CQC report explained · a residential care home
What the CQC found at The Boltons
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm. Medicines management had improved, staff levels were sufficient, and risk assessments were in place, although inspectors were only somewhat assured about preventing visitors from spreading infections.
- Effective?
- Good
- People's physical, emotional and social needs were assessed, and staff had suitable skills and training. Inspectors noted that emotional and psychological wellbeing was not routinely recorded, and people were not asked about their preferred breakfast during the visit.
- Caring?
- Good
- People and relatives described the care as kind and supportive. Staff respected privacy, dignity and people's choices, and encouraged people to remain as independent as possible.
- Responsive?
- Good
- Care plans were personalised and staff responded to changes in people's health and communication needs. The home provided activities and contact with families during lockdowns and had a satisfactory complaints process.
- Well-led?
- Good
- The management team had improved audits, notifications and oversight of the service. The culture was positive, but inspectors recommended reviewing the duty of candour process because written outcomes had not always been sent to the relevant person.
What inspectors found, May 2021
The Boltons was rated Good; inspectors found kind, safe care and improvements since the previous inspection, with some records and infection control checks needing attention.
This was an unannounced inspection on 7 May 2021. One inspector and an Expert by Experience visited the home. They spoke with five people, 12 relatives and staff, observed communal areas, and checked care records, medicines, staff files and management records.
Inspectors rated the home Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. They found people were protected from abuse, had enough staff, received their medicines safely, and had care that reflected their needs and preferences.
Staff were described as kind and caring. People were supported to keep their independence and relationships, including during pandemic restrictions. The home also worked with health and social care professionals and had improved its quality checks.
The previous rating was Requires Improvement, published in January 2020, with three breaches. Inspectors found enough improvement had been made and the home was no longer in breach. They still identified some improvements needed, including recording emotional wellbeing, checking meal arrangements and reviewing the duty of candour process.
Safer medicines
Medicines management had improved since the previous inspection. Records, staff competency checks and reviews of incidents helped reduce the risk of errors.
“People received their medicines safely and in the right way. Time-sensitive medicines were given at the correct intervals.” from the report
Kind and respectful care
People and relatives spoke positively about staff. Inspectors observed staff listening to people, respecting their choices and protecting their privacy.
“We observed conversations and interactions between staff and people. They were relaxed and casual, staff spoke appropriately with people and listened to what they had to say.” from the report
Personalised support
Care plans reflected people's health and social needs. Staff knew how people communicated and supported their preferences, routines and independence.
“There were a satisfactory range of care plans, individually tailored to a person's health and social needs.” from the report
Support during lockdowns
The home worked to reduce social isolation during the pandemic. Staff provided activities, one-to-one contact and phone or video contact with important people.
“The service responded proactively during the pandemic. Care workers led various daily activities during the lockdowns.” from the report
Improved management oversight
The home had improved its audits and action plans since the previous inspection. It also made the required notifications to CQC.
“The management team continued to implement a quality assurance system which included different audits, so they could assess and monitor the service delivered.” from the report
Emotional wellbeing records
needs fixingDaily records did not routinely include people's emotional and psychological wellbeing. Managers accepted this and said they would address it with care staff.
“We noted that emotional and psychological welfare were not routinely recorded.” from the report
Choice at mealtimes
needs fixingPeople were not asked about their preferred breakfast during the inspection, and drinks were not offered until the end of the meal. Managers said they would carry out unannounced checks.
“We noted people were not asked about their preferred breakfast on the day of our site visit.” from the report
Visitors and infection control
needs fixingInspectors were only somewhat assured that visitors were protected from catching and spreading infections. The provider was signposted to resources to improve its approach.
“We were somewhat assured that the provider was preventing visitors from catching and spreading infections.” from the report
Duty of candour records
minorThe home had not always sent written outcomes to the relevant person after notifiable safety incidents. It provided further evidence after the inspection, and inspectors were satisfied that action had been taken.
“However, the management team had not always sent outcomes in writing to the 'relevant person'.” from the report
- 01How do you now record and review my relative's emotional and psychological wellbeing?
- 02How do you make sure residents are asked about their preferred breakfast and receive drinks during meals?
- 03What changes have you made to protect visitors from catching or spreading infections?
- 04If something goes wrong, how will you explain the outcome in writing to my relative or the appropriate person?
- 05How will you make sure my relative's care plan and risk assessments are kept up to date?
This was a planned, unannounced inspection covering all five key questions, including infection prevention and control; the report also checked progress against the previous Requires Improvement rating. This explanation was written from the published report of 20 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, January 2020
Rated Requires Improvement; inspectors found kind and effective care, but medicines and management checks were not always safe or reliable.
This was an unannounced inspection on 2 and 3 December 2019. Inspectors spoke with people living in the home, relatives, staff and a visiting professional. They observed care, toured the building and checked care, medicines, staffing and management records.
People generally felt safe and relatives said their family members were safe. Staff were kind, trained and knew people well. Food, activities, healthcare support and involvement in care were also viewed positively.
However, medicines were not always managed safely. Some instructions for medicines given when needed were incomplete. Records did not always show that less restrictive options had been tried before medicines were given secretly. The home also did not always tell CQC about serious incidents promptly.
The overall rating was Requires Improvement. Safe and Well-led were rated Requires Improvement, while Effective, Caring and Responsive were rated Good. The provider was required to send an action plan, and CQC said it would monitor progress and return to inspect.
Kind and respectful care
People, relatives and professionals described staff as caring, kind and respectful. Inspectors saw staff seeking consent and protecting people's dignity and privacy.
“People and relatives felt the staff were kind and caring, and the service had a calm atmosphere.” from the report
Trained and supported staff
Staff had up-to-date mandatory training, regular supervision and an induction before working alone. Staff said they felt supported and worked well as a team.
“Staff training records confirmed staff had up to date training to meet people's needs and ensure their safety.” from the report
Good health and daily support
People received support from healthcare professionals when needed. They could choose their food and where to eat, and inspectors observed respectful mealtime support.
“People had access to health and social care professionals and attended appointments when required.” from the report
Improved environment and infection control
The new provider had improved premises safety, cleaning and infection control. Fire, equipment and other safety checks were in place.
“The new provider had taken steps to improve infection control practices in the service.” from the report
More activities and family contact
People were encouraged to join activities and maintain relationships with relatives. Inspectors noted more activity involvement than at the previous inspection.
“We observed people were encouraged to get involved in various activities a lot more than at the last inspection.” from the report
Medicine safety
seriousInstructions for some medicines given when needed were not detailed enough. The home could not show that covert medicines were necessary or regularly reviewed, and one time-sensitive medicine had conflicting administration times.
“The registered person did not ensure the systems were in place or robust enough to demonstrate safe management of medicine.” from the report
Important incidents not reported promptly
seriousThe manager did not always tell CQC about serious injuries, a police incident or allegations of abuse within a reasonable time. CQC said this meant it could not check whether appropriate action had been taken at the time.
“The registered person failed to notify the Commission of notifiable events, 'without delay'.” from the report
Quality checks missed problems
seriousThe home's audits did not identify the medicine and notification concerns. This delayed action to correct them.
“The provider's quality assurance processes were not always effective.” from the report
Some care plans lacked detail
minorMost care plans were person-centred, but some did not give enough specific information about a person's condition or how staff should support them. Some end-of-life plans also needed more detail.
“Some information could be more specific and individual to the person.” from the report
Recruitment records needed clarification
minorSome previous employment information was incomplete or unclear, including why staff had left earlier health or social care jobs. The provider supplied further information after the inspection.
“We found some discrepancies with previous employment information.” from the report
- 01What changes have been made to the instructions and records for medicines given when needed?
- 02How do you now check that covert medicines are necessary, used as a last resort and regularly reviewed?
- 03How do you make sure time-sensitive medicines are given at the correct time and that records agree with prescriptions?
- 04How do you ensure serious injuries, safeguarding concerns and other reportable incidents are notified to CQC without delay?
- 05What new quality checks are in place to make sure medicine and reporting problems are identified promptly?
This was an unannounced inspection covering all five key questions, including the premises and care, and was the first inspection under the new legal entity. This explanation was written from the published report of 31 January 2020 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 Boltons
4 rated inspections over 5 years: the service has held its Good rating throughout.
- May 2021Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2020Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2018Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- April 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2019
Registered with the Care Quality Commission on 2 August 2019.
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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