Ballington 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

Staff did not always follow the provider’s patient observation policies and procedures. Incidents of missed observations and staff sleeping had been reported, and patient safety incidents had occurred as a result. Managers had actions plans in place to prevent further occurrences and manage previous incidents. Not all clinical staff received regular supervision. At the time of our inspection only 52% of clinical staff were up to date with their supervision requirements. The service did not always have enough permanent nursing staff who knew patients well, and relied on the use of agency. However; Staff received training to keep people safe. Staff assessed risk well. They minimised the use of restrictive practices and followed good practice with respect to safeguarding. New starters received an induction. Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. Patients told us they were involved with planning their care. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Between 1 January and 27 March 2024, there had been 22 incidents of missed observations, staff sleeping on observations or a patient had been able to self harm whilst on observations. We reviewed a selection of these incidents whilst on site. We found that managers had responded quickly and actions had been put in place. Managers reviewed observation records daily and took appropriate action where issues were raised. During our on site assessment we saw evidence that actions had been taken to respond to risk and to share learning across the service. The service had regional governance processes in place. It reviewed internal and external patient safety incidents and shared learning through handovers, daily huddles, monthly operations meetings, team meetings and supervisions.

All patients that we spoke to said that staff were supportive and they felt listened to. Two patients said that they had made complaints in the past and that these had been dealt with swiftly and appropriately.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff told us there was a commitment to take immediate actions to keep people safe from abuse and neglect and gave examples of where leaders had taken action. These included daily audits of observations, increased frequency of observation training and competencies and changes to the observation paperwork. Staff also gave examples where there had been practice issues and managers had ensured that they were working safely through further development and training. Leaders told us that they were working in collaboration with their partners including local safeguarding teams, commissioners and the wider organisation. Staff told us that they understood how to protect patients from abuse and how to recognise abuse. Staff were aware of safeguarding procedures and knew how to report concerns. Staff could give clear examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

We saw that there were systems, processes and practices to make sure people are protected from abuse and neglect however these were not always effective. Incidences of missed observations had been identified quickly, and the service had taken action to prevent further occurrences. However, this had not fully resolved the issue. Further incidents of patient observations being missed had occurred. The service had notified CQC of these and shared how this was being escalated by the service. Staff received training on how to recognise and report abuse, appropriate for their role and had kept up to date with their safeguarding training.

All patients that we spoke to said that staff were supportive and they felt listened to. Two patients said that they had made complaints in the past and that these had been dealt with swiftly and appropriately.

Staff told us that patients are involved in making decisions. They told us that they actively support patients to be involved in their care through regular 1:1s, involvement in MDTS and regular community meetings. Staff told us that that care plans and risk management plans were regularly reviewed with patients. Leaders told us that care plans and risk management plans were discussed and reviewed with the patient and that patients had positive and collaborative relationships with the MDT.

Patients told us that they feel listened to and involved in their care. Patients told us that they are involved in care planning and regularly discuss their discharge plan. Patients told us that they know what their plan of care is and risks were discussed, including observation levels and reasons for any changes. Patients told us that they have regular 1:1s and were positive about staff within the Multi-disciplinary team (MDT) and said that they were actively involved in meetings held with the team. Patients also told us that community meetings were held regularly and that staff and managers attended these.

We reviewed care plans, risk assessments and observation sheets for 6 patients. Care plans demonstrated that people were informed about any risks and how to keep themselves safe. Risk assessments were person-centred, proportionate, and regularly reviewed with the person, where possible. Care Plans, observations sheets and handover records showed that risks were assessed and people and staff understood them.

At the time of assessment the service had a number of vacancies, there were 10 full time equivalent (FTE) health care assistant vacancies and 1.2 FTE qualified staff vacancies. We reviewed staffing levels from 1 January to 2 April 2024, which consisted of 184 shifts. Of these, 20 shifts were short of 1 or 2 healthcare workers. Where there were vacancies and sickness, the service used non permanent staff. The levels of non-permanent staffing were high. During the same reporting period as above, 47% of shifts were filled by locum staff; 44% of these were for healthcare workers. Managers told us the majority had long term bookings, although some did not work at the hospital regularly. Not all staff had received regular supervision. As of March 2024, only 52% of healthcare assistants and qualified nurses were up to date with their one to one supervision requirements. Safety huddles and reflective practice sessions were also in place.

Staff told us that the service did not have enough nursing and support staff and that they had high rates of agency staff. Shifts were filled predominantly by agency staff which increased pressure on staff who were permanent and more familiar with patients. Managers and staff told us that they made sure that all staff, including agency had a full induction before working at the service, this included ensuring that competencies in completing observations. Managers recognised that the issues with patients observations were predominantly by agency staff members and were taking additional measures to ensure that these staff were competent. Managers told us that they were actively trying to recruit staff after a number of staff had left following changes to the service.

Patients told us that there was a high level of agency staff that did not always engage with them.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.