Bilton Court is a care home providing care and support for up to 48 older people, some with dementia and some with a physical disability. It is situated on a residential estate on the outskirts of the town of Wellingborough in Northamptonshire. On the day of our visit, there were 38 people using the service.

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.

Bilton Court is a care home providing care and support for up to 48 older people, some with dementia and some with a physical disability. It is situated on a residential estate on the outskirts of the town of Wellingborough in Northamptonshire. On the day of our visit, there were 42 people living in the home.

The inspection was unannounced and took place on 6 May 2015.

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 2008 and associated Regulations about how the service is run.

People told us they felt safe living in the service. This was also confirmed by the relatives that we spoke with, who said that staff kept their family members safe and free from harm.

Staff had an understanding of abuse and the safeguarding procedures that should be followed to report potential abuse. Systems in place had been followed and appropriate action taken to keep people safe, minimising any risks to health and safety.

Risk assessments within people’s care records were completed accurately and reviewed regularly. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks.

Staff told us that they were not allowed to commence employment until robust checks had taken place in order to establish that they were safe to work with vulnerable people. There were adequate numbers of staff on duty to support people safely and ensure everyone had opportunities to take part in activities of their choice.

Medicines were managed safely and the systems and processes in place ensured that the administration, storage, disposal and handling of medicines were suitable for the people who lived at the service.

There was a positive culture within the service that was demonstrated by the attitudes of staff that were supported through a system of induction and training based on the needs of the people who lived there.

Staff understood the processes in place to protect people who could not make decisions. Where people lacked the capacity to make decisions, we found that best interest meetings were held and details documented in people’s care records.

People told us that the food they had was good and they had sufficient quantities of it. They also said that they had a good choice of meals and were able to get snacks and fluids throughout the day.

People had access to health care professionals to make sure they received appropriate care and treatment to meet their individual needs. Staff followed advice given by professionals to make sure people received the treatment they needed.

People were relaxed, comfortable and happy with the staff that supported them. Staff talked with people in a friendly manner and they assisted people as required, whilst encouraging them to be as independent as possible.

There were regular reviews of care for each person who used the service which enabled individual care to be monitored.

People felt that staff maintained their privacy and dignity and respected them as individuals.

Staff said that communication in the home was good and they felt able to make suggestions. There were regular meetings for staff which gave them an opportunity to share ideas and give information about possible improvements to the registered manager.

People and their relatives told us that they knew who to speak to if they wanted to raise a concern. They were happy with the service provided and how staff provided their support. There were systems in place for responding to complaints.

The service was led by a registered manager who had good support from the provider. It was evident that staff strived to provide good quality care for people and took the chance to learn lessons so improvements could be made in the future.

The inspection was carried out by an inspector and an expert by experience who gathered evidence to help us answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive to people’s needs? Is the service well-led?

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.

Our inspection looked at how the people who lived in the home were involved in decisions about their care and welfare at the home. We looked at care plans of the people who lived in the home and talked to the people who lived there, their family members and staff.

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.

People who used the service told us that they were encouraged to express their views and make choices. People told us that they were well looked after by staff. One person told us, "I'm very well looked after. The staff are good. I know their names. They come quickly when I use my call button''. A relative we spoke with said ‘’ they show generous affection for the people here and support them well’’ and added ‘’ this is a home rather than an institution.'' We saw that people’s support plans were detailed and took account of people’s individual needs and how this would be supported. We saw that the home had adequate numbers of carers to support the people living there.

We carried out this inspection visit to check that improvements had been made in areas where we found non compliance in May 2012. People told us that although there was a lot of agency staff, these staff were now getting to know their needs and it didn’t take quite so long to get the help they needed. People also told us that they liked the fact that managers visited them to check whether they had any concerns.

We carried out this compliance review as part of our planned review programme. We also checked to see if improvements had been made since our last inspection visit on 26 January 2012.

We spoke with six people who used the service. Five of the six people we spoke with were satisfied with the help and support that they got. Their comments included “Staff are very good to me and I get help when I need it”. Another said “I have nothing to complain about, I have all I need”. We found that the person who was less satisfied with the care needed help from two care staff and had to wait until two staff were available to assist. The majority of staff we spoke with said that improvements in staffing levels had been made and most of the time there were enough staff to give people the help they needed.

Some people who used the service had complex needs which meant they were not all able to tell us their experiences. We watched how staff attended to the needs of people and the level of care they provided. We saw that staff worked hard to respond to people’s needs and to deliver the care that they needed.

We found that overall improvements had been made to the care people receive since our last inspection. Additional work is needed to ensure that people's consent to their care is obtained appropriately and that staff have the training to meet people's needs.

We saw that people who use the service were treated with dignity and respect. Most

people that we spoke with thought that there had been improvements since our inspection

in October 2011 and that they did not have to wait so long for staff to help them.

People who use the service remarked on the fact that staff were helpful and comments

about staff were summarised by one person who said "staff are friendly and help me when

I need it".

People who use the service told us that they enjoyed the meals. One said "The food is

nice and there is a lot of choice".

We spoke with six people who told us that most of the staff treated them with respect. One person said “most staff are very good, but a small number of them can be a bit abrupt”. This person did say that staff were not unkind to them and that they felt safe at Bilton Court. Someone else spoke about staff who “cannot do enough for me”.

Two people who need help from two carers told us that if they need help to go to the toilet they have to wait a long time. Another said they felt lucky that they didn’t need so much help.

One person told us that they had been in a lot of pain during the night but that there had not been anyone on duty who could give him painkillers. We found that a second person had asked for pain relief and not received it on the same night.

One person told us that staff had forgotten to apply their prescribed cream for two days. Another person told us that she did not get her medication at the right times.

People using the service told us that staff treated them with respect and one person told us that staff were patient with people with dementia.

People were generally happy with the staff but said there were not enough of them. Comments included: “I don’t want staff to think that I am complaining as they are very good, I do have to wait, but they come when they can.”, One person commented that they found it upsetting when they saw others having to wait a long time to be helped to the toilet. Another told us that there can be lengthy waits for assistance, particularly if someone needs two staff to help them.

Positive comments were received about the food and people told us that there are plenty of choices available.