Archived: Bankfield Care Home

Bankfield Care Home is registered to provide care for a maximum of 37 people. The manager told us 11 people were using the service when we inspected. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection the service did not have a registered manager although a manager was due to commence three days after the inspection. The manager who was covering the service on a temporary basis told us they would be applying to register as the manager of Bankfield Care Home. 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.

Staff we spoke with understood safeguarding procedures and were confident people were safe. There were enough staff during the day but staffing arrangements on a night meant sometimes people had to wait for care. The provider took action and increased staffing on a night soon after the inspection. We noted some environmental issues around the service which could compromise people’s safety; some of these issues were being addressed by the provider, such as a broken passenger lift. Other issues such as a lack of personal protective equipment for staff had not been picked up by the provider.

People felt well cared for and told us staff were caring. People enjoyed the meals and received support to make sure their health needs were met. Systems for making sure people received support to make decisions about their care where appropriate and the care planning process had improved. The range of activities had been limited because of restricted access to communal and outdoor facilities.

Staff received training which helped them understand how to do their job well but there was a lack of support and supervision.

The provider had continued to develop the service but some of their systems and processes were not effective. For example, we found some people did not have access to suitable dining and bathing or showering facilities. These issues had not been picked up by the provider even though people had not accessed these facilities since the lift had broken at the beginning of January 2018. The provider was responsive when we brought the matters to their attention.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014: Staff did not receive appropriate support and supervision: The provider’s systems and processes did not enable them to assess, monitor and improve the service.

The service had a registered manager. 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 inspection in December 2015 we rated the service 'Requires Improvement' and found one breach of regulation. At last inspection in December 2016 we rated the service 'Requires Improvement' and found improvements had not been made and the service was still in breach of the same regulation plus an additional two regulations. We issued a requirement notice because the provider did not always assess and mitigate risks to people's health and safety. We also took enforcement action and served two warning notices because care was not always appropriate and did not always meet people's individual needs, and systems and processes were not operated effectively and an accurate record of each person’s care was not always maintained. At this inspection we have rated the service 'Requires Improvement'. We found the provider had improved some aspects of the service although this was not sufficient to meet regulation. They were still in breach of the same three regulations plus an additional regulation.

We found medicines were not managed consistently or safely and risks to people were not always well managed. Environmental risks were generally well managed however, there were areas of the home that needed repairing and decorating. There was no formal plan to address the environmental issues.

People told us they felt safe living at Bankfield Care Home and staff we spoke with told us they would report any concerns to the registered manager. They had received training around how to safeguard people. Staffing arrangement s were appropriate and recruitment processes ensured checks were carried out before staff started working at the service.

Staff felt well supported in their role. Staff received training and supervision although records showed some staff had only received one supervision session in the last six months and some training was out of date. The registered manager was taking action to make sure training and supervision was kept up to date. Staff we spoke with told us they would recommend the home as a place to work and would be happy for their relative to live at the home.

People were complimentary about the staff who cared for them, and during the inspection we observed some very caring and kind interactions. However, we also observed times when people’s privacy and dignity was not respected.

The quality of care planning and care recording varied. Some care plans were detailed and provided clear guidance around how care should be delivered; others did not cover people’s needs or were not followed. The registered manager had identified that further development was required around how they met the requirements of the Mental Capacity Act 2005 and our inspection findings confirmed this.

People were offered varied meals and had plenty to eat and drink. They received appropriate support to make sure their health needs were met. People told us there was not very much to do and not enough opportunity to go out. The registered manager acknowledged that activity opportunities for people needed to improve and was confident this would be addressed once a new activity worker started at the end of June 2017.

The provider had quality management systems in place but we found these were not always operated effectively. Sometimes areas for development were identified but not actioned. A number of issues we identified at the inspection had not been picked up through the provider’s quality management systems.

Systems were in place to respond to concerns and complaints.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. These related to safe care and treatment, consenting to care, person centred care and governance. We will report on the action taken when it is complete.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

At the last inspection in December 2015 we rated the provider ‘Requires Improvement’ and found one breach of regulation. At this inspection we found significant improvements had not been made and the service was still in breach of this regulation plus an additional two regulations.

A registered manager was not 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.’ A new manager had recently been appointed who intended to begin the registered manager application process in the near future.

People and relatives we spoke with said they felt safe in the home and they thought the home provided good quality care.

Most people had updated risk assessments in place demonstrating risks to their health and safety had been assessed. However we found in some instances risk assessments were not up-to-date and saw examples of care plans not being followed by staff.

Overall medicines were safely managed, although some improvements were needed to ensure medicines were consistently managed in an appropriate way.

We concluded there were sufficient staff deployed to ensure people received prompt and safe care. Safe recruitment procedures were in place to help ensure staff were of suitable character to work with vulnerable people.

The premises was well maintained and safely managed with adequate communal space for people to spend time.

People and relatives spoke positively about the food provided by the home. People’s nutritional needs were assessed and action was taken when people lost weight. However kitchen staff were not always fully aware of people’s individual needs and preferences.

The service had made Deprivation of Liberty Safeguards (DoLS) applications for those it suspected were being deprived of their liberty. However care documentation was not sufficiently robust to evidence the service was fully acting within the legal framework of the Mental Capacity Act 2005 (MCA)

People had access to a range of health professionals and when appropriate, the service referred people to these professionals in a timely way.

Staff received a range of training to help ensure they had the skills to care for people effectively. Most training was up-to-date with a plan in place to address any expired training.

People and relatives told us staff treated them with kindness and compassion. Our observations of care and support confirmed this. People’s views were listened to and their choices respected by staff.

People and relatives spoke positively about the overall standard of care provided. We saw some good person centred care plans in place, although some care plans were not up-to-date and did not reflect people’s current needs. We also saw some instances where staff were not following the required plan of care, demonstrating people’s care needs were not always met.

People and relatives provided mixed feedback about the activities on offer at the home with some people stating they would like more to do. An activities co-ordinator had been recently employed and we saw evidence they were in the process of improving the activity provision for people.

A system was in place to log, investigate and respond to complaints. People and relatives told us they felt comfortable raising complaints.

The service continued to be in breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities 2014) Regulations. This should have been prevented through the operation of robust systems to assess, monitor and improve the service. We were also concerned about the high turnover of management within the organisation.

People and staff told us that there was a positive atmosphere within the home and they felt able to raise any queries or concerns with the management team.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations. You can see what action we asked the provider to take at the back of the full version of this report.

Bankfield Care Home is registered to provide accommodation and personal care for up to 37 older people. Bedrooms are mostly ensuite and are set over two floors. There are two lounges, one split into two parts, and a dining room on the ground floor. On the day of the inspection there were 26 people living at the home.

The registered manager has been in post for several years. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 who used the service told us they felt safe. Staff had received training and understood their responsibilities in in keeping people safe.

Procedures for staff recruitment were in place and thorough checks were completed before staff started work to make sure they were safe and suitable to work in the care sector.

We recommended that the service considers the National Institute for Health and Care Excellence (NICE) Guidelines for Managing Medicines in Care Homes to improve management of medicines .

Staff told us they felt supported by the manager and we saw that staff received regular training and updates.

People and relatives we spoke with told us they liked the staff and found them caring and helpful.

There were enough staff on duty to meet people’s care needs and the manager said they kept this under continuous review.

We saw people enjoyed the activities provided at the home.

People had access to healthcare services and these were accessed in a timely way to make sure people’s health care needs were met.

Staff treated people with respect but some improvements were needed in care practice to ensure people's dignity needs were met.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS) but we recommended that the provider puts processes in place to make sure that Mental Capacity Assessments are completed thoroughly and accurately.

Care plans were in place and had been developed with a person centred approach but varied in detail and quality and there was little evidence of people being involved in the planning and review of their care.

People told us if they had any concerns or complaints they would feel able to take these up with the staff or the manager. The manager maintained an overview of any concerns or complaints.

Quality assurance systems were in place and were maintained well by the manager but action plans were not developed to inform people of the results of quality assurance surveys.

The provider did not respond to concerns made directly to them in a timely manner.

We found one breach of regulations and you can see what action we told the provider to take at the back of the full version of the report.

Referring to a care assistant, "She's lovely this girl, she loves us".

"Some staff are more caring than others".

"They are cheerful and they care about us".

"The food is ok, it's not fantastic but it's tasty"

We saw a letter, which had been published in the local paper, from some relatives of a person who had lived at the home. The letter was praising the staff at the home and included "The depth of compassion, patience and kindness is palpable"

The service has recently started to provide intermediate care. This is funded by the local CCG (Care Commissioning Group) formerly known as the Primary Care Trust and is a service for people who need some extra care and support between leaving hospital and going home. We saw that the staff at the home were working well with the staff from the CCG to make sure people got the support they needed.

We saw that staff were attentive to people's needs and that care documentation was of a good standard. Staff we spoke told us that they enjoyed working at the home and received good support from the manager.

'I like it alright.The food is lovely"

"There are plenty of drinks whenever you want them, I like tea. There seems to be enough staff"

'The staff look after us properly ' all of them do. I feel safe living here'

"It's a lovely building. Can't think of anything that would make things any better"

"It can be a bit annoying when people that are 'muddled up' keep shouting"

"We are well looked-after, the staff are caring. The food is okay and we get a choice. Everything here is as good as it could be'

"We would like to go out more"

Two people said they would like more to do, one person said "maybe just a game of Bingo on an evening"

"You couldn't wish for nicer staff"