Ball Tree Croft

Updated 7 December 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Ball tree croft is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since registration. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with two relatives about their experience of the care provided. We spoke with four members of staff including the registered manager, deputy manager, and care workers. We spoke with four people and observed their care and support to help us understand their experience. We reviewed a range of records. This included four people's care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We received feedback from one health professional who visited the service

Updated 7 December 2021

About the service

Ball tree croft is a residential care home providing accommodation and personal care and is registered to provide care for up to 20 people with a learning disability and/or autistic people.

The service was divided to provide respite care for four people and permanent accommodation for up to 16 people. The premises were arranged in three adjoining houses each with a self-contained kitchen, lounge and dining area. At the time of the inspection the service was provided to 12 permanent people. The respite care had been paused due to the COVID-19 pandemic.

People’s experience of using this service and what we found

People told us they felt safe with staff. A person told us they liked all the staff. Relatives had no concerns about the safety of people.

There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm.

Risk assessments were carried out to make sure people received their care safely and had opportunities to take part in activities which interested them and promoted their independence.

Medicines were managed safely, and staff had a good knowledge of the medicine systems and procedures. Staff had received training and had competency assessments of their practice. There were adequate numbers of staff to meet people's needs.

We observed kind and caring interactions between people and staff. Staff showed genuine regard for the people they supported.

The registered manager was accessible, supportive and had good leadership skills. Staff were aware of the values of the provider and understood their roles and responsibilities. The service had a quality assurance system and any shortfalls were identified and addressed. There was a culture of listening to people and positively learning from events so similar incidents were not repeated. As a result, the quality of the service continued to develop.

People were not fully supported to have maximum choice and control of their lives due to the layout and model of the service. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People did not always receive care that was personalised to their needs.

People's needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, Right Care, Right Culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well-led the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The service is made up of a main building where people normally have meals, rather than in their individual shared houses, food was fully prepared by staff. The medicines are kept in the main building and transported to the houses for administration.

The service was undertaking a review of these things, as during the recent COVID-19 outbreak people had been eating meals in their own shared houses to avoid cross infection. Each house has a kitchen that is fully equipped but very small and it would be difficult for more than one person to cook with staff support. There had been a new kitchen installed in the shared dining area of the main building and this was used to support people to prepare lunches for themselves with support. The service was trying to mitigate the limitations of the environment. The service was registered in 2011, it would be unlikely that this type of service model would be eligible to be registered with CQC now.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection The last rating for this service was Good (published 17 August 2017).

Why we inspected

We carried out the inspection to look at the infection prevention and control measures the service were taking in respect of an outbreak of COVID-19. We widened the scope of the inspection from a targeted inspection to become a focused inspection which included the key questions of safe and well-led.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.