The Boltons

The Boltons is a residential care home providing personal care to 20 people aged 65 and over at the time of the inspection. The service can support up to 27 people. Some people supported by the service are living with dementia or a mental health condition.

The premises are two interconnected houses and people live across three separate floors. There are single bedrooms, most of which have their own ensuite toilet and bathroom. There are some communal bathrooms, two communal dining rooms and a communal lounge. There is a large garden to the rear of the building.

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

Improvements were made to medicines management since the last inspection. People were protected from abuse, neglect and discrimination. There were satisfactory risk assessments for people’s care. Premises risks were assessed and managed. There were enough staff deployed to meet people’s needs. Infection prevention and control was satisfactory.

People's likes, preferences and dislikes were considered. Staff had the necessary knowledge, skills and experience to support people. Staff had a good knowledge of people's needs. People received enough food and fluids to prevent malnutrition and dehydration. People's care was provided in conjunction with local and community-based health and social care professionals. The service was compliant with the provisions set out in the Mental Capacity Act 2005. The service was appropriately decorated and refurbished.

The staff were kind and caring. People and relatives were complimentary about support provided by the staff at The Boltons. People's rights were respected, and their dignity and privacy maintained. People's independence was promoted. People were involved, as far as possible, in their care planning and reviews.

Care plans were individualised. The daily notes were satisfactory. Some improvement in documenting people’s emotional and psychological health was required. The service worked to prevent social isolation during the pandemic and lockdowns. There was a satisfactory complaints mechanism in place. There was good planning for people's end of life care.

The management team had correctly notified us of incidents required by the regulations. Improvements were made to the governance of the service. Audits and other quality assurance processes were better used to gauge, monitor and report on the quality and safety of care. Appropriate actions were taken when issues were identified. There was a positive workplace environment. The management team were knowledgeable, skilled and experienced and were able to lead the service well. The service showed transparency and accountability in reporting matters when things went wrong. We made a recommendation about reviewing the duty of candour process.

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 did not support this practice.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 31 January 2020). There were three breaches of the regulations. 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 regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Boltons is a care home without nursing and provides a service for up to 27 older people, some of whom may have mental health needs. The services provided include respite care. At the time of inspection there were 23 people living at the service.

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

The registered manager did not always ensure the quality assurance system in place was used effectively to help oversee the service and ensure compliance with the fundamental standards.

The management of medicines was not always safe. The registered manager also did not notify the CQC of serious injuries, police incident or allegations of abuse in a timely manner.

The new provider had made improvements in relation to premises, infection control and keeping records for duty of candour since acquiring the service.

People reported they felt safe living at the service. Relatives felt their family members were kept safe in the service. The registered manager and staff understood their responsibilities to raise concerns and deal with incidents or allegations of abuse. Risks to people’s personal safety had been assessed and plans were in place to minimise those risks. There were contingency plans in place to respond to emergencies and the premises and equipment were kept clean.

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.

The staff team were up to date with their mandatory training. The registered manager had planned and booked training when necessary to ensure all staff had the appropriate knowledge to support people. Staff received ongoing support via regular supervision and appraisals and felt supported and maintained great team work.

People received effective care and support from staff who knew them well. People enjoyed the food and could choose what they ate and where to eat. People had their healthcare needs identified and were able to access healthcare professionals such as their GP.

People and relatives felt the staff were kind and caring, and the service had a calm atmosphere. The registered manager and the deputy managers were working with the staff team to ensure caring and kind support was consistent. People and their families were involved in the planning of their care.

The registered manager encouraged feedback from people and families. The staff team recognised and responded to changes in risks to people and ensured a timely response and appropriate action was taken. The registered manager improved the way they kept accurate and legible records for when the duty of candour was applied. People were encouraged to live a fulfilled life with activities of their choosing and were supported to keep in contact with their families.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 12 December 2018). Since the last rating was awarded the provider has altered its legal entity and was registered by CQC under the new legal entity on 2 August 2019. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was the first inspection of the service under the new legal entity. Although the previous requires improvement rating was not awarded to this provider, they had full knowledge of the service’s inspection history and were responsible for maintaining and improving the service, including addressing any issues from the last inspection. The inspection was prompted in part due to the concerns identified at the previous inspection with the former provider. We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

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

Enforcement

We have identified breaches in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.