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Bilton Hall Nursing Home Good


Inspection carried out on 28 March 2018

During a routine inspection

This inspection took place on 28 and 29 March 2018. The visit on the first day was unannounced.

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

Bilton Hall provides nursing care for up to 60 older people some of whom are living with dementia. When we inspected there were 50 people living at the home. Accommodation is provided over two floors with a dementia care unit known as the 'Butterfly Unit' situated on the first floor. At our last inspection we rated the service good. There was a breach of Regulation 10 of the Health and Social Care Act (Regulated Activities) 2014, because arrangements in place to assist people to bathe or shower did not promote people’s privacy and dignity.

At this inspection we found improvements had been made and the service was now meeting legal requirements. The rating remained good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Appropriate systems were in place to ensure safeguarding concerns were dealt with appropriately. Assessments of risks associated with people's care and support were completed and steps taken to minimise the likelihood of any harm. Lessons were learnt from when accidents or incidents occurred.

Regular checks were carried out to ensure the premises were kept in a good state of cleanliness and repair. Adaptations had been made to the environment to help orientate people to find their way around the home and we were told that people were supported to access the outside space when they chose.

The provider recruited staff safely. Staffing levels were kept under review to make sure enough staff were available to provide people with appropriate, timely assistance.

While more detailed guidance was needed around the use of medicines in specific situations appropriate systems were in place to protect people against the risks associated with medicines.

Staff received appropriate training and support to provide them with the skills, knowledge and supervision they needed to carry out their roles.

People were supported to maintain good health and nutrition in partnership with other healthcare professionals when needed.

There were some occasional gaps in monitoring documentation, but overall records were well completed and showed that care was provided in line with people's needs and wishes. 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.

People enjoyed positive relationships with the staff and they were treated with respect and kindness.

People were involved in planning how they wanted their care and support delivered. Staff knew people’s individual preferences and there were opportunities for people to get involved in activities.

The provider responded to complaints appropriately and people told us they felt confident any concerns would be addressed.

Effective management systems were in place to promote people’s wellbeing and drive continuous improvement. This included internal audits and also provider audits which provided positive feedback about the service. People and their relatives were included in the development of the service through surveys and meetings.

Staff and people using the service; their relatives and representatives expressed confidence in the registered manager’s abilities to provide good quality care. Staff reported a supportive leadership with the emphasis on good team work.

Further information is in the detailed findings below.

Inspection carried out on 1 December 2015

During a routine inspection

This inspection was unannounced and was carried out on 1 December 2015. At the previous inspection, which took place on 9 September 2014 the provider was meeting regualtions.

Bilton Hall is a care home providing nursing care for up to 60 people some of whom live with dementia, physical disability or are terminally ill. There are 56 single and 2 double bedrooms and all have en-suite toilet facilities. The registered provider of the service is Ultimate Care Limited. On the day of the inspection there were 58 people living at the service.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 said they felt safe and they spoke positively about the care and support they received. Staff completed training with regard to safeguarding adults. Staff were able to speak confidently about what constitutes abuse and the procedure to follow if they suspected anyone was at risk or had experienced harm. Staff recruitment processes included carrying out appropriate checks to reduce the risk of employing unsuitable people.

There were safe systems in place to ensure people received their medicines as prescribed. Staff received appropriate training and were assessed for competency prior to administering medicines and this was reassessed regularly.

New staff had received relevant training to enable them to carry out their roles this was targeted and focussed on improving outcomes for people who used the service. This helped to ensure that the staff team had a good balance of skills, knowledge and experience to meet the needs of people who used the service.

The provider followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions.

People were offered a varied diet and were provided with sufficient drinks and snacks. People who required special diets were catered for. Where people were at risk of malnutrition appropriate risk assessments had been completed and staff sought advice from dieticians, speech and language therapists to ensure people had their nutritional needs met.

People had good access to health care services and the service was committed to working in partnership with healthcare professionals.

People told us they were treated with kindness and were happy with the support they received. We found staff approached people in a caring manner and overall people’s privacy and dignity was respected. However, we observed some incidents where people’s dignity was not respected and these were reported to the manager.

People looked well cared for and appeared at ease with staff. The home had a relaxed and comfortable atmosphere.

People were involved in activities they liked and were linked to previous life experience, interests and hobbies. Visitors were made welcome to the home and people were supported to maintain relationships with their friends and relatives.

The service had a complaints procedure and people we spoke with were familiar with it and told us they would feel confident in raising concerns with managers. They also told us they felt they could talk with any of the staff if they had a concern or were worried about anything.

People completed an annual survey about the quality of the service. The provider reviewed this feedback used it to address any shortfalls and improve the service.

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service. They told us the registered manager was supportive and promoted positive team working.

Inspection carried out on 9 September 2014

During an inspection looking at part of the service

A single inspector carried out this inspection to check that the provider had taken action to improve two areas that we found non �compliant at our last inspection of this service.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We felt confident the provider had addressed the issues raised at the previous inspection which meant people who live at the service were at reduced risk of infection and live in an environment which was clean and hygienic. We found that improvements had been made and the areas in the home previously identified had been cleaned thoroughly and were now clean. Infection control auditing was in now in place and action had been taken to address issues that were found. The laundry had been refurbished which reduced the risk of cross contamination.

Is the service well led?

The previous inspection identified although the service had a range of quality assurance systems they were not tailored to the needs of the client group. Since the previous inspection the manager had produced a simplified, bullet point version of the dementia strategy which she discussed with staff during supervision and staff meetings. The manager had also met with relatives with the aim to gather views about the development of the specialist dementia care unit. The manager also told us of the links she has made with other agencies providing services for people living with dementia in the local area and the plans to work collaboratively with them. This will help enhance the support people receive and enhance staff skills and knowledge.

Inspection carried out on 17 June 2014

During a routine inspection

A single inspector, inspection manager and an expert by experience carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.


Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continuously improve.

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The manager told us about applications that had been submitted. We found staff had received training with regard to the Mental capacity Act 2005 and Deprivation of Liberty safeguards. Some staff we spoke with were unclear about their understanding of MCA and DoLS and the provider may consider re visiting this with staff.

People were at risk of infection because there were areas of the home where good infection control guidance had not been followed. More effective auditing and monitoring would help reduce this risk.

When people were identified as being at risk, their care plans showed the actions that would be required to manage these risks. These included appropriate referrals to other health and social care professionals such as dentists, opticians, occupational therapy and dieticians.


People's health and care needs were assessed with them, and they were involved in developing their plans of care. Care plans provided sufficient information which explained how each person needed to be safely supported by staff. We saw that in the main people's wishes and preferences had been clearly recorded, so that they were cared for in the way they had chosen. However, those people living with dementia would benefit from care planning which was more person centred and reflected current good practice.


We saw staff were kind and respectful when speaking with or supporting people.

We saw that staff acted in a kind and respectful way People looked well cared for and appeared at ease with staff. The home had a relaxed and comfortable atmosphere.

People told us they were supported by kind and attentive staff. One person commented �The care here is very good, I�m very satisfied�.

Another person said in response to the improvements to their health �I put it down to the excellent care here and the lovely staff, I can�t knock them; they�ve been brilliant, just pushing me enough to keep me going�.


People using the service, their relatives and other professionals involved with the service completed an annual survey. This enabled the manager to address any shortfalls or concerns.

People we spoke with knew how to make a complaint if they were unhappy.

The provider had sought specialist advice in order to improve services provided to people living with dementia and had implemented recommendations made.

We saw a staff team that acted professionally and responded appropriately to people's care needs. People were being assisted promptly and we saw that the staff had time to spend socialising and engaging with people. For example we observed one person appeared to be quite warm and the activities coordinator called for a carer to change this person into something cooler so they were comfortable.

Well led.

While systems to audit and monitor the service were in place, they were not sufficiently effective to assess and manage risks to the health, safety and welfare of people who used the service and others.

The provider had procedures in place for reporting any adverse events to Care Quality Commission (CQC) and other organisations such as safeguarding, police, deprivation of liberty, and the health protection agency. Our records showed that the provider had appropriately submitted notifications to CQC about incidents that affected people who used services.

Inspection carried out on 17 February 2014

During an inspection looking at part of the service

In December 2013 we carried out a routine inspection to Bilton Hall. We identified at that time, concerns regarding the care and welfare of people living in the dementia unit at this home. Following this, the provider wrote to us and told us what they were going to do to address the issues identified. This inspection was carried out to check that the issues had been addressed. During our discussion with the manager we saw evidence that specialist advice had been sought about how to develop the dementia unit and work was progressing with this according to the action plan timescales. However, we found further concerns regarding the care and welfare of people living in the dementia unit and found people were at risk of not having their health and welfare needs being met.

We observed staff, spoke with them and looked at records. We were unable to assure ourselves that people�s needs were being met as the records were unclear and staff were unable to provide us with consistent information about how people were cared for safely.

Inspection carried out on 13 December 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service including talking to people who lived at the service, staff, visiting relatives and observing the care provided. We spent time with people using the service and we observed staff being friendly and warm towards people.

We observed that staff and people using the service had positive relationships and people appeared relaxed and comfortable with their surroundings; with staff and the activities they were engaged in. We saw that staff spoke at a pace which met people's needs and engaged with people in a calm and patient way. One person said �The staff are lovely, they look after us here really well.� Another person told us �Staff are fantastic, I have all I need here.� The relative we spoke with told us �The nursing care is excellent and they communicate with me really well.�

We felt that staff would benefit from further training in order to improve the care and support people living on the dementia unit received.

Improved monitoring and auditing arrangements would ensure consistency in relation to the safety of the recording and administration of medicines.

There were sufficient staff available; we saw people being assisted promptly and we saw that staff had time to spend socialising and engaging with people.

The provider had effective system in place to regularly assess and monitor the quality of service that people received.

Inspection carried out on 28 June 2012

During a routine inspection

We inspected Bilton Hall Nursing Home at 07.15 hours, because concerns had been raised with the Commission that the health and welfare of people was being compromised. The specific concern was that people were up and dressed by 07.30 hours, irrespective of their wishes. On the day of our visit we found two people who were dressed and downstairs when we arrived. We observed people getting up at various times throughout the morning. We observed other people who stayed in bed.

We spoke with seven people who live at the home. They told us that the staff "were nice" and "I am well looked after". They all told us they were able to make choices about when they went to bed and when they were dressed for the day. One peson said" I have always got out of bed before 6 in the morning, I am able to do this here". Another person said she "decided whether to have breakfast in bed or to go to the dining room". She was able to make different choices to "please me". Another person said that they "would recommend it to anyone"

People we spoke with told us that they enjoyed the food and could choose. Their preferences were accommodated. We were told "The kitchen staff are excellent, my wife has pureed food. It is pureed to look appetising. The vegetables and meat or fish are in individual portions. I don't think you could get any better"

People told us that there were activities each day; one person told us "the activity organiser arranged for us to see the Olympic torch at the top of the road".

The commission had been alerted to staff members' attitude to other members of the team and to people living at the home. During our visit we observed people being treated with respect and staff who were working together as a team.

We spoke with seven relatives who were visiting. They told us that the staff "were warm and welcoming". They told us that the Manager is very good and if they had any concerns they would speak to her. One relative told us " if my wife was not here she would not have survived". Others told us that they "Could not fault the excellent care". We were told by one relative that he "Noticed how kind the staff are to other residents". We were told that the staff had been �supportive and helpful to all family members". One relative told us �I would move in here if I needed care". A relative who spoke to us said �All the staff are good, you never see them getting shirty with anyone"

We spoke with other health professionals who told us that they had �a good professional, working relationship with the staff".

Inspection carried out on 17 November 2011

During an inspection looking at part of the service

People told us they were very happy with the care and support they were receiving at Bilton Hall Nursing Home.

Inspection carried out on 3 August 2011

During a routine inspection

People told us that they were well looked after, that the home was kept clean and that the food continued to be very good. People told us that staff are kind to them. People's general comments about their care were,� Yes it is fine living here, we are all well looked after. The food here is very good.� Another person said, �Yes it is ok living here. I know I have to be here. Staff are generally good, some staff are better than others.�

We spoke to several relatives who were visiting the home. They made comments such as �they feed people and keep them clean and they have nice food here and are well looked after. The only thing that is lacking is the little bit of TLC, such as making sure their hearing aid is working but apart from that all the staff are lovely� another relative said, � I am very satisfied with the care my wife receives at Bilton Hall. In particular I would like to commend the nursing care and the standards of food which is provided. If I have a matter of concern it is dealt with immediately.� Another relative we spoke to was full of praise about the staff that work at the home and said, �All staff are real people, the manager is very good and the home is run like a tight ship, but in a humane way. Some staff are pragmatic and others are gentle it is a good combination of staff and they all work really hard. The atmosphere at the home is very good. It is a good place. The food is also very good. The staff really do respect people�s dignity here� and another relative told us �My relative is well cared for, they don�t make her get up when she is having an off day. Overall the home is very good.�

A joint visit was carried out with the Local Authority - North Yorkshire County Council as we had concerns about staff following correct procedures such as serious incidents in the home and the hour�s staff were working.

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