Ballater House

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 75 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Systems were in place to learn from incidents. The management team met once a week to discuss any incidents and shared learning from this, which would then be further discussed in staff meetings if needed. The regional manager told us, “There’s an immediate response and reporting to make things safe. There’s a debriefing and handovers.” Staff echoed the culture of learning from incidents. One staff member said, “Let’s say a fall, I will put on [the care monitoring system] what actually happened and the intervention that was taken. I’d report to the nurse and they will come to assess immediately. At handovers we talk about incidents. I feel able to raise them.”

A recent random CCTV review found a staff member to be asleep on the sofa during a night shift. Following this, additional out of hours checks by the management and compliance team were initiated to prevent reoccurrence.

Relatives felt confident in the staffing team responding to incidents. One relative told us, “As far as I can see they deal with everything very well.”

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.

The management team were flexible in their approach to transition plans based on people’s needs. A relative told us, “[Family member] was in hospital before he got to the care home. The transition to the hospital to the home was good.” The regional manager told us, “Some people find transition plans stressful, some want a short sharp decision, so we cater it to their needs. We can do overnights, visiting outside, come here on longer visits here. We’ve done all which ways.” This ensured a personalised approach for people in order to meet their individual preferences and wellbeing 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 were up to date with the safeguarding training, and were able to tell us their responsibility in ensuring people were safeguarded. One staff member told us, “First of all, I would log it on my daily notes and then I would take a picture on [the care planning system]. I would inform the nurse or my manager. We have whistleblowing too and the safeguarding team.” Another staff member said, “If we see anything then we inform the line manager or clinical lead. We can whistle blow or tell the safeguarding team. It’s attached everywhere and we know the email and everything.” The regional manager added, “We also had all of our managers put into face-to-face level 3 safeguarding training to make sure they are robustly supported.”

The provider’s safeguarding log provided a robust oversight of any concerns and what action was taken to ensure people were safeguarded.

The principles of The Mental Capacity Act 2005 were being followed. Decision-specific mental capacity assessments were in place and appropriate applications for Deprivation of Liberty Safeguards (DoLS) had been submitted. This ensures that people’s liberties can be lawfully restricted in order to keep them safe where they lack mental capacity. A relative told us, “The care [family member] receives is done with his best interest at heart.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s care plans contained extremely detailed risk assessments which were personalised to their own health and wellbeing needs. These included risk assessments around how to manage aggression and negative fixations between people using the service to prevent any incidents occurring. Health care plans were in place for people’s medical diagnoses. For example, one person had a diagnosis of Parkinson’s disease. Their health care plan included information on how this presented with the person, how staff should support them with their mobility, and that they required time-specific medicine to help manage the symptoms associated with the condition. Health care plans were also in place for rare conditions to ensure staff had the information required to help support the person and prevent any complications that may be associated.

Care plans also contained detailed information on how to prevent people from having episodes of heightened anxieties and aggression, such as distraction techniques. We observed one person become highly anxious and verbally aggressive during our assessment. Staff were seen to follow the recommendation within the person’s care plan and give them space and then reapproach them after a couple of minutes. Relatives echoed this, with one relative telling us, “The staff look after him very well. They’ve had to deal with him blowing up occasionally and they deal with that in the correct fashion, which I wouldn’t even know how to start.”

Equipment was in place to manage risks to people. One person was known to experience seizures. We observed a seizure mat was in place under the person’s bed. This alerted staff to when the person was experiencing a seizure so they could ensure the person received immediate support. We observed the mat was checked daily to ensure it was functioning correctly.

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

Regular environment checks were conducted to ensure the safety of people. This included areas such as gas safety checks, equipment maintenance, and Legionella testing.

The cook for the service was aware of their responsibility in ensuring the kitchen remained a safe environment. They ensured the refrigerator was clean and all items were in date. They told us, “Opened items have the expiry dates.” They also ensured a temperature check on the refrigerator was recorded each day, and we observed no gaps in the recording sheet for this. The cook told us. “They (other staff members) do it when I’m not here.”

The provider had implemented a signing in book at the entrance of the service. This ensured any visitors who signed in to the service could be identified in an emergency such as a fire.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff told us there were enough of them to meet people’s needs. One staff member told us, “Yes, the work is manageable. We have enough staff to do the job.”

Staff were recruited safely. This included pre-employment checks such as gathering references, identity documents and ensuring the person had a Disclosure and Barring Service (DBS) check. this ensures potential staff members are of good character to be working with vulnerable people and have no previous convictions.

Staff received regular supervision meetings to discuss their concerns, wellbeing and professional development. This ensured staff received ongoing support from the management team.

Training was carried out in block sessions. The regional manager told us, “We now do block training, it’s easier to rota as staff are out of the service for one week. Staff find it much easier as they know where they are each day rather than in training 1 week and then not again for 4 weeks.” Training modules were relevant and specific to people’s needs. One staff member told us they had received training on a particular type of seizure so they had the knowledge they required to care for a person living at the service who experienced them.

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.

We observed staff wearing appropriate personal protective equipment (PPE) throughout the day. This included the cook who was wearing a hairnet and apron when preparing food. Staff told us there was enough PPE available within the service and they had never run out of stock. Hand sanitiser was available at various points throughout the service.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Medicine storage and administration practices were safe. Medicines were locked in a secure trolley and cupboard and keys were always held with the person administering medicines for the day. There were no gaps in medicine administration record (MAR) charts. This meant people were receiving their medicines appropriately. People’s medicine profile pages included important information such as any allergies they may have and their preferred way to take their medicines.

Environmental temperature checks of the medicine room and refrigerator were completed daily to ensure medicines had not lost their efficiency due to being stored at an unsafe temperature. Medicines with a limited shelf life had date of opening and dates to be used by recorded on them.

Relatives were kept informed about their family members’ medicine requirements. One relative told us, “I’ve had paperwork telling me what his problems are and the staff communicated with me why the medication is needed.” This allowed relatives to still feel involved in their family member’s care.