Bilton Hall Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

There was a learning culture within the service. Staff told us the quality of the service had improved and leaders confirmed action plans were in place and being worked through. Systems and processes were in place to ensure appropriate referrals were made to external professionals when needed. People were generally supported to be involved in understanding and managing their own risks and needs, however, some potential risks were identified during the assessment. Care plans and risk assessments had been reviewed. Some risks in the environment were observed. The provider resolved these immediately following our feedback. People told us they felt safe, and staff were knowledgeable about safeguarding. We received mixed feedback about staffing, and recruitment processes were not always fully robust. People received their medicines at the right times but there were inconsistent processes for recording the use of emollient and barrier products and thickening agents. There had been struggles with staffing levels in the housekeeping department and this had impacted on the cleanliness of the service, but 2 new staff members had recently been recruited.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt able to raise concerns and they were listened to. People were involved in their care plans and in a ‘resident of the day’ initiative where people were given meaningful one to one time with staff and management and supported to raise any concerns or queries.

Staff told us the quality of the service had improved over the last few months. Action plans were in place and leaders spoke about the positive input into the home and the new systems and initiatives they had introduced to improve the quality of the service. Future plans were in place for ongoing improvements.

Accidents, incidents, and safeguarding concerns were analysed for trends, triggers and themes so learning could take place. Learning was disseminated in staff meetings and handovers. Audits were completed and action plans were prioritised using a risk-based approach. We noted though that the provider’s audits had not identified all the issues we found during the assessment. The provider was responsive to feedback and implemented improvements during the assessment.

People and relatives did not have any concerns about access to other healthcare professionals. However, one concern was raised about the effectiveness of communication and the preparedness of staff when a person was leaving the home to access another service. It was fed back that staff had not been made aware of the transition in a timely manner.

Staff and leaders confirmed there was a weekly ward round with the GP, which the deputy manager attended each week for consistency. Discussions and outcomes following the ward round were recorded and then passed to staff during handovers.

Partners did not express any concerns about the pathways in place to enable people to access and transition to other services.

Systems and processes were in place to ensure appropriate referrals were made to external professionals when needed.

People told us they felt safe and spoke positively about the nature of staff and the support provided.

Staff were knowledgeable about safeguarding, had received training, and had no current safeguarding concerns.

Positive, kind, and caring interactions were observed. No safeguarding concerns were observed during the assessment. No bullying, harassment or discrimination was observed or reported.

Systems and processes were in place to deal with safeguarding appropriately. Safeguarding concerns were investigated and tracked. Policies and information about safeguarding was readily available in the service and on display.

People were generally supported to be involved in understanding and managing their own risks and needs. The service had introduced a system called ‘resident of the day’ where each department discussed an individual’s needs, views, and wishes with them and people were involved in the development of their support plans. However, some environmental concerns identified during the assessment placed people at risk of possible harm. Further, some recording issues identified, such as the lack of robust fire drill recordings and the lack of clear repositioning records, placed people at risk of possible harm. We found no evidence that people had been harmed and the provider took action immediately following our feedback.

Care plans and risk assessments had been reviewed. These reviews had involved people themselves, their relatives where appropriate, observations, and conversations with staff about people’s preferences. Staff told us how relatives had been given ‘life stories’ to complete and these were added to the care plans and actioned by nurses. Leaders and staff told us about the ‘resident of the day’ initiative which will continue to assist with monthly reviews of support plans and risk assessments.

People were supported in a way which was as least restrictive as possible, and which met individual needs. However, some risks in the environment were observed, including potential unsafe access to prescription creams and lotions. The provider removed this risk immediately following our feedback.

Staff carried out appropriate risk assessments and these were reviewed on a monthly basis. The provider used recognised tools to assess risks. However, some risks identified during the assessment had not been identified through the provider’s systems and processes.

One person told us the hoist was not always available when needed and another person told us their call bell was not always within reach. There were some risks to people’s environment identified on inspection. The provider resolved these issues immediately following feedback.

Leaders told us about daily walkarounds and regular audits to ensure the safety of the premises. Staff did not raise any concerns about the safety of the environment.

Some risks in the environment were observed including potentially unsafe access to prescription medicines and stairways. The provider resolved these issues immediately following feedback.

Health and safety checks were in place and up to date. Systems and processes around fire drills needed improvement. Fire drills were taking place, but recording was not sufficient. Following feedback, the provider implemented new paperwork to record fire drills appropriately.

Feedback from people and relatives about staffing levels was mixed. Some said there were enough staff, and they came quickly when needed, whereas others said there were not enough staff and they sometimes struggled to find someone.

Leaders told us a dependency tool was used to calculate the required staffing levels based on people’s needs. Staffing levels were above the amount assessed as required by the dependency tool. However, staff gave mixed feedback as to whether there were enough staff. Some staff said there were enough staff and others said this was not always the case, and they felt their tasks were rushed because of this. Staff spoke positively about training. They said they had enough training to meet people's needs and the quantity and quality of training had improved over recent months. Staff confirmed they had supervisions and competency checks.

There appeared to be enough staff on duty. The layout of the building and the number of communal areas meant that at times a member of staff was not always visible. Call bells were answered in a timely manner.

Most required recruitment checks were in place, but not all. An ongoing audit was being conducted of all staff files, but the audit did not cover all required recruitment checks. Competency checks were not always clearly recorded. The provider implemented a new recording system following feedback.

We received mixed feedback from people and relatives about the cleanliness of the service. Some people had no concerns and told us, “The home is kept clean and there are always cleaners around.” However, others told us there was room for improvement and comments included, “A focus on deep cleaning and attention to detail would be beneficial.”

Domestic staff were knowledgeable about their role and understood correct procedures. Staff spoke about struggling due to being short staffed in the housekeeping department, but they told us there had been recent improvements. A new head housekeeper and a domestic assistant had just been appointed.

Some areas of the carpets were dirty and required a clean and vacuum. Some areas of the service required maintenance to support good infection prevention and control.

Cleaning schedules were in place and completed, although these had not been signed off by the manager. There had been previous struggles with staffing in this department but during our assessment new staff were recruited and the provider told us they would commence deep cleaning.

People were given their medicines in a safe and kind way, and at the right times. Staff had written protocols to help them administer people’s ‘when required’ medicines in the way prescribed to meet each person’s needs.

Staff told us medicines processes in the home had improved under the current managers. Managers said they knew further improvements were needed. The competency of the senior care worker administering medicines had recently been assessed but the home’s training matrix had not been updated. The training matrix showed the nurse on duty’s medicines training was overdue.

Medicines were kept at the right temperatures. Medicine storage rooms were secured with a keypad. Medicines requiring additional storage safety arrangements were stored appropriately, but there was no risk assessment or standard operating procedure for regularly changing the key safe codes to improve security. Medicine administration records were complete and no medicines were out of stock. However, care workers followed inconsistent processes for recording the use of emollient and barrier products and thickening agents.