Bank Close House

Bank Close House is a residential care home providing personal care for to up to 27 people. The service provides support to people over 65 with dementia or physical needs. At the time of our inspection there were 14 people using the service.

The accommodation is set in two buildings connected by a glass walkway. There are two communal seating areas as well as two dining areas, several bathrooms and toilets throughout the building. Bedrooms are spaced out on the upper floor of the main building or in the extended building to the rear of the property.

People’s experience of using this service and what we found

The provider had made improvements however these had not yet been embedded. There was currently no registered manager. The provider had ensured a daily presence of a quality manager from the provider’s other locations and business arrangements.

We saw that audits had been completed; however, in some instances they had not identified areas of improvements or checks to ensure a consistent approach. However, in other areas they had been used to make direct changes and monitor improvements.

Staff we spoke with felt their views were not always listened to, especially in relation to staffing and deployment. The provider had recognised this and was in the process of improving communication.

People’s views had been considered for meal choices, however there was a lack of daily activity options for people to engage in. This had been impacted upon by the reallocation of staffing but was being addressed with a consistent number of staff being recruited.

Risk assessments had been completed and risk mitigations were in place. However, some information had not been detailed in all areas of the care plans, but the impact was minimal due to detailed handovers.

The home followed the required guidance in relation to COVID-19, however some areas of the home had not been maintained around equipment and people’s bedrooms. These were addressed immediately during the inspection.

There was enough staff to support people’s needs, however the staff had not always received the required training for their role or the details of completed training had not been recorded.

Medicines were managed safely. However, the stocks for boxed medicines had not been regulated as part of the audits, to cross reference with administration.

Relatives commented positively about the care, their relative received, reflecting kind and caring staff.

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 5 August 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. We found some improvements had been made however, the changes had not always been embedded.

No areas of concern were identified in the other key questions. We therefore we did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same, Requires Improvement. This is based on the findings at this inspection.

Why we inspected

The inspection was prompted in part due to concerns received about infection control and management support. A decision was made for us to inspect and examine those risks.

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.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bank Close House on our website at www.cqc.org.uk.

Follow up

We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Bank Close House is a residential care home providing personal and nursing care to 17 people aged 65 and over at the time of the inspection. The service can support up to 27 people.

The accommodation is set in two buildings connected by a glass walkway. There are two communal seating areas as well as two dining areas, several bathrooms and toilets throughout the building and bedrooms are spaced on the upper floor of the main building or in the extended building to the rear of the property.

People’s experience of using this service and what we found

Improvements had been made to audits and actions being completed. However, this was not fully embedded to provide us with the assurances it was sustainable.

Relatives felt there was limited communication, and this had impacted on them receiving the correct information in a timely way in relation to COVID19 and any events which had occurred in relation to their relative.

Safeguarding was not embedded, and concerns were raised as to incidents being investigated or reported.

Staff recruitment was safe, however, there were concerns in relation to the assessment of people’s needs in relation to the dependency tool. We have made a recommendation about a review of the dependency tool and staffing levels

Staff were kind, however felt restricted by the lack of support from management and communication. Risks to people were now assessed and actions taken to mitigate the impact. Medication was managed safely, and lessons had been learnt.

Infection prevention and control was now well managed, however consistent management of the environment could be improved to maintain standards.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection was Inadequate (published 1 December 2020)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. We found improvements had been made and the provider was no longer in breach of Regulations 12 and 18. However, not enough improvement had been made or sustained in the well led section of the report and this remains in breach of Regulation 17.

No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

This service has been in Special Measures since 4 November 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bank Close House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to Regulation 17 Good Governance, this in relation to the sustained improvements in relation to management and oversight of the home.

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.

About the service

Bank Close House is a residential care home providing personal care to 17 people at the time of the inspection, some of whom were living with dementia. The service can support up to 27 people across two floors in two buildings connected by a glass walkway. The accommodation also contains two communal seating areas as well as two dining areas. There are several bathrooms and toilets throughout the building and bedrooms are spaced on the upper floor of the main building.

People’s experience of using this service and what we found

The provider’s audits now reflected areas identified for improvement from external professional audits, we saw some of these had been completed, however other areas were still outstanding and further assurance and a consistent approach to driving improvements was required.

The laundry area of the home had been improved since our previous inspection, however there was no allocated staff to ensure this task was completed in a timely manner.

The staff had recently received training on current guidance for wearing personal protective equipment (PPE). The level of staffing now reflected the dependency tool with the support of regular agency staff.

People had not always been consulted on the choice for their environment and other areas had not always been identified that improvements were required.

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 Inadequate (published xxxxxx).

Why we inspected

We undertook this targeted inspection to review aspects of the providers good governance in relation to the Well led domain. This inspection was to check concerns identified at the last inspection had been resolved in line with the action plan the provider had produced. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on enforcement or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

This inspection was not rated.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Bank close House on our website at www.cqc.org.uk.

Follow up

We will request an updated action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bank Close House is a residential care home providing personal care to 20 people at the time of the inspection, some of whom were living with dementia. The service can support up to 27 people across two floors in buildings connected by a glass walkway. The accommodation also contains two communal seating areas as well as two dining areas. There are several bathrooms and toilets throughout the building and bedrooms are spaced on the upper floor of the main building.

People’s experience of using this service and what we found

People living in the service were not safe and were placed at risk of harm. The service was inspected during the COVID-19 pandemic. Risk management, poor infection control processes and reduced staffing levels put people at increased risk. Records relating to people’s care did not always contain sufficient information or guidance to enable staff to provide the safe care and support people required .

The registered manager was not present on our first inspection, however they were present for the following two inspection days. Leadership and governance arrangements were not fully effective, impacting on staff morale and team work. Systems and processes were in place to monitor the quality and safety of the service, but these had not identified the issues highlighted at this inspection. At the second and third inspection we saw some improvements had been made following involvement of external professionals advice and the providers action plan.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 10 April 2019).

Why we inspected

The inspection was prompted in part, due to concerns we received about infection control practices and staffing at the home. As a result, we undertook a review of Infection Prevention and Control (IPC) practices to assess whether the service was compliant with IPC measures. This took place on 04 November and was unannounced.

During the targeted inspection a number of concerns were found around infection control and governance and this prompted a further unannounced focused inspection which took place on 09 November 2020 and 17 November 2020. The overall rating for the service has now changed from good to inadequate.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In relation to infection control, risk management, staffing, leadership and oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

About the service:

Bank Close is a care home that provides personal care for up to 27 people. The accommodation is across two sites joined by a glass walkway. The main building contains communal spaces which include two lounges, a dining area and a conservatory. There are several bathrooms and toilets throughout the two buildings. Bedrooms are in the upstairs of the main building and in the adjoining building. At the time of the inspection there were 23 people using the service.

People’s experience of using this service:

At our last inspection we identified some areas which required improvement in relation to audits. At this inspection we saw some improvements had been made, however we found that these did not always offer the necessary information. This could have an impact on the care people received following an accident or incident as trends had not been identified. We found an error in the medicines, this had not been identified by the medicine audit. Audits were not consistently completed which raised concerns that the provider did not always have a robust system of quality monitoring.

People were supported by staff who know how to report any concerns and protect people from harm. There were enough staff to support people’s needs and staff had been recruited safely. Staff had received training for their roles and this was ongoing to keep up to date with any changing guidance. Risks to people had been assessed and where appropriate, measures put in place to reduce the risks. The environment had been made safe and there were measures to reduce the risks of infections. People’s medicine was managed safely and when events or incidents had occurred lessons were learnt and improvements made.

There was a homely feel and areas of the home had been refurbished. People were able to be part of the decision making in respect of the colour of the carpets in the home and what food they wished to be included on the menu. Dietary needs had been catered for and refreshments were available with snacks throughout the day. Health care was an integral part of the support provided and we saw that referrals had been made to a range of professionals. Any guidance they provided had been included and followed. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were treated with kindness and compassion. Their needs were respected and they were able to choose how they spent their day. People’s information was stored in accordance with confidentiality laws. Some people continued to access their spiritual needs from visiting churches to the home.

The care plans covered all aspects of people’s care. The details included individual’s care needs, any risks and their preferences. Staff felt supported and the provider had introduced new systems which supported the care plans to be more accessible and detailed. Information was available in different formats to support people’s understanding. The environment had been refurbished and people were able to personalise their own space. There was an opportunity to engage in interests and hobbies.

There was a registered manager who understood the requirements of their registration. The complaints policy was in place and people felt confident in raising any concerns. We had received notifications about events and incidents so we could monitor the action the provider had taken.

The registered manager had engaged in local partnerships to ensure people received a good experience with their health and well-being.

Rating at last inspection: Requires Improvement (Published January 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection which was ‘Requires Improvement.’ At this inspection we found the required improvements had been made and we have rated the home overall as ‘Good’.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected this home on 4 December 2017. At our last inspection in June 2015 we found the provider was meeting all the regulations and we rated the home overall Good. However we rated the section welled as Requires Improvement as the provider had not always been pro-active in determining service improvements for people’s care. At this inspection we saw that these improvements had not been made and further improvements have been identified.

Bank Close Care Home is a care home. People in care homes receive accommodation and 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. Bank Close accommodates 27 people, at the time of our inspection there were 25 people using the service.

The service had a registered manager in post. 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 were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not always support this practice. We have made a recommendation about decision specific assessments to support people when they lack capacity.

There were not always sufficient staff to support people’s needs, this meant people often waited for their personal needs to be met. Risk assessments had not been completed to reflect individuals safety and considerations ion how to reduce the risks associated with the environment or people’s needs.

The environment did not always reflect measures to reduce infections. However staff used their protective equipment effectively. Some people were not supported to be independent when they received their meals. The rooms used for the dinning and lounge areas were crowded and did not support people being able to use these rooms freely or to have relatives join them. There was limited signage around the home to support people’s to make choices or provide them to orientation.

People’s care plans were not up to date and did not reflect their identified needs. People’s aspirations and aspects which affected them as an individual had not been included in the planned care. People’s choices in response to end of life care had not been completed and their wishes documented to so that their wishes could be followed.

Audits had been completed, however they had not always been used to consider trends and to drive improvements or reduce people’s risks. There was a mixed response to the support people, relatives and staff received from the manager and provider. Complaints had been responded to, but the actions taken had not been followed up to ensure the complaint had been resolved.

Staff had developed caring, respectful relationships with the people they supported. People’s privacy was observed and consideration was shown to people to support their dignity. Relatives and friends were welcomed to visit freely.

Staff had been recruited safely and they knew how to protect people from the risk of abuse. The staff had received training for their role and felt the training provided them with knowledge and skills. Referrals had been made to health professionals and there was a proactive approach to ensuring people’s health needs had been met. Medicine was stored and administered safely, to meet peoples prescribed needs.

People’s feedback had been sought and this was planned to be repeated. There had been some partnership working with local organisations, which included schools, churches and health professionals. People received some stimulation to support them to remain active, however it was identified some people would like more opportunities to participate in activities.

We saw that the previous rating was displayed in the reception of the home as required and was displayed on their website. The manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken

This is the first time the service has been rated Requires Improvement overall and the second consecutive time they have been rated requires improvement in Well Led.

We found 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 the report.

People and staff we spoke with told us they were pleased with improvements made at the home. One person said, “It’s a different spirit altogether. There’s more to do now and the staff are happier.” Staff told us, “The atmosphere is a lot better” and, “It’s better organised now and things are getting done.”

We found that people’s dignity and privacy were usually respected and their needs were usually met. There was a more structured approach to providing activities for people to take part in, although we did not see any organised activities during our visit.

Staff we spoke with knew what they should look out for and report regarding adult abuse. However, more than half of the staff had not received training about vulnerable adults or had not received this training in the last year. This meant that staff may not know how to identify, report and respond appropriately to suspected or actual abuse.

There were new systems in place to assess the risk of and to prevent and control the spread of infection. We saw that the systems were being operated effectively to ensure people lived in a clean and hygienic environment.

We found there were usually enough staff with the right skills to meet the needs of people using the service.

When we inspected Bank Close House in August 2013, we found concerns regarding the cleanliness, hygiene and maintenance of the home. We also had concerns about how records were kept and found that important events had not been reported to CQC as required. We served four warning notices on 4 September 2013 requiring the provider to be compliant with the relevant regulations by 2 October 2013.

At this inspection we found that appropriate action had been taken to ensure certain events were reported to CQC as required. However, the provider was still not meeting the essential standards of cleanliness and hygiene, maintenance of the premises, and keeping records.

We found that there were no effective systems in place to prevent and control the spread of infection. We found numerous areas of the home and items of equipment where appropriate standards of cleanliness and hygiene were not maintained.

We found that some improvements had been made to the premises. However, the provider had not put appropriate measures in place to ensure the adequate maintenance of the home.

We found that improvements had been made to people’s care records. However, no changes had been made to improve the storage and organisation of archived records.

Our action included serving four warning notices on the provider, requiring them to be compliant with the relevant regulations by 2 October 2013. We visited on 8 and 14 October to check if the provider was compliant with the relevant regulations. We found that the provider had achieved compliance with one of the regulations but was still not meeting the other three. We met with the provider on 25 October 2013 and they assured us that they were now compliant with the relevant regulations.

At this inspection in November 2013 we found that the provider had made some improvements and introduced new systems regarding cleanliness and infection control. They were not fully compliant with the regulation, but the measures they had taken had reduced the impact and risks for people using the service.

We found that the provider had made improvements to the premises and had achieved compliance with the regulation about the premises. They had introduced systems to monitor the safety and condition of the home.

We found that the provider had achieved compliance with the regulation about records. They had taken appropriate action to ensure that records were stored securely and could be located promptly when needed.

People we spoke with told us they were treated with respect. One person said, “The staff are always polite with me and everyone else here.” We saw that staff were courteous and friendly to people in the home. However, we found that people’s views were not always respected or acted on.

We found that care was not always planned and delivered to meet people’s needs, including their social and psychological needs. People told us they were bored and were offered little stimulation. One person said, “It’s just the TV or sleeping, really.”

We found a lack of systems to ensure the cleanliness of the home and to prevent and control infection. We saw areas and items in the home that were not adequately clean.

The home and grounds were not sufficiently well maintained to ensure that people lived in an environment that promoted their wellbeing.

People told us there were not always enough staff to meet their needs. They said, “They’re a lovely bunch, but we want more of them!” We found that the planned staffing levels were regularly not achieved.

Records were not always accurate or up to date. Archived records were not kept securely and could not be located easily when required.

We found that the systems in place for identifying, assessing and managing risks relating to the health, welfare and safety of people using the service were more effective than at our previous inspection. Audits had been carried out and action had been taken where risks or issues were identified.

We found that there had been no incidents since our last inspection that required reporting to the Care Quality Commission. However, we found that staff were generally more aware of the requirement to report incidents.

We found that improvements had been made in care planning and review, and in ensuring guidance was available for staff about dealing with emergencies.

People using the service had an accessible home and there were appropriate measures in relation to the security of the building. The maintenance of the home was not always adequate to ensure safe and comfortable surroundings for people living there.

Sufficient and appropriate equipment was provided to promote the independence and comfort of people using the service. However, systems in place and staff awareness were not fully effective to ensure that people were protected from the risks of unsafe equipment.

There were sufficient staff available to meet the needs of people using the service. However, the arrangements for covering staff absences were not fully robust or effective.

We found that little progress had been made since our last inspection in developing effective systems to monitor the quality of the service provided and to assess and manage the risks to people using the service.

We found that records containing personal information were not always accurate or securely kept.

People told us, “I’m comfortable here”, and, “They look after us”. We found that people's needs were assessed. However, we found that the planning and delivery of care did not always meet the person’s individual needs and or ensure the welfare of the person. For example, we found gaps and lack of detail in people's care plans and we found that care plans and risk assessments were not always kept up to date.

Most people told us they enjoyed the meals. We found that people were provided with suitable food and drink and appropriate support from staff to meet their needs. However, we found that people were not always given appropriate choices at mealtimes to ensure their preferences were met.

We saw that people were asked for their views about the service provided. However, we found that the system for assessing and monitoring the quality of the service provided did not include regularly asking for the views of others, such as staff and the relatives of people using the service.