Ballater House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

This meant people’s needs were met through good organisation and delivery.

This service scored 82 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

There was a wide range in the age of people being supported at Ballater House, ranging from 21 years old to 80 years old. Despite this and the complexities in people’s care and mental health needs, staff ensured people received care that was relevant to them to help people achieve better all-round wellbeing.

For example, one person had expressed their wish to access adult websites. The regional manager told us, “He is able to as an adult. Our internet is restricted so we supported him to purchase a dongle, so he is able to access these websites now, but we have told him it needs to be legal content.” Due to the person feeling they were listened to, there had been a visible reduction in their episodes of anxiety and aggression. Another person had been supported by staff to get back in touch and build a relationship with a family member. The staffing team told us it had been an emotional milestone for the person and them. This had resulted in the person no longer being tearful when other people living at the service had their relatives visiting as they now felt they belonged to a family.

A further person required additional support to spend time with a family member in the community. The staffing team put together a risk assessment and visiting plan to ensure the safety of the person at all times and worked to ensure professional partners were assured of the mitigation strategies put in place. This resulted in the person’s relationship with their relative rebuilding and them now being able to spend time together in the community. This in turn had brought a lot of comfort and happiness to the person.

The regional manager told us, “It’s completely up to people what they what want to do. Some people love Costco, some love the park, another the pub. [Person] wanted to visit a relative’s grave, so we supported him to do that. We take [another person] to Croydon to meet his mum and leave him with her so they have time together. [A further person] loves to go to Redhill. He loves to buy things for people like a ball for everyone to play in the garden. Sometimes some of them like to go together.” Each person had 1:1 care hours with a staff member so these individual needs could be fulfilled to support people’s mental health. Relatives felt this resulted in personalised care, with one relative saying, “They do know him as a person. They try and do as much as they can for him.”

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

People were supported to continue practising their faith when living at Ballater House. One person was Jewish. All staff including the cook were aware that the person did not eat pork, and they were supported to attend the synagogue each weekend. One staff member told us, “Staff are put in place to ensure he is able to go.” This ensured that living in a care setting was not a barrier to people continuing to enjoy important aspects of their lives.

The regional manager told us that if there were any gaps in the rota due to illness or annual leave, shifts would be offered to permanent staff as overtime and then to agency staff. This meant the use of agency staff was minimal, so people received consistent care.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Information on how people could raise a complaint if they wished to was on display within the service. We also observed a residents meeting take place on the day of our assessment. Within this, the newly appointed manager provided people with information on what an advocate was and how they could access one if they needed to.

Relatives were also kept up to date with their family member’s health and wellbeing. One relative told us. “When there is a problem with my relative, [the clinical lead] always rings me.”

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

During the residents meeting which took place during our assessment, we observed people being asked what they would like to appear on the menu. We observed that one person was hard of hearing, so a staff member was repeating anything the manager discussed in the meeting to the person to ensure they did not miss out on feedback and information and were given a chance to put their view forward to others.

Relatives’ meetings could be difficult to arrange because of geography. However, the regional manager said, “We update families, we’re driven by how they like to be updated.“ Relatives told us they were involved in their family member’s care as much as possible. One relative told us, “When there have been questions about his care, they contacted me immediately. I get asked often about my views.”

Staff were aware of people’s individual communication needs, and these were recorded in people’s care plans. The regional manager told us, “Some of our service users have very different communication needs and staff know these.”

The provider was exceptional at ensuring people could access the care, support and treatment they needed when they needed it.

Staff advocated for people to ensure their mental and physical health needs were supported by other professionals, even when there were obstacles in achieving this. The regional manager told us, “We have a problem because we are on the border of Surrey and London. The rules around the Croydon teams have got stricter. We referred [person] to the Croydon mental health team who declined as the service is in Surrey. We referred to Surrey and they said no because their GP is in Croydon. So [the clinical lead] is pushing back to the person’s care coordinator to get support for this.”

They also described how another person who lived at the service had experienced a mental health crisis due to changes to their medicines. When they referred the person to the community mental health team they were advised to give the person the maximum sedative each day to combat this. Staff spoke up and said this was not appropriate. Due to a lack of support from external community agencies, staff accompanied the person to AE to ensure they were listened to and appropriate support sought.

The regional manager told us, “I really feel the staff advocate well for the people here, and I think that’s because they get to understand their views and needs.” This was evident through the support they were continuing to provide to a person who lived at the service who was currently an inpatient at a mental health hospital. They told us, “They kept not inviting the person’s aunt to ward rounds so we’ve been fighting for that. They didn’t ensure he has his glasses or his shoes on either, so we’ve spoken up about that too.”

Staff ensured they investigated accessibility options for people when in the community. This included confirming there was disabled access for settings such as the cinema and pub before supporting people to attend. This ensured people’s experience when in the community was smooth and minimised stressful events that could trigger their anxiety.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff were aware of their responsibility to ensure people with different backgrounds and beliefs had equity in the care they experienced. One staff member told us, “We have to treat people equal and respect their religion.”

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

End of life care plans were in place where people or their representatives had been content to have the conversation. A staff member told us, “I know that [person] has a care plan for end of life care. I know he has a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR). He likes Johnny Cash. We would contact the Family.” DNACPRs are a medical order or decision made by a patient or their healthcare team, indicating that CPR should not be administered if the patient's heart stops or they stop breathing. Another person’s end of life care plan contained information on how they would like their final days and burial to be based on their religion. This allowed staff to support people the way they wished at the end of their life.