CQC report explained · a residential care home
What the CQC found at The Bill House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- Recent medicines-management problems were identified, including inaccurate signing of medicines records and a period when no night staff member was trained to administer medicines. These issues had been addressed before the inspection, but the improvements needed to be sustained.
- Effective?
- Good
- This area was not inspected during this focused visit. The previous rating was used because no concerns were identified in the information reviewed about this area.
- Caring?
- Good
- This area was not inspected during this focused visit. The report's overall findings described a caring environment, but the previous rating was used.
- Responsive?
- Good
- This area was not inspected during this focused visit. The previous rating was used because no concerns were identified in the information reviewed about this area.
- Well-led?
- Good
- Inspectors found strong management systems, including audits, action tracking and learning from incidents. The manager and staff understood their roles and worked to improve the service.
What inspectors found, May 2021
The Bill House is rated Good overall, but safe care Requires Improvement after recent medicines-management shortfalls.
This was an unannounced, focused inspection on 20 April 2021. One inspector spoke with people and staff, observed care, and checked care, medicines, recruitment and management records.
The home was caring and generally safe in practice. Risks were assessed, staffing levels were considered sufficient, staff recruitment checks were completed, and people received medicines as prescribed at the time of inspection.
Inspectors found recent problems with medicines management. A staff member had signed records to say medicines had been given when they had not. The home had taken action, but improvements needed to be sustained. The manager also needed clarification about when to notify CQC about abuse or alleged abuse.
The overall rating was Good. Safe was rated Requires Improvement and well-led was rated Good. The other three areas were not inspected during this visit, so their previous ratings were used in the overall rating.
Risk management
Risks such as falls, choking and skin damage were assessed, with steps taken to reduce harm. Staff used care information to support people safely.
“Risks to people were assessed as needed, to keep people safe and to mitigate the risk of harm.” from the report
Staffing and recruitment
Inspectors found enough staff to meet people's needs and found appropriate checks in the two recruitment files reviewed.
“Staffing levels were sufficient to meet people's care and support needs.” from the report
Personalised support
Care plans recorded people's needs and preferences. Daily activities were arranged around what people wanted to do, including activities important for people living with dementia.
“People's needs and preferences were recorded in their care plans.” from the report
Quality monitoring
The home had introduced audits covering medicines, infection control, the environment and health and safety. Incidents and accidents were recorded with actions to prevent them happening again.
“A robust system of audits had been implemented to monitor and measure the service provided, and to drive improvements.” from the report
Incorrect medicines record
seriousA staff member had signed medicines records to confirm medicines had been given when they had not. The report says there was no impact on people, and the management team investigated and acted before the inspection.
“a member of staff who had signed Medication Administration Records (MAR) to confirm people had received their medicines, when they had not.” from the report
Night medicines cover
needs fixingFor a period, there was no night staff member trained to administer medicines. This had been corrected before the inspection, but the manager had not known that this cover was required.
“there was always a member of staff who had been trained to administer medicines at night if required.” from the report
Reporting abuse concerns
needs fixingThe manager needed clarification about when alleged abuse must be reported to CQC. The manager confirmed they understood the requirement after it was discussed.
“The manager's understanding of when to notify CQC of any incidents of abuse or alleged abuse required clarification.” from the report
- 01How do you check that medicines are actually given before a Medication Administration Record is signed?
- 02How do you make sure every night shift has a member of staff trained to administer medicines?
- 03What medicines audits, spot checks and competency assessments are now carried out, and how often?
- 04What would you do if a medicine was missed or a record was signed incorrectly?
- 05How do you make sure abuse or alleged abuse is reported to CQC when required?
This was an unannounced focused inspection of Safe and Well-led only; the other ratings were carried over from the previous comprehensive inspection. This explanation was written from the published report of 27 May 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2019
The Bill House was rated Good; inspectors found safe, kind and personalised care, with improvements since the previous inspection.
This was a planned, unannounced inspection on 14 and 18 November 2019. One inspector spoke with six people, two relatives, staff and a healthcare professional. Records about care, medicines, staffing and how the home was managed were also checked.
Inspectors found that people were protected from abuse and avoidable harm. Risks were assessed and reviewed, staffing was sufficient, medicines were managed safely and the home was clean. People received suitable food, healthcare and support from trained staff.
Staff were described and observed as warm, kind and respectful. Care plans included people's preferences, communication needs and activities. The home had improved from Requires Improvement at the previous inspection, published in November 2018, to Good in all five areas.
Improved risk management
The home had addressed problems found at the previous inspection. Staff had current guidance about risks such as falls and this information was reviewed.
“People's risks were identified, assessed and managed safely.” from the report
Enough staff
Inspectors found staffing levels were based on people's needs. Extra staff were used at busy times, and call bells were answered promptly.
“There were sufficient staff to meet people's needs.” from the report
Kind and respectful care
Staff knew people well and supported their dignity, choices and independence. Inspectors observed calm and patient interactions.
“Staff were warm, kind and caring with people.” from the report
Personalised support
Care plans recorded people's histories, preferences and communication needs. Activities were arranged around people's interests, and relatives were involved in reviews.
“Care plans were written in a person-centred way and contained detailed information about people, their preferences, and how they wished to be supported.” from the report
Medicine trolley security
needs fixingThe medicine trolleys in reception were not secured to the wall when inspectors visited. The manager said replacement trolleys would be secured after the planned pharmacy change.
“Two trolleys located in the reception area housed all the medicines people required. These were not secured to the wall and we pointed this out to the registered manager.” from the report
Pharmacy delivery reliability
minorThe home was planning to change pharmacy because medicines had not always been delivered on time. Inspectors said this had not affected people receiving their medicines at that point.
“the current pharmacy was not reliable in relation to delivering medicines on time” from the report
- 01Have the medicine trolleys now been secured to the wall?
- 02Has the change to the new pharmacy been completed, and have there been any further delays in medicine deliveries?
- 03How are current staffing levels matched to my relative's needs, especially at busy mealtimes?
- 04How would you plan activities around my relative's interests and communication needs?
- 05How will my family be involved in reviewing the care plan and decisions about care?
This was a planned inspection covering all five CQC questions, following the previous Requires Improvement rating. This explanation was written from the published report of 18 December 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of The Bill House
5 rated inspections over 5 years: the service has held its Good rating throughout.
- May 2021Goodcurrent ratingstayed GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2019Goodup from Requires improvementSafe: GoodWell-led: Good
- November 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- March 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2016GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2013
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 3 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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