Bilton Hall Nursing Home

Updated 31 May 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was completed by one inspector, a specialist professional advisor and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Bilton Hall Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Bilton Hall Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection the manager registered with CQC no longer worked at the service and a new manager had been employed.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with five people who used the service about their experience of the care provided and one relative. We spoke with nine members of staff including the area manager, general manager, deputy manager and care staff, admin staff, the activity coordinator and maintenance person. We reviewed a range of records. This included five people’s care records. We reviewed the medicines administration records for nine people. We reviewed a range of documentation relating to the safe management of medicines including people’s administration charts. We reviewed medicine error incident forms and subsequent learning from these. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including audits, spot checks, meeting minutes, rotas and policies and procedures were reviewed.

Updated 31 May 2022

About the service

Bilton Hall Nursing Home is a residential care home providing accommodation for people who require nursing or personal care to up to 60 people. The service provides support to people living with dementia, people over the age of 65 and people under the age of 65. At the time of our inspection there were 44 people using the service. The building is adapted into three wings, each with separate facilities. One of the wings specialises in providing care to people living with dementia.

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

People did not receive safe care and support as staff were not reliably trained to support their required needs.

Risk assessments were in place and considered risks and how to minimise them. Medication was administered safely, documentation for topical medicines was not always in place. We have made a recommendation about this. Infection prevention and control practices had improved. Staff were recruited safely, and lessons were learnt when things went wrong.

People were afforded choice and control over their care and there were activities available. Information was available in a variety of formats and care planning was to a good standard.

People were included in decisions about their care and the provider had systems in place to work with other organisations. There was a new manager in post who had a plan to improve the standard of care and systems to 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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 December 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of all the regulations found on the last inspection.

Why we inspected

We received concerns in relation to the management of catheter care and the standard of food at the service. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed and remains requires improvement, based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this full report.

The provided already had plans in place to retrain staff in regard to catheter care and a new general manager was improving the standard of care and culture within the service

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to staff training and poor knowledge on catheter care at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.