Bank House Care Home

Updated 29 September 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors, a medicines inspector, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Bank House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Bank House is a care home registered for nursing care; however, this is currently not being provided. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection the service did not have a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 27 June 2023 and ended on 10 July 2023. We visited the service on the 27 June 2023 and 3 July 2023.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people who used the service and the relatives of 2 people. We also spoke with 8 members of staff including the deputy manager, senior carers, care staff, kitchen staff and the activity co-ordinator.

During the inspection visit we looked at the management of people’s medicines and reviewed care plans. We also looked at areas of health and safety, staff recruitment and management systems. Additional evidence, sent to us electronically, was reviewed remotely.

Updated 29 September 2023

About the service

Bank House Care Home is a residential care home providing personal care and support for up to 43 people. The service is also registered to provide nursing care; however, this is currently not provided. At the time of this inspection, 20 people were using the service.

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

Robust governance systems had still not been implemented and embedded, to provide clear oversight of the service and help identify and drive improvements. The provider had failed to employ and retain a registered manager, establishing consistent management and leadership, which is a condition of their registration.

Serious health and safety concerns had yet to be completed ensuring the safety and protection of people living and working at Bank House Care Home. On-going work was required to improve the appearance and hygiene standards within the home.

People’s prescribed medicines were not managed and administered safely. Risks to people’s health and well-being, such as falls and risk of choking, were not effectively monitored and managed.

An electronic care planning system was in place. Whilst records provided information about peoples likes, dislikes and daily routines, other areas lacked sufficient detail or had conflicting information about people’s support needs. Accurate and complete paper records were not maintained, omitting people’s full names and dates.

Relevant legislation and guidance had not been followed where people lacked the capacity to make decisions for themselves. Records were not personalised and did not show people’s relatives or advocates had been consulted with ensuring decisions were made in the persons best interests.

An effective system was not fully in place to evidence that people were supported to eat and drink safely and advice from the speech and language therapy team was followed. Records did not assure us that fluid thickener (used for people with swallowing difficulties) was being administered as prescribed. In addition, new guidance from the speech and language therapist had not been incorporated into one person’s care plan.

Due to the concerns identified during the inspection, we could not be assured that people received a high quality, compassionate and caring service.

Records showed team meetings were poorly attended and supervisions were infrequent, providing little information regarding any discussion, review of working practice or additional learning.

Lawful authorisations to deprive people of their liberty were in place, where necessary. People told us they were able to have 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.

Appropriate recruitment checks were completed prior to new staff commencing work. Sufficient numbers of staff were available throughout the day; on-going recruitment was taking place to reduce the need for agency staff. A programme of training was available. Staff felt morale was good and they were supported by the deputy manager. People living at the home were complimentary about the staff team. They and their relatives said they would recommend the home to others.

An effective safeguarding system was not fully in place. Systems for the reporting and responding to any concerns were not always followed. Whilst complaints records were requested but not provided, we were advised that no issues had been raised since the last inspection.

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 and remained in special measures (published 19 December 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. We found sufficient improvements had not been made and the provider remained in breach of the regulations.

This service has been in Special Measures since June 2022. During this inspection the provider has not demonstrated improvements have been made. The service remains in special measures.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements.

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.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, responsive, effective, and well-led sections of this full report.

Enforcement

We have identified 5 breaches in relation to governance, care planning including capacity and consent, health and safety, complaints, safeguarding and medication.

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

The overall rating for this service is ‘Inadequate’ and the service therefore remains 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.