Ballards Ash

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Lessons were not always learnt to continually identify and embed good practice. Incidents and accidents were recorded, however, it was not always evident what had happened and what actions had been taken in response. Whilst immediate action had been recorded such as seeking medical help, management reviews were not always clearly recorded. This meant it was not always possible to see what lessons had been learned to prevent recurrence.

Relatives said they had been informed of incidents and accidents, however, there were times when there was a lack of detail about exactly what had happened and action taken as a result.

The provider told us they did regular meetings with managers where learning from incidents across the organisation was discussed. Information for working safely was then shared with staff.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Leaders said if people needed to be transferred to hospital, staff would go with the person to make sure the person was safe. People’s records and health needs would be shared with medical professionals which included information on people’s communication needs.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff received training on safeguarding and understood how to report any concerns. Relatives said people were safe at the service, and we observed people being supported by staff safely. Safeguarding incidents had been shared with the local authority in a timely way. Action was taken to support people appropriately which included updating family members about actions taken.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that staff had applied for DoLS authorisations. Where these had been granted there were no conditions.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks to people’s safety had been assessed and safety measures put in place. However, some of the safety measures were restrictive to others in the service. Restrictions had not been regularly reviewed, and there was no evidence to show what actions had taken to lessen their impact on people or remove them when they were no longer necessary. Leaders said the provider had just produced a risk register document which would help evidence all risk restrictions and action taken to review and reduce where safe to do so.

We found 1 person had experienced some falls and the circumstances of how they fell were similar. For example, the person had fallen in the same place. Risk management plans had not been updated to provide staff with guidance on how to prevent recurrence.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Health and safety checks were regularly completed, and premises and equipment were regularly serviced and checked for safety. We observed staff using equipment safely and making sure people were supported as per the guidance in their care plans. Staff practised emergency evacuation drills with people. This helped people become familiar with emergency procedures.

The provider did not always make sure there were enough qualified, skilled and experienced staff. Some people had commissioned hours for 1-1 support. It was not evident how all of this support was being provided due to staffing arrangements. We shared this feedback with leaders who took immediate action to review and adjust staffing rotas.

Some relatives and staff said there were not always enough staff to support people. Staff said the staffing was not unsafe, but more staff would help support people to engage more with their local community. One member of staff said, “There are probably not enough staff, but it is not unsafe. I think we do a good job to try and overcome things.” Leaders said staff recruitment had been challenging. However, the service was now fully staffed so leaders were hopeful they could adjust staffing rotas to better support people.

Staff had been recruited safely and were provided with an induction and ongoing training. Staff had regular supervisions and opportunities to develop their knowledge and skills. Specialist training for supporting people with learning disabilities had been provided. This included specialist behaviour support training delivered by the provider’s behaviour support team. This meant staff had expert guidance and advice from a team who also knew people well.

In addition to training and supervision staff were often assessed for competence in certain areas. For example, medicines and moving and handling were areas which required an assessment of competence. Whilst records were kept of observations these were not always personalised to the member of staff. The provider acknowledged this was an area that required review and were in the process of completing a competency tracking record. This would enable managers to monitor completion of observations for each member of staff.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service was clean and well maintained. Whilst staff carried out most of the cleaning, people were also encouraged to do as much for themselves as possible. Staff had access to personal protective equipment and had been provided with training on infection prevention and control.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Medicines administration records (MAR) did not always record people’s allergy status. Also, where staff had handwritten the MAR a second member of staff had not always checked and signed the MAR. This meant if there was an error in writing the MAR this would not be identified. Staff were monitoring blood glucose levels for 1 person and using a machine that was not calibrated. This meant they could not be assured of accurate results. The provider took immediate action following our feedback and replaced this machine.

Medicines were administered as prescribed. The records we reviewed provided assurance that medicines were not being used to control people’s behaviour. Medicines were regularly reviewed by the staff from the local GP practice or by a specialist consultant where needed.

Person-centred care plans were in place to support people with their health needs such as diabetes and epilepsy. Some people were prescribed medicines to be administered on a when-required basis for health conditions such as constipation and pain. Guidance in care plans and protocols was in place to administer these medicines consistently.

Medicines were stored securely and at appropriate temperatures. There was an adequate stock of prescribed medicines.