This inspection took place on 22 February 2017.

Bilney Hall is a care home that provides accommodation and personal care for up to 64 people. It is split into three separate areas. There were 52 people living in the home on the day of the inspection, some of whom were living with dementia.

There was a registered manager employed at the home. They registered with us in November 2016. 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 home is run.

At the last inspection in June 2016, we asked the provider to take action to make improvements in a number of areas to improve the quality of care that people received. This included improvements in relation to: the management of risks to people’s safety; staffing levels within the home; staff training, recruitment and supervision; how the staff obtained consent from people; providing people with care based on their individual needs and governance arrangements within the home. We conducted a further inspection of the home in November 2016 specifically to ascertain whether the provider had adequately improved their governance systems. At that inspection we judged that they had done this. At this inspection we followed up the other areas that had required improvement and we found that the necessary improvements had been made in these areas.

Systems were in place to protect people from the risk of abuse and avoidable harm. The staff had received sufficient training and supervision to provide people with good care and to reduce risks to people’s safety.

People received their medicines when they needed them and there were enough staff to support them when required and to meet people’s individual needs.

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.

Consent was sought from people before a task was undertaken. Where people lacked capacity to make their own decisions about their care, consent had been obtained in line with the relevant legislation.

People received enough food and drink to meet their individual needs and they were supported to maintain their health.

The staff were kind, caring and compassionate and knew the people they supported well. They listened to people, quickly dealt with any concerns they raised and treated them with dignity and respect.

People’s individual wants and needs had been assessed and the staff were meeting these. People were treated as individuals and were encouraged to participate in activities that were meaningful to them and that enhanced their well-being.

The leadership in the home was good. The staff received direction and understood their individual roles and responsibilities. The registered manager and provider had instilled an open door culture where staff and people felt happy to raise concerns without fear of recriminations.

People and staff were involved in the running of the home. Their suggestions for improvement were listened to and where possible, implemented. Systems and processes were in place to assess, monitor and improve the quality of care people received. Where incidents had occurred, a full investigation had taken place and learning applied to reduce the risk of the incident from re-occurring again in the future.

We carried out an unannounced comprehensive inspection of this service on 28 and 30 June 2016. A breach of the legal requirements was found and a warning notice was issued in respect of this breach. We gave the provider until 1 September 2016 to meet the legal requirements in relation to this warning notice. We undertook this focused inspection to check that they had undertaken changes to meet these requirements. This report only covers the findings in relation to that notice.

We have not changed the overall rating for this service as a result of this inspection, which was only to follow up our enforcement action. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bilney Hall on our website at www.cqc.org.uk.

Bilney Hall is a care home that provides accommodation and personal care for up to 64 people. There were 48 people living in the home on the day of the inspection, some of whom were living with dementia.

At the time of the inspection, the home 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. The registered manager was not present during this inspection visit.

At the previous comprehensive inspection the systems in place to assess and monitor the quality and safety of the care provided to people were not effective. This had resulted in some people receiving poor care and being at risk of harm.

At this inspection we found that improvements had been made. The provider had extensively reviewed their quality monitoring systems and had made some changes to increase its effectiveness. New auditing schedules had been introduced and a number of audits had regularly taken place to identify if any shortfalls had occurred in relation to the quality of the care being provided. Where shortfalls had been found, action had been taken to improve the care people received.

The warning notice we issued had been complied with.

This inspection took place on 28 and 30 June 2016. The first day was unannounced.

Bilney Hall is a service that provides accommodation and residential care for up to 64 people, most of whom are living with dementia. The home is split into three ‘wings’ which are called Liddell, Dibben and Old Hall. During the inspection, there were 49 people living at the home.

During our last inspection in November 2014, we found that improvements were required in some areas. These included improving staffing levels within the home to meet people’s needs and preferences, staff knowledge of the deprivation of liberty safeguards and the provision of meal choice to people. Improvements were also required in the monitoring of the care provided within the home and the environment for people living with dementia. These concerns resulted in two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond with two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that sufficient improvements had not been made in all of these areas and that other concerns were found during this inspection visit. These concerns resulted in six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was a registered manager working at the service but they were not present during the inspection. 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 home is run.

The provider had failed to make sure that the required improvements identified during the last inspection had been made. There was a lack of effective systems in place to assess, monitor and improve the quality and safety of the care people received.

There were not enough staff working in the home to meet people’s individual needs and preferences and to keep them safe. Some risks to people’s safety in respect of the premises had not been identified in a timely manner. Where risks had been identified, actions had not always been taken to reduce the risk of people experiencing harm.

The principles of the Mental Capacity Act were not always being followed when making decisions for people who lacked the capacity to consent to their care. Therefore, people’s rights may not have been protected. Some areas of the environment had been improved to assist people living with dementia. However, these improvements had not been extended to all relevant areas of the home.

People received their medicines when they needed them and they received enough to eat and drink. People were supported to maintain their health and were able to make choices about the care they wanted to receive.

The staff were observed to be kind when they engaged with people but a consistent caring approach was not always demonstrated. People and visitors found the staff approachable and felt comfortable to make a complaint if they were unhappy about any aspect of the care being provided.

We have made a recommendation regarding improving the environment for people living with dementia.

This inspection took place on 14 November 2014 and was unannounced.

It is a residential care home providing care and support for up to 54 older people, some who may be living with cognitive impairments. It is split between three units, The Old Hall, Dibben Wing and Liddell Unit.

There was a registered manager working at the service. 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.

During this inspection we found that care staff were not always available to support people when required. We also found that senior staff administering medicines were delayed in the process due to the volume of people requiring medicines.

In certain parts of the building we found areas of risk that could have caused harm to people living in the home, staff or visitors.

People told us they felt safe and that staff supported them safely. Staff were aware of safeguarding people from abuse and knew who to report concerns on to. We found that accidents and incidents were monitored and acted on appropriately and that risks were assessed and reduced or removed.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We made a recommendation in this report that asked the provider to support staff with their understanding of this act.

We found staff were supported with induction and training but training to support people living with dementia, beyond the one day induction training, had not been given to the majority of staff.

People enjoyed their meals and were given choices. Drinks were readily available to ensure people were hydrated.

The health professionals in the community worked together with the home to ensure a suitable health provision was in place for people living there.

We found the layout of the home was difficult for people who may have memory problems or living with dementia as there were no visual prompts or signs to direct people.

All the comments we received were positive when talking about the staff team. We were told they were caring, kind, respectful and courteous.

People’s needs were responded to but not always in a timely manner. People living with dementia were not being supported in the most appropriate way.

The manager had systems in place to monitor and audit the quality of the service provided. However, they were not found to be fully efficient in some areas of the service provided.

There were a number of breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

You can see what action we told the provider to take at the back of the full version of the report.

We saw that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We spoke with two people using the service and they told us that they were asked about what they wanted to do and that their wishes were “always” respected.

We spoke with six people using the service about the food on offer. All comments received were positive. One person told us that they “Always like the food” another person told us that “All the food is good.” A third person commented “There is always plenty of choice and the amount is always just right”. A fourth person told us “I have nothing to grumble about, the food and choice is always to my liking”.

Appropriate checks were undertaken before staff began work to ensure that only suitably vetted people were employed to work with vulnerable adults.

We saw that people's records were well maintained and stored securley.

We did however find that the medication systems within the home did not always ensure people's health, welfare and safety.

We reviewed the falls monitoring system and found significant improvements had been made. We reviewed all the falls incident forms from the past three months on Liddell Unit (01 July 2012 - 31 September 2012) and found that each incident had been appropriately logged on the falls calendar in the carers office. This meant that we were confident carers would now be able to identify a person who had suffered frequent falls and take the necessary action.

We spoke with two members of staff who confirmed that since our visit in May 2012, they had received infection control training. They were both able to tell us about improvements that had been made, which included the disposal of any bed sheets found to be stained, the completion of cleaning checklists and the initiation of hand gels in various areas of the home. Our review of staff training records confirmed that a staff training session on infection control had been held in June 2012.

We were unable to speak with many people using the service because, due to cognitive impairments such a dementia, they were unable to effectively communicate their experiences to us. We therefore gathered evidence of people’s experiences by observing the care and support provided during the day on Liddell Unit. We found staff to be respectful and encouraging to the people using the service.

During our visit to Bilney Hall on 14 December 2011 we spoke with eleven people who live in the three main areas of the home.

People told us "Its such a lovely place to live, I feel like the lady of the manor."

"The staff are very pleasant, they are very attentive and help me when I ring the bell."

"I don't have to wait very long before a member of staff comes to help me."

"I do enjoy my meals here, in fact I've got to watch my weight."

"Its lovely to go out to the garden, the staff take me out when the weather is warmer."

One person told us they had no complaints, and said "What a lovely place to live."

Overall, the comments received by both people living at Bilney Hall and those who visit were very positive about the care and support they receive from the staff.