Bannow Retirement Home

Bannow Retirement Home is a residential care home providing personal care to 25 people at the time of the inspection. Bannow Retirement Home is registered to provide care and support for up to 26 older people. The care needs of people varied, some people were living with dementia while others required support with mobility and behaviours that challenge.

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

People and their relatives told us they were happy with the service they received. They described the care workers as kind and caring.

Systems for monitoring quality and managing risks continued to be effective. People told us they were happy with the care they received, and that staff helped them to feel safe. Risk assessments and care plans guided staff in how to provide care safely and in the way the person preferred. There were enough suitable staff employed to ensure people were safe.

Appropriate infection control procedures for the Covid-19 pandemic were in place to keep people safe. Staff had received additional training and used appropriate Personal Protective Equipment.

People, their relatives and staff told us that communication was good and that staff listened to them and involved them in their care. Staff and professionals were complimentary about the registered managers person centred approach and responsiveness to people’s changing needs. One staff member said, “(The registered manager) has good leadership skills and loves to get things done.”

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 this practice.

Rating at last inspection

The last rating for this service was Good (published 21 November 2019)

Why we inspected

The inspection was prompted in part by notification of a specific incident, following which a person using the service died. This incident was not subject to a criminal investigation. The information CQC received about the incident indicated concerns about the management of falls, medicines management and policies and procedures around seeking medical support. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. The provider had taken action to mitigate the risks and these had been effective. Please see the safe and well-led sections of this report.

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 Bannow Retirement Home on our website at www.cqc.org.uk.

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.

Bannow Retirement Home is a residential care home providing personal care to 22 people at the time of the inspection. Bannow Retirement Home is registered to provide care and support for up to 26 older people. The care needs of people varied, some people had dementia care needs that included behaviours that challenged. Other people's needs were less complex and required care and support associated with old age, mild dementia and memory loss.

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

People were happy with the care they received and felt relaxed around staff who treated them with compassion and kindness.

People felt safe while there was sufficient safe deployed to ensure that their safety was maintained. People were safe at the home and protected from the risk of abuse.

People were supported to eat and drink well and received healthcare support when they required it. People received effective support from trained staff who knew their needs well.

People were supported to have maximum choice and control of their lives and supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received a service which was responsive to their needs. Staff ensured that people were engaged and had meaningful occupation and activities.

The registered manager sought to continuously improve care for people, to change things when they went wrong, and to seek support to make these improvements. People told us the registered manager was visible in the service and took an active role in their support. People, their relatives and staff told us that the registered manager supported them. There were effective quality assurance systems in place that were used to drive service improvements.

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 Requires Improvement (published 7 November 2018).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Bannow provides care and support for up to 26 older people most of whom are living with dementia. The care needs of people varied, some people had complex dementia care needs that included behaviours that challenged. Other people's needs were less complex and required care and support associated with old age, mild dementia and memory loss. Most people were fully mobile and able to walk around the service unaided. At the time of this inspection there were 19 people living at the home.

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 in November 2017, the service was rated requires improvement. We asked the provider to take action. The provider submitted an action plan saying what they would do to meet the legal requirements in relation to the breaches we found. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. At this inspection we found that the breaches of Regulation 11 we previously found, in relation to the provider not acting in accordance with legal requirements in seeking consent, had been met.

We found that the breaches of Regulation 12 we previously found, in relation to the provider not ensuring the safety of people by assessing the risks to their health and safety, had also been met.

We found that the provider had also met the breaches we found in relation to Regulation 17 where the provider had not ensured that good governance had been maintained and that systems were not fully in place to monitor and improve the quality and safety of the service provided.

We also found that the breaches of Regulation 18 we previously found, in relation to the provider not ensuring that staff were given the appropriate support to carry out their duties, had been met. The provider had also met the second breach of Regulation 18 in relation to not previously ensuring that sufficient numbers of suitably qualified staff were deployed.

Whilst improvements had been made to people’s in-house activities, this was not consistent for everyone. Some people were not receiving the stimulation and social engagement that they needed to improve their quality of life. We identified this as an area of practice that continues to need improvement.

The provider and registered manager had made improvements to the governance and systems to monitor and improve the quality of service provided. Although the actions taken were evident and ensured that the provider was no longer in breach of the regulation, the improvements were not yet fully embedded and sustained. Therefore, this remains an area of practice that needs improvement.

We observed some good caring practices and engagement between staff and people. However, we observed some practices where staff did not always ensure people’s dignity was maintained. This is an area of practice that needs improvement.

People told us they felt safe living at the home. People were protected from abuse by staff who understood their role in keeping people safe. The safeguarding adults’ policy was up to date so staff had up to date information to refer to about how to keep people safe from abuse. Staff we spoke with understood how to keep people safe from abuse.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff were aware of their responsibilities around the Mental Capacity Act 2005.

The provider had a safe recruitment system in place. Relevant checks which had been completed before staff began working with people.

Staff were now receiving the support that they needed to enable them to be effective in their roles. Staff told us they were receiving regular supervision sessions and felt better supported by the management team.

People and their relatives were involved in developments at the service and their views were sought. People had been able to give feedback about the service through reviews of their care and through satisfaction surveys.

The provider had implemented a robust system to assess the risk of, and prevent the spread of, infections and to ensure that the premises were safe and clean.

Staff were receiving the training they needed to meet the needs of people at the service.

Risks were identified and managed effectively. Care plans provided clear guidance for staff in how to care for people safely. Assessments and care plans were holistic and identified people’s needs and preferences.

People’s medicines were managed and administered safely and in accordance with the provider’s policy.

People were supported to ensure that they had enough to eat and drink and to access the healthcare services they needed. The service was accessible and had the adaptations and equipment needed to meet the needs of people living there.

People were supported to plan for care at the end of their lives if they wanted to do so. Staff were responsive to complaints and took appropriate actions to resolve concerns raised by people or their relatives.

Incidents and accidents were recorded and monitored. Lessons were learned when things went wrong and changes were made to improve the service.

Bannow provides care and support for up to 26 older people most of who are living with dementia. The care needs of people varied, some people had complex dementia care needs that included behaviours that challenged. Other people’s needs were less complex and required care and support associated with old age, mild dementia and memory loss. Most people were fully mobile and able to walk around the home unaided. At the time of this inspection there were 23 people living at the home.

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.’

This comprehensive unannounced inspection took place on 7 and 10 November 2017. Bannow was last inspected in October 2016 and was rated Good. We brought this inspection forward to follow up on concerns raised by whistle-blowers and because there had been a high number of safeguarding referrals. ‘Whistleblowing’ is when a worker reports suspected wrongdoing at work. Officially this is called, ‘making a disclosure in the public interest.’ We originally planned to carry out a focussed inspection but during our inspection we changed from a focused to a comprehensive inspection.

In recent months we received concerns from two whistle blowers (WB). During our inspection we received concerns from a third WB and following our inspection we received further concerns from another WB. Concerns included a lack of cleanliness, poor moving and handling and poor care. We looked at some of the concerns raised and asked the provider to carry out an investigation of the remaining concerns. We found some of the concerns were substantiated and some the provider had already addressed.

We found there was a lack of consistent and strong leadership or provider oversight. We identified areas of record keeping that needed to improve to document more clearly the running of the home. For example, in relation to incident records. Improvements were needed in relation to auditing as a number of areas we identified had not been picked up as part of regular monitoring. This included auditing in relation to care planning and cleanliness. Staff morale was low, staff did not receive regular supervision and did not feel supported. There were also some shortfalls in the management of medicines prescribed on an ‘as required’ basis, in relation to monitoring of catheter care, and in consideration of risks when caring for people whose behaviour can challenge. We saw some practices did not demonstrate a caring approach was always used.’ We made a recommendation to expand the dementia friendly activities available.

Information regarding Deprivation of Liberty Safeguard (DoLS) and mental capacity were not detailed in care plans. (A DoLS is used when it is assessed as necessary to deprive a person of their liberty in their best interests and the methods used should be as least restrictive as possible).

Staff did not have all the information they needed to understand why some people had restrictions in place and this left the potential for some people to have been unnecessarily restricted.

Whilst on the first day of inspection the environment was not clean, staff morale was low and there was a tense atmosphere. There was a marked difference on our second day. The environment was clean, staff were positive and there was a calm and pleasant atmosphere. Staff spoke about it having been a difficult year but were keen and eager for change and were positive about changes that had already been planned. Management had recognised that changes were needed and a senior’s meeting had been planned with the area manager to assess how improvements could be made.

There were on-going improvements to the environment; painting in the lobby and stairways was underway. Equipment checks were consistently carried out and fire safety checks were up to date.

Appropriate checks had taken place before staff were employed to ensure they were able to work safely with people at the home.

People had enough to eat and drink and the menus were varied and well balanced. Appropriate referrals were made to health care professionals when needed and people were supported to attend health appointments.

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 this report.

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.

This comprehensive unannounced inspection took place on 06 and 10 October 2016.

Staff had a good understanding of the risks associated with supporting people. They knew what actions to take to mitigate these risks and provide a safe environment for people to live. They understood what they needed to do to protect people from the risk of abuse. Appropriate checks had taken place before staff were employed to ensure they were able to work safely with people at the home.

The registered manager and staff had completed training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They had assessed that some restrictions were required to keep people safe for example, the front door was locked, there was a sensor on the stairs and stair gates on each floor, the use of bed rails for some people and lap straps on wheelchairs. Where this was the case referrals had been made to the local authority for authorisations.

There were safe procedures for the management of medicines. People had access to healthcare professionals when they needed it. This included GP’s, dentists, community nurses, opticians and dentists.

People were asked for their permission before staff assisted them with care or support. Staff had the skills and knowledge necessary to provide people with safe and effective care. Staff received regular support from management which made them feel supported and valued. They were encouraged to develop their skills and take on additional responsibilities.

The registered manager was approachable and supportive and took an active role in the day to day running of the service. Staff were able to discuss concerns with them at any time and know they would be addressed appropriately. Staff and people spoke positively about the way the service was managed and the positive culture.

The home had recently recruited an activity coordinator. This was a new role and at the time of inspection the role was evolving. Each person’s needs and wishes were being assessed and it was hoped that this role would be an asset to people and to the home. There was a variety of activities offered and this was under continual review to ensure that people’s needs were met.

Staff were kind and caring, they had developed good relationships with people. They treated them with kindness, compassion and understanding. Staff supported people to enable them to remain as independent as possible. They communicated clearly with people in a caring and supportive manner. We received very positive feedback from relatives and visiting professionals about the care provided.

We found that the home had put in place new systems for monitoring the quality of service provision. The new systems were working well and records demonstrated that the home was continually reviewing and improving upon the service it provided.

During our visit we noted environmental issues that caused us to look more closely at that essential standard. We saw that measures had been put in place to address problems caused by a broken boiler. Due to the increased risks in relation to fire safety a referral was made to the fire service.

Most people using the service had complex needs which meant they were not able to tell us their experiences. Those who could speak to us told us that they were well cared for and that staff looked after them well. They said that the portable heaters worked well and they had not been cold. One person told us, 'I don't feel the cold. I don't put my heater on in the mornings. I put it on in the evenings if I need to.'

Those who could speak with us told us that they were looked after well. One person said 'By and large the staff are very good, I don't bother with activities, I watch others.' We spoke with a relative of one person who told us, "We can't fault the home in any way, my mum has settled in well and the home are good at keeping us informed of her progress."

We observed staff interacting positively with people and noted that staff took time to speak with people individually over the course of the afternoon. Where appropriate, specialist advice and support, was obtained.

Overall, we found that care plans clearly documented the needs of people and how they should be met.

Staff roles in relation to cleaning were clear. The home was generally clean. Although there were a number of systems in place to monitor the quality of the care and environment, records did not fully demonstrate that they were effective.

Those who could speak with us told us that they were looked after well. One person said, "The food is good and we have a choice.' Another person said 'The staff are good to us.'

We observed staff interacting positively with people. Where appropriate, specialist advice and support was obtained.

There were sufficient numbers of staff on duty and staff felt well supported. Staff were clear about what they should do if they suspected abuse. We noted shortfalls in record keeping which meant that the home was not always able to demonstrate that care was provided in line with people's assessed needs.