Bilton House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Incident forms were completed that detailed the circumstances surrounding incidents and accidents involving people and what actions were taken. Actions to reduce further risks were also documented. For example, referrals to the falls clinic and increased checks following a fall. Falls were reviewed according to the specific times they occurred, which allowed the registered manager to identify higher‑risk periods across a 24‑hour day. This analysis provided evidence for the need to have an extra staff member during those periods, which has since been implemented.

Staff spoken to knew what actions to take should someone have a fall. One staff member told us, “People are monitored after a fall, and this information is always handed over.”

The registered manager understood their responsibility to be open and honest with people when errors and omissions occurred.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People had a ‘hospital passport’,which ensured important information about the person’s care needs could be shared if they required medical treatment outside of the home. The registered manager ensured the person’s family were updated as soon as possible. One relative told us, “When [name] went into hospital, [registered manager’s name] phoned us straight away. The hospital had all the information they needed”

Where people had made a decision not to receive any medical intervention in the event of a cardiac event, this was known and could be shared.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People felt safe living at Bilton House. Comments included, “I feel safe here as it feels like home,” and “I feel absolutely safe I’m well looked after.”

Staff had received safeguarding training and understood their responsibilities to keep people safe from abuse. The registered manager demonstrated clear awareness of their obligation to report any safeguarding concerns to the local authority and to us, The Care Quality Commission (CQC).

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that the registered manager had recently submitted several DoLS applications for people after previously being unaware of their responsibilities. They lacked knowledge in this area and had been signposted by the local authority to further training prior to our inspection. The training had been scheduled but had not yet taken place. The registered manager demonstrated a commitment to developing their understanding to promote the rights of residents.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Care records informed staff about risks associated with people’s health and wellbeing and the action they needed to take to mitigate identified risks. However, some risk assessments required further detail. For example, behaviour risk assessments lacked proactive strategies to prevent challenging behaviours. One person’s risk assessment for accessing the community required additional control measures to better protect them from potential harm.

The management team had been working on improving the quality of risk assessments and we saw examples of this, which included care records that detailed how to support a person to mobilise while reducing the risk of falls. Care records also contained information for staff to support with medical conditions such as diabetes or skin integrity concerns. Records were regularly updated.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

During our inspection, we saw a stair gate at the top of the stairs leading to the first floor, however on the other side of the landing, a second set of stairs were easily accessible. The registered manager confirmed there was no one living on this floor who they considered to be at risk, however, there was no explanation as to why a gate was there in the first place. They told us, “It has always been this way.” Following our visit, the registered manager assured us that a stair gate would be installed to reduce any potential risk, while residents would continue to use the lift so that unnecessary restrictions were not placed on them.

We found an electrical cupboard with a sign stating ‘no access’ was unlocked. Immediate action was taken to address this.

Records confirmed equipment checks took place regularly and the maintenance team had a schedule of formal environmental checks.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

The majority of people felt there were not enough staff to meet their needs. One person told us, “Sometimes they are very short staffed,” another person said, “Sometimes there is not enough staff around, but it is mostly when they are getting people ready for bed.” People also reported long waiting times when pressing their call bell. However, 1 person told us, “I think that there is enough staff, loads of people around.”

People told us staff were trained well for the job. Comments included, “The staff seem to be well trained and know what they are doing,” and “Most staff seem to know what they are doing and are efficient at their job.” However, staff competencies were not routinely checked meaning the provider could not be assured that staff had up‑to‑date skills and knowledge needed to deliver safe, effective care.

Agency staff were used, and copies of their training records were held on file. However, these records were out of date, and updated information had not been requested. When we highlighted this issue, the registered manager immediately contacted the agency provider to obtain the necessary up‑to‑date training information.

Staff were recruited safely and systems were in place to check their suitability before employment commenced.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People did not have concerns about the cleanliness of the home. One person told us, “It is always clean and tidy here.”

Staff had completed training in infection prevention and control, and personal protective equipment was readily available throughout the home. Hand sanitiser was also easy for people to access.

We found the home was clean, well maintained, and free from odour and records showed that daily cleaning and monthly deep cleaning took place.

However, we found some issues such as unlabelled food open in the fridge, which may have increased risk to people. We observed some staff wearing acrylic nails and bracelets, which could prevent effective hand hygiene.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Overall, medicines were managed, stored and administered safely, in accordance with best practice guidance and people told us they received their medicines as prescribed. One person told us, “I do have medication, they never forget.” However, we found improvement was needed to ensure staff had more detailed, personalised information about when PRN (as required) medication was needed to ensure effective symptom management.

Staff had received training in the safe handling of medicines; however, the provider did not have a system to regularly assess their competence. As a result, the provider could not be assured that training was consistently applied in practice, increasing the risk of medication errors.

The provider had policies and procedures in place to provide guidance to staff on medicine management if needed.