Bilney Hall

We found the following examples of good practice.

Staff were observed to be wearing Personal Protective Equipment (PPE) in line with current government guidelines, to ensure the safety of people supported, visitors and the staff team.

Ventilation was encouraged in numerous areas of the service to encourage air replacement whilst a comfortable temperature was maintained.

Clear guidance was on display to ensure people were reminded on how to keep safe with social distancing and correct procedures staff should follow when donning and doffing PPE.

People had clear care plans in place in relation to COVID-19, this ensured risks could be mitigated and people could be supported in a personalised way.

Bilney Hall is a residential care home providing personal and nursing care to 62 people aged 65 and over at the time of the inspection. The service can support up to 63 people mostly living with a diagnosis of dementia.

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

The service accommodated people with a wide range of needs but predominantly those living with dementia. Accommodation was flexible and spacious. The layout of the building was taken into account when rostering staff. Staffing levels had improved and people received consistent support from regular staff. Agency staff had not been used for more than five months.

There was good communication, team work and management oversight. Staff told us the service had vastly improved since the registered manager had arrived and told us they received the training and support they needed to work effectively.

Although staffing was assessed to be sufficient, people’s experiences varied with some expressing concern about staff’s responsiveness. Relatives also commented they could not always find staff at busier times of the day. We have made a recommendation about this.

Risks to people’s safety were mostly well managed but we identified several environmental issues., These were rectified straight away which gave us confidence in the service. Risks assessments were in place and there were control measures in place to actively reduce risk. Audits were completed regularly and there was an established programme of refurbishment and replacement. The service had recently spent a lot of money on the service to bring it up to the required standards. We found overall the service was very clean with no odours and observed staff using personal protective equipment when supporting people. Staff received regular health and safety training and training in infection control, both were covered as part of staff’s initial induction. There were a few concerns about cleanliness, in relation to chips in paintwork and wear and tear which could harbour infection but there was a plan in place to address this.

Staff recruitment processes were robust. This helped to ensure only suitable staff were employed. Staff were supported in their employment, completing a detailed induction and received ongoing training and development, supervision and annual appraisal.

Medicines were given safely and as required and people’s health care needs were regularly monitored. The registered manager kept a detailed clinical risk register which indicated any concerns about people using the service. This could be related to a recent fall, unplanned weight loss, frail tissue viability or current infection. People were discussed at a daily head of department meeting to help ensure all actions were being taken and all key staff were aware of changes in people’s health.

People benefited from a nice environment suited to their needs. We found however signage was poor and the building was difficult to navigate. The service has since addressed this. Social activities were planned, and there were designated activity coordinators, who provided regular activity. The scope of activity was being improved upon, but all staff needed to recognise the importance of activities of daily living and promoted people to engage across the day.

Staff were observed to be caring and had good interpersonal skills and had a good understanding of dementia and how it might impact on the person. Care plans were sufficiently detailed, but we felt they could be more descriptive in terms of people’s preferred routines and how staff might reduce people’s anxiety around their routines. We have made a recommendation about care plans.

The registered manager told us they were well supported by their regional manager and were able to influence the budget and ask for additional resources as they saw fit. They described the regional manager as responsive which helped them effectively manage the service. The registered manager was a qualified nurse, very experienced in care and a good communicator. They knew people’s needs extremely well and ensured the service was well planned and staff sufficiently supported. We met the regional manager and discussed the schedule of audits which were top heavy and did not sufficiently focus on people’s experiences. The service did an annual quality assurance survey but the return of these was low and therefore unreliable. This year forms had been amended to make the questions easier, but surveys were not appropriate for everyone using the service. The regional manager said they were developing a dementia strategy, and this would be adopted by the organisation. We have made a recommendation about audits being more specific to the needs of people using the service and have suggested accreditation in dementia and end of life care would improve outcomes for 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.

Rating at last inspection

The last rating for this service was Good. The last report was published, (15 March 2017.)

Why we inspected

This was a planned inspection based on the previous rating.

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

Bilney Hall is a care home that provides accommodation and personal care for up to 64 people. It is split into three separate areas. There were 52 people living in the home on the day of the inspection, some of whom were living with dementia.

There was a registered manager employed at the home. They registered with us in November 2016. 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 and associated Regulations about how the home is run.

At the last inspection in June 2016, we asked the provider to take action to make improvements in a number of areas to improve the quality of care that people received. This included improvements in relation to: the management of risks to people’s safety; staffing levels within the home; staff training, recruitment and supervision; how the staff obtained consent from people; providing people with care based on their individual needs and governance arrangements within the home. We conducted a further inspection of the home in November 2016 specifically to ascertain whether the provider had adequately improved their governance systems. At that inspection we judged that they had done this. At this inspection we followed up the other areas that had required improvement and we found that the necessary improvements had been made in these areas.

Systems were in place to protect people from the risk of abuse and avoidable harm. The staff had received sufficient training and supervision to provide people with good care and to reduce risks to people’s safety.

People received their medicines when they needed them and there were enough staff to support them when required and to meet people’s individual needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Consent was sought from people before a task was undertaken. Where people lacked capacity to make their own decisions about their care, consent had been obtained in line with the relevant legislation.

People received enough food and drink to meet their individual needs and they were supported to maintain their health.

The staff were kind, caring and compassionate and knew the people they supported well. They listened to people, quickly dealt with any concerns they raised and treated them with dignity and respect.

People’s individual wants and needs had been assessed and the staff were meeting these. People were treated as individuals and were encouraged to participate in activities that were meaningful to them and that enhanced their well-being.

The leadership in the home was good. The staff received direction and understood their individual roles and responsibilities. The registered manager and provider had instilled an open door culture where staff and people felt happy to raise concerns without fear of recriminations.

People and staff were involved in the running of the home. Their suggestions for improvement were listened to and where possible, implemented. Systems and processes were in place to assess, monitor and improve the quality of care people received. Where incidents had occurred, a full investigation had taken place and learning applied to reduce the risk of the incident from re-occurring again in the future.

We have not changed the overall rating for this service as a result of this inspection, which was only to follow up our enforcement action. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bilney Hall on our website at www.cqc.org.uk.

Bilney Hall is a care home that provides accommodation and personal care for up to 64 people. There were 48 people living in the home on the day of the inspection, some of whom were living with dementia.

At the time of the inspection, the home had a registered manager. 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 and associated Regulations about how the service is run. The registered manager was not present during this inspection visit.

At the previous comprehensive inspection the systems in place to assess and monitor the quality and safety of the care provided to people were not effective. This had resulted in some people receiving poor care and being at risk of harm.

At this inspection we found that improvements had been made. The provider had extensively reviewed their quality monitoring systems and had made some changes to increase its effectiveness. New auditing schedules had been introduced and a number of audits had regularly taken place to identify if any shortfalls had occurred in relation to the quality of the care being provided. Where shortfalls had been found, action had been taken to improve the care people received.

The warning notice we issued had been complied with.

Bilney Hall is a service that provides accommodation and residential care for up to 64 people, most of whom are living with dementia. The home is split into three ‘wings’ which are called Liddell, Dibben and Old Hall. During the inspection, there were 49 people living at the home.

During our last inspection in November 2014, we found that improvements were required in some areas. These included improving staffing levels within the home to meet people’s needs and preferences, staff knowledge of the deprivation of liberty safeguards and the provision of meal choice to people. Improvements were also required in the monitoring of the care provided within the home and the environment for people living with dementia. These concerns resulted in two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond with two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that sufficient improvements had not been made in all of these areas and that other concerns were found during this inspection visit. These concerns resulted in six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was a registered manager working at the service but they were not present during the inspection. 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 and associated Regulations about how the home is run.

The provider had failed to make sure that the required improvements identified during the last inspection had been made. There was a lack of effective systems in place to assess, monitor and improve the quality and safety of the care people received.

There were not enough staff working in the home to meet people’s individual needs and preferences and to keep them safe. Some risks to people’s safety in respect of the premises had not been identified in a timely manner. Where risks had been identified, actions had not always been taken to reduce the risk of people experiencing harm.

The principles of the Mental Capacity Act were not always being followed when making decisions for people who lacked the capacity to consent to their care. Therefore, people’s rights may not have been protected. Some areas of the environment had been improved to assist people living with dementia. However, these improvements had not been extended to all relevant areas of the home.

People received their medicines when they needed them and they received enough to eat and drink. People were supported to maintain their health and were able to make choices about the care they wanted to receive.

The staff were observed to be kind when they engaged with people but a consistent caring approach was not always demonstrated. People and visitors found the staff approachable and felt comfortable to make a complaint if they were unhappy about any aspect of the care being provided.

We have made a recommendation regarding improving the environment for people living with dementia.

We were provided with various pieces of information from the provider and found that the necessary improvements had been made.

We spoke with six people using the service about the food on offer. All comments received were positive. One person told us that they 'Always like the food' another person told us that 'All the food is good.' A third person commented 'There is always plenty of choice and the amount is always just right'. A fourth person told us 'I have nothing to grumble about, the food and choice is always to my liking'.

Appropriate checks were undertaken before staff began work to ensure that only suitably vetted people were employed to work with vulnerable adults.

We saw that people's records were well maintained and stored securley.

We did however find that the medication systems within the home did not always ensure people's health, welfare and safety.

We spoke with two members of staff who confirmed that since our visit in May 2012, they had received infection control training. They were both able to tell us about improvements that had been made, which included the disposal of any bed sheets found to be stained, the completion of cleaning checklists and the initiation of hand gels in various areas of the home. Our review of staff training records confirmed that a staff training session on infection control had been held in June 2012.