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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.

Inspection carried out on 12 March 2012

During a routine inspection

We carried out this review to check on the care and welfare of people using the service.

During our visit we spoke with seven people using the service, three relatives, four members of staff and the manager.

The people using the service and the relatives that we spoke with told us that they were happy with the care and support being provided.

We looked at the care plan files for three people. We saw that they contained current information that informed staff about how best to meet people’s assessed needs. We also saw that people were supported with their healthcare needs. We noted that the care plans we looked at were audited on a regular basis.

We were told that the activities provided by the home were enjoyed by people, and noted that there were a variety of activities available on a weekly basis. People we spoke with commented that they enjoyed a weekly scrabble group, the arm chair exercise sessions, the weekly fellowship and monthly church services in particular.

In the Clarice Cooper wing we saw that there was great emphasis on providing an environment based around meeting the needs of people with dementia. We saw that there were lots of older artefacts for people to look at, or pick up and explore, along with displays on the walls from wartime, or the age of the silver screen.

People we spoke with told us that they felt safe in the service and that they liked the staff.

We spoke to the staff on duty about the safeguarding procedures for the service. They told us that they had completed training in safeguarding vulnerable adults and were able to talk through the processes they would follow should abuse be suspected. Training records we were provided with confirmed that the staff team had received training in this area.

We looked at the staff recruitment processes for the home. These confirmed that a robust recruitment procedure safeguarded the people using the service.

We looked at the systems in place for the management of medication. We saw that overall, on the day of our visit, the systems in place did not place people at unnecessary risk. We have however suggested that the home should consider making improvements in relation to staff training for the management and administration of medication.

We looked at the staff rotas over a three week period of time. We saw that the numbers of staff on each shift were appropriate to the needs of the people using the service. We asked the staff on duty if the felt there was adequate staff available and they told us that they felt that there was.

We looked at staff training and found that there were gaps in the mandatory training for staff. We spoke with the manager about this and she told us that she was aware of the need to provide staff with updates in areas such as first aid and fire safety. We were subsequently provided with information that advised that training in these areas had been booked. We have however suggested that the home should consider making improvements in relation to staff training.

We looked at how the service measures the quality of care and support provided. We were told that the service carried out an annual survey to seek the views of the people using the service. We saw the results for the survey undertaken in 2011 which indicated an overall satisfaction with the service that was being received, however we noted that some relatives had made comments about areas they felt could be improved. We were told that although the results of the surveys had been audited, the home had not compiled an action plan with a view to addressing the comments made by the relatives. We have suggested that the home consider making improvements to how it deals with information gathered from surveys.

We saw that the health, safety and welfare of people living, working and visiting the home was monitored by appropriate checks and measures.

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