Bilton Court

We found the following examples of good practice.

Safe arrangements were in place for visitors to the service including relatives and friends, professionals and others. This included a booking system, rapid LFD testing, showing evidence of vaccination, hand washing and sign in process.

Isolation, co-horting and zoning were used to manage the risk of infection spread. This meant people self-isolated in their rooms when necessary and staff were allocated to work in certain areas of the service should anyone test positive for COVID-19.

Enhanced cleaning and disinfection of all areas of the service continued to take place to reduce the risk of cross contamination.

There was plenty of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser available. PPE stations were located around the service. Used PPE was disposed of safely in clinical bins.

Staff followed good practice by changing into and out of their uniforms in an allocated room, and kept their personal belongings in plastic bags to reduce the risk of any infection spread.

A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. This meant swift action could be taken if anyone received a positive test result.

The staff team worked together to cover any vacant shifts to ensure safe staffing levels were always maintained. Agency staff were sometimes used when essential, and processes were followed to enable this safely.

The registered manager had good oversight of infection prevention and control processes. They undertook regular quality assurance checks. Policies and procedures were in place and up to date, which supported good practice in all areas of infection prevention and control.

Bilton Court is a residential care home providing personal and nursing care to 44 people aged 65 and over at the time of the inspection. The home can support up to 47 people.

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

Bilton Court had a welcoming environment, where relatives told us staff were calm and caring, with a good understanding of peoples care needs. Staff were kind and knowledgeable in relation to promoting independence. People living at the home were involved in planning their own care and were able to express their views. They told us they felt listened to.

Systems were in place to protect people from abuse. Staff received training and were aware of whistleblowing processes. Risks were assessed, and guidance was provided to staff to ensure risks associated with care, were minimised. There were suitable numbers of staff, who were recruited safely and in line with current legislation. There were systems and processes in place to report accidents and incidents.

Initial assessments were undertaken which reflected choices and needs. Staff were offered regular training, staff told us they had enough training to meet people's needs effectively. Consent to care was sought and recorded. The person receiving care was 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 home supported this practice.

Activities and the quality of the food were important at Bilton Court, with the aim of wanting to enhance peoples’ quality of life, by providing a varied range of social activities throughout the day and week. Preparing meals daily from fresh, seasonal ingredients, allowing for choice and preferences on the day.

The registered manager had a clear vision. Staff told us they felt supported in their role and told us morale in the team was good. The registered manager had made close links within the community and worked in partnership with other agencies and health and social care professionals. Systems were in place to provide scrutiny of the care being provided and to ensure it was safe and of good quality.

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 3 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

The inspection was unannounced and took place on 25 April 2017. At the last inspection on 6 May 2015 the service was rated Good. At this inspection we found that the service remained Good.

The service 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.

People using the service continued to receive safe care. Robust staff recruitment procedures were followed. The staffing levels met people’s needs. People were protected from the risk of harm and received their prescribed medicines safely.

People using the service continued to receive effective care and 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 support this practice.

People received care from staff that had the appropriate knowledge and skills to meet their needs, and they were supported to maintain good health and nutrition. Staff were provided with a thorough induction and on-going training. They had attended a variety of training to ensure they were able to provide care that was based on current practice. Staff received regular supervision and appraisal from their allocated supervisors.

Staff knew the people who used the service well and delivered care that respected people’s individuality and diversity. People were treated with dignity, kindness and compassion and encouraged to be involved in planning their care and support. The care plans were personalised giving details on people’s needs and preferences. People knew how to raise a concern or make a complaint and the provider had effective systems in place to manage complaints.

People benefitted from using a service that had a positive, person centred ethos and an open culture. People, their relatives and staff had confidence in the registered manager’s ability to provide high quality managerial oversight and leadership. Established quality monitoring systems were used to drive continuous improvement.

Below is a summary of what we found.

The summary is based on our observations during the inspection, speaking with people who used the service and their relatives, the staff supporting them and from looking at records.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

When we inspected we found that there were sufficient numbers of experienced and competent staff on duty to safely meet people's care needs. We saw that staff had been appropriately trained and received the managerial support they needed to do their job. People were cared for in an environment that was clean and hygienic and the equipment in place for staff to use was appropriately maintained. This meant that people were protected from the risk of neglect or unsafe care.

There were suitable arrangements in place to respond to emergencies, with the manager or deputy manager available 'on call' to support staff to manage the situation safely and in a timely way.

Is the service effective?

People's needs had been assessed before they were admitted to Bilton Court. After admission to the home we saw that people's needs were regularly reassessed to ensure they received the safe care they needed. This meant that staff had the information they needed to minimise identified risks to people.

We spoke with staff and observed their engagement with people and we found that they had a good knowledge of each person's care needs and preferences. Their awareness of people's needs was evident in their conversations with us.

We found that the service provided people with adequate nutritious food and drink that ensured they maintained good health.

Is the service caring?

We observed that staff interacted with people in a friendly, respectful and kind manner. They encouraged and supported people to do things for themselves where possible. One person said, "All the staff are so kind. I really am glad I am here." Another person told us, "I'm very satisfied with the care and attention they give me I've never had any problems. I'm very happy with my room." We were also told, "I like the staff very much they just know what I need they're very kind."

We saw that staff were able to communicate effectively with people with limited verbal communication and to meet their needs with respect and dignity.

Is the service responsive to people's needs?

We observed that staff responded promptly to people's needs, both physical and social, although there were at times delays in responding to call bells. We saw that care plans and risk assessments had been updated when people's needs had changed, and that referrals had been made to other health and social care professionals when required. The service took account of individual preferences, and supported them to access a variety of activities.

We saw that although there was enough staff on duty to meet people's needs, both staff and people told us that they felt there was not always sufficient staff, particularly at weekends and peak times, including meal times. One person said, "Staffing levels have improved. They are much better now than they used to be.' This was confirmed by a member of staff who said, "Staffing can be an issue at times but it is so much better than previously.'

Is the service well-led?

There was a registered manager in post on the day of our inspection.

Staff told us that they received a good level of managerial support to enable them to carry out their duties. We found that the provider had ensured there were robust quality assurance processes in place. This meant that people were assured of receiving the care they needed in a way that suited them.

The provider regularly sought the views of people using the service and their representatives by listening to them, and took account of their feedback to improve the service.

We received mixed feedback from the people who spoke with us. Family members told us, 'The staff work hard, some are excellent, but they are rushed off their feet.'

Another person said, 'X has been here six years and I have seen ups and downs. The Managers' have made a positive difference.'

We saw that the Provider had appropriate policies and procedures in place for the recruitment of staff.

We also reviewed how comments and complaints were managed. We found that concerns were managed in accordance with appropriate policies and procedures, with feedback provided to the complainant and an escalation procedure available if required.

Finally, we reviewed how the home dealt with information and records of the people who lived at the home and of the staff members. We found that the Provider had clear policies and procedures in place and information was used and stored securely.