Bankhouse Care Home

Bankhouse Care Home is registered to provide nursing and residential care for up to 52 people who may be living with dementia in one adapted building. At the time of the inspection 31 people were receiving care and support at the home.

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

People were cared for by staff who were caring and knew people’s needs and wishes. We found some areas of the home required cleaning and clutter needed to be removed to minimise the risk and spread of infection. Risks to people from the environment were not always managed. Care documentation and management of medicines required improvement, and this was being addressed by the registered manager and management team.

People told us they felt safe, and they were supported by staff who helped them quickly if they needed this. Checks were completed to help ensure prospective staff were suitable to work with vulnerable people and staff had completed training to support their skills and knowledge. Risk assessments relating to care were carried out to help minimise the risk of avoidable harm and staff knew the help and support people needed.

One area of the home had been identified as requiring action to improve the environment. We have made a recommendation about the timescale for completion of improvements to the environment.

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.

People were referred to health professionals if this was needed and there was regular contact with external health teams to ensure people’s needs were identified and met.

Checks and audits were carried out to identify what had gone well, or if improvements were required. These did not always drive improvement. Staff told us they were supported by the registered manager and management team, and they could approach them to ask for advice or guidance. The provider identified individual achievements and staff were recognised for their contribution to people’s lives. People were consulted and asked their views on the service provided. They told us they were happy at the home and were confident any comments or complaints they made would be listened to. Staff told us they felt supported by the registered manager and management team and they were able to approach them if they needed support and guidance.

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 27/09/2019).

Why we inspected

The inspection was prompted in part due to concerns received about the management of skin integrity and wound care, personal care, call bells and staff training. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report. The provider responded to our concerns and took action to improve the service. This has minimised associated risks.

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

Enforcement and Recommendations

We have identified breaches in relation to the management of infection prevention and control, the management of environmental risk and governance. We have also made a recommendation regarding the timescale of completion for the outstanding actions in relation to improvements to the environment at one part of the home.

Please see the action we have told the provider to take at the end of this report.

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. 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.

Bankhouse Care Home is a care home providing personal and nursing care to 42 older people at the time of our inspection. The service can support up to 52 people. Accommodation is comprised of three units, including a unit for people living with dementia. There are sufficient washing and toilet facilities along with multiple shared spaces, including dining, lounge and garden areas. Bankhouse Care Home will be referred to as Bankhouse within this report.

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

Staff promoted lunch as a sociable and supportive event to enhance each person’s appetite and provide a dignified meal service. People commented they enjoyed their food and were offered a choice of meals.

The registered manager and staff had developed caring relationships with people and their relatives centred on retaining their dignity and privacy. Those we spoke with told us staff had a warm, caring and kind attitude.

The management team provided clear guidance for staff about care planning processes to ensure they were responsive to people’s needs. This included a programme of activities, which staff followed, to enhance each person’s wellbeing and sense of self-worth.

The registered manager ensured staffing levels and skill mixes were sufficient to meet people’s needs. One person said, “There is always someone to help me.” Staff commented they had good levels of training and supervision to support them in their roles.

The registered manager ensured nurses were extensively knowledgeable in the safe management of each person’s medicines. People confirmed they received their medication as prescribed.

People stated they felt safe at Bankhouse. One person told us, “I feel safe and looked after.” The registered manager had robust systems to monitor, assess and mitigate risks. They guided staff about safeguarding people against harm or abuse.

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. People said staff consistently gained their consent before supporting them.

The provider had commenced a programme of upgrades to enhance everyone’s safety and welfare at Bankhouse. The management team worked closely with other services to share and gain good practice to improve people’s welfare.

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 30 August 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

Bankhouse Care Home is a ‘care home’. People in care homes receive accommodation and nursing 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.

Bankhouse Care Home is registered to accommodate up to 52 people who have nursing needs or people living with dementia. The home comprises of two general residential and nursing units and a unit for people living with dementia. All accommodation is located on the ground and first floor. At the time of the inspection there were 40 people who lived at the home.

There are a range of communal rooms, comprising of three lounges, and two dining rooms. There is a garden area with seating for people to use during the summer months. Car parking is available at the home.

The service had a registered manager in place. 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.

Bankhouse Care Home has been inspected before but this is the first time it has been inspected since it changed legal entity. Since the last inspection Bankhouse Care home has a new registered provider and we do not refer to the locations previous inspection history.

During this inspection we found the registered provider failed to consistently ensure documentation and support met people’s nutrition and hydration needs.

This was a breach of Regulation 14 HSCA RA Regulations 2014 (Meeting nutritional and hydration needs). The registered provider had not done all that was reasonably practicable to offer guidance, encouragement and help to people to eat as appropriate.

We noted there were times when staff did not consistently have an appreciation of people’s individual needs around privacy and dignity.

This was a breach of Regulation 10 HSCA RA Regulations 2014 (Dignity and respect). People were not treated with dignity and respect at all times.

You can see what action we told the provider to take at the back of the full version of the report.

We looked at staffing at Bankhouse Care Home. We were told people were safe and deployment was structured. We received mixed feedback on staffing levels. We have made a recommendation about this.

We looked at the storage, administration and documentation around medicines. Records we looked at did not consistently guide staff on how to manage people’s ongoing health conditions. We have made a recommendation about this.

Care plans we looked at did not always contain information to guide staff in the delivery of responsive care to meet people’s needs. We have made a recommendation about this.

We saw evidence of activity events that had taken place and of scheduled events. Information around daily scheduled activities did not reflect what we saw during our inspection. We have made a recommendation about this.

We found the service did have clear lines of responsibility and accountability. The manager was supported by a deputy manager who shared the responsibility of managing the home.

We spoke with the manager about consultation with people and relatives. Care plans showed involvement from people and relatives. Senior management visited the home regularly and met with people and relatives as part of their role.

The staff had daily handover meetings to share up to date information on people. They also had formal staff meetings.

We looked at recruitment procedures to ensure people were supported by suitably qualified and experienced staff. Records we viewed had a full employment history included. Staff we spoke with confirmed they did not start in post until the management team completed relevant checks.

Relatives told us staff treated their family members as individuals and delivered personalised care that was centred on them as an individual. We saw staff took time and chatted with people as they performed moving and handling procedures in communal areas.

The registered provider had refurbished the home to ensure people living with dementia were living in an environment that promoted their safety, independence and positive wellbeing.

Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. The registered provider had reported incidents as required.

People are 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.

Staff were knowledgeable of people’s needs and we observed them helping people as directed within their care plans.

Staff delivered end of life care that promoted people’s preferred priorities of care.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. We found supplies were available for staff to use when required, such as hand gels.

There was a complaints procedure which was made available to people and visible within the home.

The management team used a variety of methods to engage with people their relatives and staff. Staff told us the management team were approachable and relatives told us the registered manager took regular walks around the home to assess the environment.

The service had procedures to monitor the quality of the service provided. Regular audits had been completed. There were systems to record safeguarding concerns, accidents and incidents and corrective action took place as required. The service carefully monitored and analysed such events to learn from them and improve the service.

The service had on display in the reception area of their premises their last CQC rating, where people could see it. This has been a legal requirement since 01 April 2015.

We carried out an unannounced focused inspection of the service on 27 September 2017. During this inspection, we looked at evidence related to the Safe and Well-led areas of the inspection process.

Bankhouse Care Home is registered to accommodate up to 52 people who have nursing needs or people living with dementia. At the time of our inspection, 39 people were living at the home. The home comprises of two general residential and nursing units and a unit for people living with dementia. All accommodation is located on the ground and first floor. There are a range of communal rooms, comprising of three lounges, and two dining rooms. There is a garden area with seating for people to use during the summer months. Car parking is available at the home.

The home had a manager who is registered with the Care Quality Commission. 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 the last inspection on 15, 18 May and 09 June 2017, we rated the service as Requires Improvement. We found medicines were managed safely. We saw people received their medicines in safe way, at the time they needed them. However, we saw some advice from a pharmacist was not documented. We also saw a cream chart was not available. We made recommendations regarding these concerns.

During this inspection, we noted staff responsible for assisting people with their medicines were trained to ensure they were competent and had the skills required. Medicines were safely kept and appropriate arrangements for storing medicines were in place. Documentation related to the administration of creams and medicines were in place.

At the last inspection, we asked people for their opinion on the staffing levels at the home. We received mixed feedback. We saw one person required support and there were no staff available. We discussed this with the registered manager who amended the rotas to include additional staff at peak times. We made a recommendation regarding the staffing provision at the home.

At this inspection, we found staffing levels were suitable with an appropriate skill mix to meet the needs of people who used the service. The organisation of staff throughout the home was planned so staff knew their role and responsibilities and which unit they would be working on.

During this inspection, we noted staff had received safeguarding training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

Care plans were in place detailing how people wished their care to be delivered. Risk assessments had been completed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided. There was written evidence that indicated staff were supporting people as identified within their risk assessments.

The provider had recruitment and selection procedures to minimise the risk of inappropriate employees working with vulnerable people. Checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff.

The management and staff were clear about their roles and responsibilities. They were committed to providing good care and support to people who lived at the home.

The registered provider had a range of quality assurance audits that were completed regularly to maintain people’s safety and welfare.

This comprehensive inspection took place on the 15, 18, May 2017 and the 09 June 2017. The first day was unannounced.

Bankhouse Care Home is registered to accommodate up to 52 people who have nursing needs or people living with dementia. The home comprises of two general residential and nursing units and a unit for people living with dementia. All accommodation is located on the ground and first floor. At the time of the inspection there were 42 people who lived at the home.

There are a range of communal rooms, comprising of three lounges, and two dining rooms. There is a garden area with seating for people to use during the summer months. Car parking is available at the home.

The home has a manager who is registered with the Care Quality Commission. 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 the focussed inspection of Bankhouse Care Home in December 2016 the service was rated as ‘requires improvement’ overall, with ‘requires improvement’ ratings in three of the key questions ‘is the service safe?’ ‘is the service responsive?’ and 'is the service well – led?’ We identified a breach of Regulation 12, (Safe care and treatment) as medicines at the home were not managed safely.

During the comprehensive inspection carried out in May and June 2017, we found medicines were managed safely. We saw people received their medicines in safe way, at the time they needed them. We saw some advice from a pharmacist was not documented. We have made a recommendation regarding this. We also saw a cream chart was not available. We have made a recommendation regarding this.

We asked people their opinion on the staffing levels at the home. We received mixed feedback. During the inspection we saw one person required support and there were no staff available. We discussed this with the registered manager who amended the rotas to include additional staff at peak times. We have made a recommendation regarding the staffing provision at the home.

We checked to see there were appropriate recruitment procedures at Bankhouse Care Home. We found staff were checked to ensure they were of suitable character before they started work at the home and references were obtained. This helped ensure only suitable staff were employed.

Staff told us they received training and supervision to enable them to fulfil their role. Staff said they enjoyed the training and further training was available if this was required. We viewed documentation which evidenced staff received supervision and training.

People we spoke with gave us mixed feedback regarding the meals provided at the home. Some people told us they considered the food could be improved. Other people told us they liked the meals provided. We discussed this with the registered manager who said they responded to feedback from people in order to improve the meals provided.

We asked people if they felt safe. People told us they did. One person said, “I feel safe here.” We saw staff supported people in a safe way. We observed one person being supported with their mobility. The person was supported in accordance with their care plan which helped ensure their safety.

During the inspection we spent time in all areas of the home. We did this to observe the interactions between people who lived at the home and the staff who supported them. We saw staff spoke gently and kindly to people and people told us they liked the staff. One person who lived at Bankhouse Care Home said, “They’re lovely. Very kind.”

We asked people their opinion on the activities provided at the home. Some people told us they were bored. We discussed this with the registered manager. They told us the activities co-ordinator employed at the home was on leave and as a result they were recruiting a temporary replacement.

We viewed care records to ascertain the care and support people received. Overall, care records contained sufficient information to inform staff how a people’s needs should be met. Records we viewed contained some evidence that people were involved in their care planning. We spoke with two people who confirmed they were consulted regarding their care needs. Feedback received from relatives was conflicting.

The service had a framework of quality assurance systems to identify if improvements were required. Staff told us they were informed if they needed to make changes to improve the service.