We rated

Ballington House as good because:

• Patients told us that they felt safe. The hospital planned and responded to individual risks well through good risk assessment and management. All staff had individual radios and the system for responding was effective.
• Staff were aware of how to report incidents. Staff produced incident reports and learning from these incidents discussed at staff meetings. Psychology facilitated incident analyses and shared findings with staff. This helped staff look at how they might improve their practice and manage patients effectively following incidents.
• The hospital had good medicines management procedures for recording, dispensing and storing of medication. There were regular audits for medication reconciliation and where possible, patients administered their own medication safely under staff supervision.
• All of the care plans we reviewed were thorough, recovery focussed and included a discharge plan with clear aims. Patients had access to psychological therapies and National Institute for Health and Care Excellence guidance was informing care planning.
• Staff carried out a range of clinical audits to monitor the effectiveness of the service provided. For example, care planning, risk management, medicines and health & safety.
• External stakeholders and carers we spoke to said they were happy with the care provided and felt the service communicated effectively with them and included them where possible in the care planning process.
• All discharges and transfers were discussed in the multi-disciplinary team meeting and were managed in a planned and co-ordinated way.
• The facilities were set up in a homely way encouraging, promoting and focusing on rehabilitation for patients. Patients living in the apartments had a kitchen and were encouraged to cook daily.
• Staff morale was good. There was a strong sense that staff felt supported by the management team. There was an open and transparent culture, staff said they could confidently raise concerns and were sure they would be responded to appropriately.

However:

• There were blanket restrictions on the unit including access to the gardens and the conservatory.
• The available displayed information did not demonstrate what safeguarding was and how to report abuse. Information displayed was not patient friendly.
• The hospital did not have a good understanding of what medication given to patients was regarded as rapid tranquilisation.
• In records we looked at there was no evidence of the Approved Mental Health Professional reports completed at the point of detention.

We met and spoke with six patients and talked with three of those patients at greater length. We spoke with the manager and deputy and talked with six other staff, including two health professionals who were at the service on the day of our visit. We also spoke with a visiting relative and observed interactions between patients and staff. We toured the premises and looked at records, a sample of care plans and looked at the experience of two patients in detail. We were told there were seven patients currently using the service, and that stays at Ballington House ranged between three months and three years.

We observed warm, relaxed and positive interactions between staff and patients.

The layout of individual apartments and rooms supported patient independence and well-being. Patients we spoke with were very positive about the staff and the service. “Staff are fantastic, they listen to you,” one patient told us.

Staff numbers and skill mix were sufficient to meet patients' needs and staff were positive about supporting and treating patients so they could progress. We saw medicines were managed appropriately and the service was addressing concerns about the room temperature at which medicines were stored. Patients told us they felt safe at Ballington House. We saw the service monitored the quality and safety of its service and had taken action when the quality of that service had caused concern.

At our last inspection on the 03 May 2013 we found that the provider did not have effective systems in place to protect people who used the service from the risks associated with the management of medicines. We requested an action plan from the provider to show how they planned to become compliant.

During this inspection, we found that the provider had put systems in place but these were not effective. We found that improvements were still needed to ensure that medicines were managed safely.

People we spoke with were happy with the care provided. We observed people being treated respectfully and staff listened to people wishes. One person we spoke with told us, "I like it here the staff are good and support me to do the things I want". We spoke to a relative who told us, " The staff are always respectful and have a good understanding of X's needs".

The provider ensured that people's information was kept confidential when discussing care and treatment with other providers involved in their care.

We found that the provider did not have an effective system in place for the recording and disposal of medicines.

We saw that staff were supported to carry out their role effectively. Staff we spoke with told us that they felt supported by their manager and were supported to develop their skills.

We found that personal records were kept securely and contained accurate and up to date information.

We spoke with people who used the service, spoke with staff and looked at records. People we spoke with told us that they had choices in how their support was provided and that they were fully involved with the planning of their care. People we spoke with told us, "It's a really good rehab" and "The staff listen to me".

People told us that they had consented to the treatment that they received. The provider had systems in place to ensure that the people who used the service who did not have the capacity to consent were protected by following legal requirements.

We spoke with people who used the service who told us, "I feel safe". People we spoke with told us that they knew who to speak to if they felt that they were not being treated appropriately.

We saw that staff had been recruited in an appropriate way to ensure that vulnerable people were protected from the risk of harm.

Staff told us that they had received an induction when they started employment and they had received regular supervisions. We spoke with staff and looked at records that showed that the provider did not have an effective system in place to analyse the training needs and provide ongoing training and development to staff.

We saw that the provider had an effective system in place to record and investigate complaints. People we spoke with told us that they knew how to complain if they needed to.

This was our first visit to Ballington House which was registered during 2011. We visited to check that people were being cared for safely. We undertook a joint visit with the Mental Health Act Commissioner who was checking that Ballington House was meeting its responsibilities under the Mental Health Act. We shared our information although the Mental Health Act Commissioner will complete a separate report.

People were admitted to Ballington House for rehabilitation due to their mental illhealth. Some people were detained patients. The accommodation was provided in single and two people apartments with each apartment having their own kitchen facilities.

People told us they were happy living at Ballington House. They said that they were given choices over how they spent their time. For example they chose what they wanted to eat and the activities they took part in.

People were involved in planning their own care. Care plans identified their individual needs and provided information on how these needs would be met. Comprehensive risk management plans were in place to try and keep people safe.

The staff encouraged and supported people to be as independent as possible. Everyone was supported to plan their meals, do their own shopping and to make their own meals. People were supported to keep their accommodation clean and tidy.

People's mental and physical health needs were assessed and identified. People were supported by a multidisciplinary team including psychiatric and psychological services. Currently there was no access to an occupational therapist and this was an area that needed to be addressed to make sure that people's support included meaningful activities to aid their rehabilitation and recovery.

We rated

Ballington House as outstanding because:

• During this inspection, we found that the hospital had addressed all the issues that had caused us to make recommendations for improvement following the inspection in May 2016.

• The hospital had a safe and exceptionally clean environment. The hospital had a vigilant approach to risk assessment and monitoring to ensure patient safety. Staff carried out frequent checks of the whole hospital throughout the day. Staff adhered to infection control principles such as handwashing. Staff involved patients in infection control audits to help them understand why it was important.

• Staff were suitably qualified and experienced for their roles. All staff received supervision regularly and annual appraisals. The hospital had good staffing levels and a stable staff team. All the patients we spoke with said there were always enough staff around, which helped them feel safe. Staff spoke highly of the hospital manager. Staff reported good morale, team working and mutual support. 

• The hospital had good medicines management practices. The hospital had a well-equipped clinic room and the appropriate emergency equipment, which staff checked regularly. Staff demonstrated good knowledge of what constituted rapid tranquillisation and carried out the required physical observations.

• All patients received timely and comprehensive assessments of their mental and physical health needs. Staff completed holistic care plans that fully captured their patients’ needs. Patients had good, timely and responsive access to physical healthcare.

• The hospital had access to a wide range of mental health disciplines that helped it provide appropriate care for patients. The hospital had regular, effective and well-coordinated multidisciplinary team meetings and handovers.

• Staff showed a strong commitment to person-centred care. Patients and their relatives praised the staff and complimented the care and the environment. Staff had built up therapeutic relationships with patients based on trust and respect that helped promote recovery. Staff asked patients about their wishes for their care during a crisis or relapse and this helped them plan the most appropriate and least restrictive intervention for each patient.

• Staff were extremely caring and encouraged patients to develop and maintain independence. There was a strong culture to encourage feedback and empower patients in a positive, innovative and inclusive manner. Patients had rehabilitation-focused activity plans that promoted self-care and helped them develop their daily living skills. Discharge planning commenced on admission and patients had clear goals of what they needed to achieve during their rehabilitation. 

• The hospital had a full range of facilities to support a structured rehabilitation programme and meet patients’ needs. The accommodation comprised self-contained apartments and studios that mirrored real life settings and prepared patients for discharge into the community. Staff drew up with patients’ weekly therapy programmes that took into account their personal interests as well as their needs. Patients spoke positively about the activities they did and felt that they prepared them for life outside the hospital.

• The hospital provided a specialist service for women with enduring or complex mental health needs. Some patients had a history of trauma or serious self-harm. The hospital offered patients a tailored rehabilitation programme. Staff encouraged patients to develop and maintain appropriate relationships that incorporated clear boundary setting between the patients, their peers and staff. Staff were fully committed to supporting patients with their individual needs associated with their gender, ethnicity, sexuality, religion or disability.

• Staff knew and understood the vision and values of the hospital. Their team objectives reflected the hospital’s person-centred, recovery-based vision. Staff worked collaboratively with patients, and promoted their independence and self-determination.

• The hospital had effective governance systems and processes for monitoring all aspects of care. The hospital manager demonstrated high level of experience, capacity and capability needed to deliver sufficient authority and to manage the hospital effectively, suggest improvements and implement changes to the service.

However:

• Most staff had limited access to specialist training that would further improve practice.