The Boltons

Updated 20 May 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Boltons 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we held and had received about the service since its registration. We sought feedback from the local authority and other professionals who work with the service. We requested information from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We checked information held by Companies House, the Food Standards Agency, the Information Commissioner’s office and the fire brigade. We looked at relevant websites and social media. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with five people who used the service and 12 relatives about their experience of the care provided. We spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with the registered manager and two deputy managers (the ‘management team’). We wrote to 15 staff members and received three responses. We received written feedback from the local authority. We completed observations of communal areas during our site visit.

We reviewed a range of records. This included five people’s care records and multiple medicines administration records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and duty of candour information.

Updated 20 May 2021

About the service

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.