CQC report explained · a nursing home
What the CQC found at Ballater House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, August 2019
Rated Requires Improvement; inspectors found kind and personalised care, but medicines records and management systems were not reliable enough.
Three inspectors carried out an unannounced, fully comprehensive inspection on 20 February 2019. They spoke with people and staff, and reviewed care plans, medicines records, risk assessments, complaints and management audits.
People generally felt safe and said there were enough staff. Inspectors found good support with healthcare, consent, care planning and daily choices. Staff often knew people well and showed kindness.
There were important shortfalls. Medicines were not always recorded correctly, dietary wishes were not always followed, and people did not always have enough individual or meaningful activities. Some staff interactions were not as respectful as they should have been.
The overall rating fell from Good at the previous inspection in August 2016 to Requires Improvement. Safe and Well-led were rated Requires Improvement, while Effective, Caring and Responsive were rated Good.
Enough staff
Inspectors found staffing levels were in line with the information they had been given, including support for people who needed one-to-one care.
“Many people living at the service required one to one support in order to keep them safe and we found there were sufficient staff available to meet this.” from the report
Kind individual support
People generally said staff were kind. Inspectors saw staff encouraging people, supporting independence and adapting communication to individual needs.
“We did observe individual staff demonstrate a kind, attentive approach to people.” from the report
Useful care information
Care plans included information about people's communication, routines, health needs, likes and dislikes. Staff were able to describe people well.
“There was a good communication passport in one person's care plan which described how staff would recognise if the person was happy, upset, angry or tired.” from the report
Healthcare support
People were supported to see health professionals when needed. Records included health appointments, reviews and hospital information.
“There was evidence that people were supported to access healthcare input when required.” from the report
Medicines recording
seriousMedicine administration records did not always show the actual time medicines were given. Some records were unclear, and liquid medicine opening dates were not recorded. This was a breach of Regulation 12.
“The recording of medicines people received required improvement as we found information was not always recorded in line with good practice and NICE guidance.” from the report
Incident monitoring
seriousAccidents and incidents were recorded, but the manager was not regularly checking them for patterns or repeated risks.
“Although accidents and incidents were recorded, the registered manager did not carry out regular analysis to look for trends or themes.” from the report
Dietary wishes
needs fixingPeople had enough food and drink, but staff did not always follow individual dietary requirements. One person who needed a lactose-free diet was given quiche.
“One person who was lactose free was given quiche for lunch.” from the report
Meaningful activities
needs fixingSome people were bored and did not always have enough individual activities or opportunities to go out. Staffing shortages sometimes affected outings.
“One person told us they enjoyed speaking to staff, but sometimes they were, "Bored.” from the report
Respectful treatment
needs fixingInspectors found examples of language and behaviour that did not fully respect people's dignity and choices.
“People were referred to as 'patients' by some staff and the service as a 'ward'.” from the report
- 01What changes have you made to record the exact times medicines are given and to check medicine records are clear?
- 02How do you now analyse accidents and incidents for repeated risks or patterns?
- 03How do you check that each person's dietary requirements are followed at every meal?
- 04How do you make sure people have regular, individual activities and enough opportunities to go out?
- 05What action have you taken to ensure all staff speak to people respectfully and support their choices?
This was an unannounced, fully comprehensive inspection covering all five key questions, with all ratings assessed during the visit. This explanation was written from the published report of 30 August 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, September 2016
Ballater House was rated Good; inspectors found safe, kind and personalised care, with improvements since the previous inspection.
This was an unannounced inspection on 11 August 2016. Three inspectors spoke with most people, relatives, healthcare professionals, the registered manager and staff. They also reviewed care plans, medicines records, risk assessments, accident records, complaints, audits, recruitment files and training records.
Inspectors found that people were safe and that medicines, staffing and risk management were handled well. Staff understood safeguarding duties and legal requirements about consent and restrictions. People received nutritious food, healthcare support and training from staff who knew their needs.
People were treated with kindness, privacy and dignity. Their care plans reflected their needs and preferences, and they were supported to take part in meaningful activities. The home had systems for complaints, feedback and quality checks.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. At the previous inspection in April 2015, the overall rating was Requires Improvement. The report says improvements followed an action plan and the appointment of an experienced registered manager.
Improved safeguarding
Staff had the training and knowledge to protect people from abuse. Inspectors found that safeguarding arrangements had improved since the previous inspection.
“At this inspection we found people were appropriately safeguarded because staff had been provided with the relevant training to keep people safe and knew what action they should take if they suspected abuse.” from the report
Kind and respectful care
Staff knew people well and involved them in decisions about their care. Inspectors saw staff asking permission before helping or intervening.
“People received good care and there was excellent interaction between people and staff who consistently took care to ask permission before intervening or assisting.” from the report
Meaningful activities
Activities were based on individual interests and included trips out, shopping, cinema visits, swimming, cycling, cooking and meals out.
“People were supported to participate in activities which had meaning to them and were individualised.” from the report
Better record keeping
The report says record keeping had improved considerably since the previous inspection. Care plans were described as detailed and informative.
“There was a considerable improvement noted in the management of records.” from the report
Some meetings were not fully recorded
needs fixingThe provider's audit found that records of some key worker meetings with people were incomplete. The registered manager was addressing this at the time of inspection.
“Issues identified as non-immediate included key worker meeting with people not fully recorded and we saw the registered manager was addressing these issues.” from the report
Medicines audit issues
minorA recent audit identified three medicines-related areas needing immediate attention. The report says these issues had already been addressed.
“We noted there were three areas requiring immediate attention. These were all related to issues surrounding medicines management. These had been immediately addressed.” from the report
- 01How do you now make sure key worker meetings and discussions with residents are fully recorded?
- 02What were the three medicines-related issues found in the recent audit, and how were they corrected?
- 03How would you support my relative to take part in activities that match their interests?
- 04How are any restrictions on my relative's freedom reviewed and kept within the Mental Capacity Act and Deprivation of Liberty Safeguards?
- 05How would staffing levels change if several residents needed one-to-one support or were attending activities outside the home?
This was an unannounced inspection of the overall service, covering all five CQC questions and providing updated ratings in each area. This explanation was written from the published report of 2 September 2016 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Ballater House
3 rated inspections over 4 years: the service has held its Requires improvement rating throughout.
- August 2019Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- November 2014
Report published without a new overall rating.
- June 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- May 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 6 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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