Archived: Bancroft Gardens Residential Home

Bancroft Gardens Residential Home is a residential care home providing accommodation and personal care to up to 16 people. At the time of our inspection there were 15 people using the service. Some of these people were living with dementia. The care home is situated in the centre of Stratford-Upon-Avon, overlooking the river.

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

Risk’s related to people’s health were not always identified, assessed or managed. Some people had recently lost weight. Records did not always evidence timely action had been taken to mitigate the risk of further weight loss.

Environmental risks were not always managed safely. There was an increased risk of falls from heights as bedrooms on the second floor either did not have a window restrictor or had a window restrictor that did not meet Health and Safety Executive standards. People could access the flat rooftop on the second floor as the key had been left in the lock. The security of the building was also compromised.

Fire risks were not always managed safely. An external agency had identified significant fire safety risks prior to our inspection. No action had been taken to reduce the identified risks.

Medicines were not always managed safely. Medicines were left unattended in the communal dining room on both days of our inspection and some medicines were not administered in line with best practice. Some people were prescribed medicines on an ‘as required’ to treat a short term or intermittent medical condition such as pain or anxiety. Some of these medicines were being administered by staff daily as a regular dose without an appropriate rationale.

There were enough staff to meet the providers assessed safe staffing numbers. However, the provider had experienced difficulties recruiting staff and as a result, staffing numbers were maintained by using temporary staff supplied through an agency. Relatives expressed concerns about the numbers of staff on shift. Required pre-employment checks had not always been completed. For example, one person was working without a valid Disclosure and Barring Service (DBS) check.

Some people did not receive care in a timely way because they were unable to summon assistance when care was needed. At various points throughout our inspection, people were calling out to receive care because they had been left without their call bell.

The quality of care provided to people at Bancroft Gardens Residential Home was inconsistent and we received mixed views from people and relatives. Some shared good experiences, whilst others did not. Whilst we saw some caring interactions between staff and people, staff had limited time to spend with people to enhance their well-being or to ensure effective communication. Some people commented staff did not always treat them with respect. People did not wish to elaborate on why they felt this way.

Basic assessments were in place to assess people’s mental capacity. However, these assessments were not decision specific and did not evidence how people had been supported and empowered to make specific decisions. People were not always supported to have maximum choice and control of their lives and staff did not always support people in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Infection control procedures were not always effective. Staff did not consistently follow current guidance when using personal protective equipment. There were limited risk management strategies to prevent infections entering the home. The home was clean, but there was no sluice facility available for disposal of clinical or bodily fluid waste. Bed rail covers were split and damaged which meant they could not be cleaned effectively. Some relatives told us there were often unpleasant odours when they visited.

The provider had not maintained effective oversight to ensure people received high quality care in a safe environment. We found widespread concerns in areas such as environmental risk management, risks to people’s health, medicines management, infection control, recruitment, mental capacity, accident and incident management and nutrition. Relatives recognised the commitment of the registered manager, but some did not feel the home continued to be well managed. Some relatives felt emotional responses from the registered manager prevented them from raising concerns.

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 7 July 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staffing, risk management and governance. 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.

We have found evidence that the provider needs to make improvement. The overall rating for the service is now inadequate based on the findings at this inspection.

You can see what action we have asked the provider to take at the end 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 have identified breaches in relation to safe care and treatment, the premises, nutrition and governance at this inspection.

We met with the provider and the local authority following our inspection. The provider confirmed their intention to voluntarily close Bancroft Gardens Residential Home and cancel their registration. We will continue to monitor this closure and will take further action if needed.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety prior to the home closure. We will work alongside the provider and local authority to monitor progress of the home closure.

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.

Bancroft Gardens Residential Home is a three storey residential home which provides care to older people including people who are living with dementia. Bancroft Gardens is registered to provide care for 16 people. At the time of our inspection visit there were 12 people living at the home. The home has a front door that leads into a small reception area with a lift. Residential care and support is only provided in the communal lounge areas and bedrooms that are located on the first and second floors. The majority of this living space is located above a retail food establishment.

People in care homes receive accommodation and nursing and/or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was 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.

At our last inspection we rated the service Good overall, with Safe being rated as requires improvement because we were not confident risks were managed safely. At this inspection we found the service remained overall Good, however ‘in Safe’ we continued to find evidence that had potential to place people at unnecessary risk. Where risks associated with people's health and wellbeing had been identified, there were plans to manage those risks. However, staff had not always followed the provider's processes and procedures to ensure safety checks within the home were implemented consistently. Some risks for particular health conditions were not included within care plans which had potential for staff not to provide consistent support.

Risks for fire safety and fire evacuation were not consistently followed by staff and we were concerned by the challenges presented by the design and layout of the building. Following this inspection, we wrote to the provider asking them to tell us how they would address our immediate concerns, and we also worked closely with the Fire Authority. The provider sent us their response and action plan and the Fire Authority visited the home on 5 June 2018. The provider has agreed to take improvement actions without delay which should minimise risks to people, in the event of a fire emergency.

People and relatives were very pleased and complimentary of the quality of care provided at the home. People felt safe living with other people in the home and they were supported by a consistent and caring staff team. There were sufficient staff to meet people's needs and staff had time to spend with people, to get to know them and what hobbies and interests they enjoyed.

Staff were available at the times people needed them and there were enough staff to respond to people’s needs and requests for assistance. Staff received training so that people's care and support needs were met by staff who knew how to support them. Staff understood their responsibility to safeguard people from harm and report any concerns they had to the management team.

People's changing needs were responded to promptly by staff and other healthcare professionals were contacted when needed. People were treated with respect by staff who addressed them by their preferred names and who supported them in line with their personal preferences and wishes. End of life care was sensitively discussed and people’s wishes were recorded so staff knew how to support people in line with their wishes.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported best practice.

People's nutritional needs were met and most of the people told us they enjoyed the food. Where people had specific dietary needs, such as soft and pureed foods, these needs were met.

Staff knew and understood how to limit the risk of cross infection and followed safe infection control practices.

The provider continued to be responsive to people's needs and people were occupied and stimulated with a variety of activities and events. Staff continually sought information from relatives and friends so they could get to know people better and relatives were involved, included and updated whenever changes were identified.

The registered manager promoted a homely atmosphere within the service. People and relatives said, everyone got on well and it was like a family.

Further information is in the detailed findings below.

Bancroft Gardens provides care and accommodation for up to 16 older people. There were 14 people living at the home at the time of our inspection.

A registered manager was 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. The registered manager was on annual leave at the time of our inspection visit so our visit was supported by the deputy manager.

People, relatives and staff all spoke positively and enthusiastically about the caring and welcoming atmosphere in the home. Staff were committed to providing a relaxed and friendly environment where people and their relatives felt valued and respected. People were treated as individuals and were encouraged to make choices about their care. People’s relationships with their relatives were respected and staff supported people to maintain this important attachment.

Staff were available at the times people needed them and had received training so that people's care and support needs were met. Staff understood their responsibility to safeguard people from harm and report any concerns they had to the management team. Where risks associated with people's health and wellbeing had been identified, there were plans to manage those risks. However, staff had not always followed the provider's processes and procedures to ensure safety checks within the home were implemented consistently.

People were involved in decisions about their care and told us they received support in the ways they preferred. Relatives told us they were informed about their family member’s health and involved in ensuring their care needs were met. Staff had information about people’s backgrounds to support them in providing person centred care and having meaningful conversations with people about things that were important to them. People were encouraged to engage in hobbies and interests they were interested in.

People received a nutritious diet, had a choice of food, and were encouraged to have enough to drink. People were referred to external healthcare professionals to ensure their health and wellbeing was maintained. People received their medicines as prescribed and staff responded quickly if they requested pain relief.

Care staff understood the principles of the Mental Capacity Act (MCA) and gained people's consent before they provided personal care.

There were processes to monitor the quality and safety of the service provided and to understand the experiences of people who lived at the home. This was through regular communication with people, relatives and staff, observations of care delivery and a series of checks and audits.

During our visit we saw people enjoyed a variety of activities. Some people were supported by staff to play board games. Some people watched television. One person went out to the local shops. We observed people having their lunch in the dining room and in the lounge. We saw that people were appropriately supported by staff and enjoyed their meal.

We saw that people's care was planned according to their needs. We found that staff understood people's needs and followed people's care plans when they supported them.

We found that people or their relatives had agreed to the care and treatment they received.

We looked at the cleanliness of the home and found that everywhere was clean. Staff we spoke with explained what steps they took to minimise the risk of infection within the home.

We found that there was a procedure in place for recording and resolving any complaints about the service.

One person who lived at the home told us, 'It's lovely here, everyone's friendly.'

A relative we spoke with told us, 'I am very happy with the care, I am welcome anytime.' Another relative told us the home was, 'Friendly, homely and has home cooked food.'

We saw people's needs had been assessed, risks identified and personalised plans of care developed for each person. There was evidence of support by healthcare professionals to ensure people's ongoing healthcare needs were met. We have asked that the provider may like to note that we did not see reference to the people's mental capacity status in their care plans or the frequency of review of their mental capacity status should it be needed.

We saw systems in place allowing people using the service and their relatives to communicate their experiences of the home and the care provided. We saw positive feedback had been given about the staff and the care people had received through these surveys.