure that all the necessary records were in place to support people and manage the home.