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Inspection carried out on 8 January 2020

During a routine inspection

About the service

Bilton House is a residential care home providing personal care and accommodation to 33 people aged 65 and over at the time of the inspection. The service accommodates up to 39 people in one house. The house is split over three floors with the ground and first floor having bedrooms for residents. This is called the ‘Main House’. The third floor has a twin visitors’ room with kitchenette and bathroom for relatives to stay overnight, and a room for staff training. One section of the home named ‘Clarice Wing’ specialises in providing care to people living with dementia.

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

People told us they felt safe living at Bilton House and were looked after by care workers who knew them well and treated them with kindness, respect and dignity. There were processes in place to protect people from the risk of abuse and avoidable harm, and staff understood their responsibilities for reporting any concerns. Measures were in place to safely manage people’s medicines and staff received training and practical guidance on medicine administration. Accidents and incidents were reported and monitored to learn from these.

Bilton House provided a homely atmosphere. Staffing levels and volunteers meant people could take part in a wide range of activities if they wanted to. People were encouraged to maintain their independence, life and the interests they had prior to moving to Bilton House. People’s needs and preferences were assessed prior to staying at Bilton House so care could be planned in partnership with them and their relatives. The registered manager used the assessment process to understand people’s past lives and experiences to better understand people in their care and provide care that was personalised.

Staff received ongoing training and their personal development was valued by the provider. Changes to how training was delivered meant staff received specialised face to face training in specific health conditions such as Parkinson’s and dementia and gave positive feedback about the learning they achieved as a result.

People received timely access to healthcare support because staff monitored changes to their health and wellbeing, sharing key information during staff handovers and with senior team members. The registered manager used research on colour schemes for people living with dementia, so their environment was better suited to their needs. Many rooms within Bilton House had access to lots of natural light which meant people could observe changing seasons and orientate themselves to time of day.

Risks to people’s physical health and safety were identified with guidance for staff to follow on managing them. People’s dietary needs were identified and assessed so people could be supported to eat and drink safely. People were given choices of what they wanted to eat and drink and alternatives were always available if they did not like what was being provided on the day.

The culture of the home encouraged people to “live their lives” and management took a positive approach to risk. People living with dementia had the freedom to explore their whole community within Bilton House whilst still being protected from avoidable harm. 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.

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 19 July 2017)

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bilton House on our website at www.cqc.org.uk.

Inspection carried out on 6 June 2017

During a routine inspection

Bilton House is a residential care home, which provides accommodation and personal care for up to 39 older people, who might live with dementia. Thirty four people were living at the home at the time of our inspection visit. At the last inspection, the service was rated Good. At this inspection we found the service remained good.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff understood their responsibilities to protect people from the risk of abuse. The registered manager checked staff’s suitability for their role before they started working at the home and made sure there were enough staff to support people safely. Medicines were stored, administered and managed safely.

Risks to people’s individual health and wellbeing were identified and care was planned to minimise the risks, while promoting people’s independence. People and their families were included in planning how they were cared for and supported. The registered manager regularly checked that the premises and equipment were safe for people to use.

People were cared for and supported by staff who had the skills and training to meet their needs. The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported to eat and drink enough to maintain a balanced diet that met their preferences and were referred to healthcare services when their health needs changed.

People told us staff were kind and caring and had the right skills and experience to provide the care and support they required. Staff treated people in a way that respected their dignity and promoted their independence. People were encouraged to maintain their interests and take part in social activities.

Staff felt supported and there was good communication between people. People knew the managers well and were encouraged to share ideas to make improvements to the service. There were checks in place to ensure good standards of care were maintained.

Inspection carried out on 2 February 2015

During a routine inspection

We carried out this inspection on 2 February 2015. The inspection was unannounced.

Bilton House provides accommodation and personal care for up to 39 older people who may have dementia. Thirty-three people were living at the home at the time of our inspection.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People we spoke with told us they felt safe living at Bilton House. Staff demonstrated a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Risks to people’s health and welfare were assessed and care plans gave staff instructions on how to minimise identified risks so staff knew how to support people safely.

There were enough staff on duty to meet people’s needs. Checks were made on staff’s suitability to deliver personal care during the recruitment process.

There were processes in place to ensure people received the medicines prescribed for them in a safe manner.

Staff received training and support that ensured people’s needs were met effectively.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). No one was under a DoLS at the time of our inspection. For people who were assessed as not having capacity, records showed that their families and other health professionals were involved in discussions about who should make decisions in their best interests.

The staff offered people a choice of meals. Risks to people’s nutrition were minimised because they understood the importance of offering meals that were suitable for people’s individual dietary needs.

Staff referred people to other health professionals for advice and support when their health needs changed.

We saw staff supported people with kindness and compassion. Staff treated people in a way that respected their dignity and promoted their independence.

People and their relatives were involved in planning how they were cared for and supported. Care was planned to meet people’s individual needs and preferences and care plans were regularly reviewed.

People were encouraged to share their opinions about the quality of the service and we saw improvements were made when needed.

The registered manager maintained an open culture at the home and there was good communication between staff members. People found the registered manager was visible and accessible.

There were quality assurance checks in place to monitor and improve the service.

Inspection carried out on 21 October 2013

During a routine inspection

We saw that there were 37 people living at Bilton House. We spoke with five staff, seven people who used the service and four visitors on the day of inspection. We looked at policies and processes, four care records and five staff records to gain further insight of the care provided.

We saw that people were involved in decisions about their care and details of their needs and interests were included in their care records. Care plans and risk assessments were in place and were updated regularly to ensure people received the care they needed.

There were a variety of activities available designed to meet people's needs and maintain their independence. Bilton House was warm and homely and people told us they liked living there. One person told us, "I am more independent here than I was at home." Another person told us, "I have everything I need."

People�s safety was protected because there were processes to report safeguarding concerns and staff received relevant training. People told us they were satisfied with the care provided and they felt safe.

There were appropriate recruitment systems in place and staff were supported by the provider. Staff told us they enjoyed their job. One member of staff said, "I like everything about working at Bilton House� and another staff member told us, "I can�t imagine working anywhere else."

People experienced good quality care because systems of monitoring were in place and there was evidence that people and their families knew how to complain if things were not right.

Inspection carried out on 21 January 2013

During a routine inspection

When we visited Bilton House, we saw there were 36 people living at the home. We spoke with four people who lived at the home, one relative, three members of staff delivering care, the manager, the deputy manager and the assistant manager. We read the care records for three people who lived at the home, observed care practice and staff's interaction with people when they were delivering care.

During our last inspection of this service in March 2012 we made three improvement actions due to concerns around management of medicines, supporting workers and assessing and monitoring the quality of service provision. During our inspection, we found that improvements had been made.

During our visit we saw people were watching a musical film in the main lounge. Some people were tapping their feet and enjoying the film. We observed another person reading a newspaper in an upstairs lounge. We saw one person in another lounge, being supported by staff to play a board game.

We observed that the home was clean and well decorated. Many people had personalised their bedrooms with their own furniture and belongings. We saw that people had pictures and photos in their bedrooms.

There was a reminiscence corner in one of the dining rooms. It was made up of memorabilia to make an �old fashioned shop�. There was a reminiscence room which was open for people to use if they wished.

Reports under our old system of regulation (including those from before CQC was created)