Bickerton House

Updated 5 May 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

This inspection was completed by one inspector.

Service and service type

Bickerton House 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 other information we had received about the service, including notifications received from the provider. The law requires providers to send us notifications about certain events that happen during the running of a service. We sought feedback from the local authority, community professionals who work with the service and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We reviewed the provider’s website. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used this information to plan our inspection.

During the inspection

We spoke with six people who used the service and a relative about their experience of the care provided. We spoke with 24 members of staff including four nurses, two newly inducted nurses who were shadowing experienced colleagues, three team leaders, five healthcare assistants, two chefs, an activities coordinator and a housekeeper. We spoke with the management team, including the registered manager, the deputy manager, the regional director, the maintenance manager, the head of housekeeping and the business manager. We spoke with the home’s GP after completing their weekly visit and a nurse who was administering a Covid-19 vaccination.

We observed care during mealtimes, activities and medicine administration rounds to help us understand the experience of people who could not talk with us. We reviewed a range of records. This included six people’s care records, medicine records and daily notes. We looked at seven staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service were reviewed, including the provider’s policies, procedures and quality assurance audits.

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 spoke with two community professionals who engaged with the service and three people’s power of attorney. A power of attorney lawfully designates a person who can make critical decisions on a person's behalf if they are unable to make these decisions themselves.

Updated 5 May 2021

About the service

Bickerton House is a care home with nursing registered to provide personal and nursing care for up to 77 people. At the time of inspection there were 20 people living in the purpose-built home, across two of four floors, one of which specialised in providing care to people living with dementia.

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

People experienced safe care and were protected from avoidable harm by trusted staff, who had completed safeguarding training and knew how to recognise and report abuse. Staff identified and assessed risks to people effectively and managed them safely. The registered manager ensured enough staff were deployed, with the right mix of skills to deliver care and support to meet people’s needs. Staff had completed a robust recruitment process, including their conduct in previous care roles to assure their suitability to support older people. People received their medicines safely from staff, in accordance with recognised guidance. Staff maintained high standards of cleanliness and hygiene in the home, which reduced the risk of infection, in accordance with the provider's policies and procedures, and government guidance.

Staff assessed all aspects of people’s physical, emotional and social needs and ensured these were met to achieve good outcomes for them. Staff were effectively supported to develop and maintain the required skills and knowledge to support people according to their needs. Staff emphasised the importance of eating and drinking well and reflected best practice in how they supported people to maintain a healthy balanced diet. Staff worked effectively with healthcare professionals to make sure care and treatment met people’s changing needs and achieved good outcomes. The home had been purpose built to meet the needs of older people and those living with dementia, with natural light flooding into all areas to help orientate people.

People were supported to have maximum choice and control of their lives and 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 experienced caring relationships where staff treated them with kindness and compassion in their day-to-day care. People were supported to make decisions about their care and these choices were respected by staff. Staff consistently treated people in a respectful manner and intervened discretely to maintain their personal dignity. Staff knew how to comfort and reassure different people when they were worried or confused.

People had experienced person-centred care, which consistently achieved good outcomes and had significantly improved the quality and longevity of their lives. People received information in a way they could understand and process, allowing for any impairment, such as poor eyesight or hearing. People were enabled to live as full a life as possible and were supported to take part in imaginative activities, which enriched the quality of their lives. People were supported to keep in touch with family and friends, which had a positive impact on their well-being. People knew how to make complaints and were confident the management team would listen and address their concerns. The service worked closely with healthcare professionals and provided good end of life care, which respected people’s wishes and ensured they experienced a comfortable, dignified and pain-free death.

The management team led by example and promoted a strong caring, person-centred culture where people and staff felt valued. Staff were passionate about their role and consistently placed people at the heart of the service, clearly demonstrating the caring values of the provider. The registered manager understood their responsibilities to inform people when things went wrong and the importance of conducting thorough investigations to identify lessons learnt to prevent reoccurrences. The governance structure ensured there were robust measures to monitor quality, safety and the experience of people within the service. Quality assurance was embedded within the culture and running of the service, to drive continuous improvement. During the pandemic, staff had used technical solutions to keep families up to date with events and activities going on in the home, which they found reassuring.

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

Rating at last inspection

This service was registered with us on 6 January 2020 and this is the first inspection.

Why we inspected

This was a planned inspection based on when the service registered with us.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

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