Bank House Care Home

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.

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. The home is a large detached building and is situated close to Bury town centre. At the time of this inspection, 16 people were using the service.

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

Prior to the inspection we were made aware the provider had not taken timely action to renew insurance required for the service. The provider is reminded of their legal responsibility in ensuring safe and effective management of the business. At the time of the inspection relevant insurance had been arranged.

A new manager was in post at this inspection. They were aware of their legal responsibilities and acknowledged areas of improvement were required. Governance systems were being developed however further assurances were required to evidence sufficient on-going and sustained improvements had been made. Clear roles and responsibilities were to be defined between the management team, along with a better understanding of the regulations and how these can be met.

We found hygiene standards had improved. The home needs some redecoration and refurbishment. External health and safety checks had been completed however actions required had not previously been acted upon. The manager was now taking steps to address this.

Effective arrangements were now in place to ensure people received timely healthcare support when needed. The management and administration of peoples prescribed medicines had also improved. We have made a recommendation about the storage and recording of some medicines.

Opportunities to promote people’s emotional and social well-being needed improvement. At times there was little engagement with people unless supporting with care tasks. People told us there were no activities or opportunities offering stimulation and variety to their day.

People’s care records needed further development. Care plans were not sufficiently person centred and failed to capture people’s assessed needs or evidence their involvement. Records were not always held securely ensuring confidentiality was maintained.

Improvements had been made to help keep people safe. There had been a reduction in safeguarding concerns and we found people were no longer being unlawfully restricted. The manager was aware of the procedure for reporting and responding to any concerns. 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. People told us they felt safe and well cared for.

Appropriate recruitment checks were now in place prior to new staff commencing employment. Sufficient numbers of staff were seen however further recruitment was taking place to reduce need for agency staff. The manager was reviewing staffing arrangements within the home and areas of training and development. Staff told us they felt more supported and, since the appointment of the manager, things ‘are now getting done’.

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 inadequate and the service was placed in special measures (published 20 June 2022). 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 some improvements had been made. However, the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 4 and 19 May 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person centred care, safeguarding, consent, recruitment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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 Bank House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified continued breaches in relation to governance, care planning, and health and safety at this inspection and a further breach in relation to meaningful activities and opportunities. We have also made a recommendation in relation to medication.

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 will continue to monitor the service and will take further action if needed.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

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. 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, 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.

Bank House Care Home is registered to provide care for up to 43 people with either nursing or personal care needs. The home is a large detached building and is situated close to Bury town centre. Accommodation is provided on two floors, accessible by passenger lift. The home is on a main road, close to public transport. There is parking available to the side of the property. At the time of this inspection, 32 people were using the service

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

Breaches identified at our last inspection in relation to recruitment and good governance, remained outstanding.

Whilst audits and checks were in place these had not been maintained following the managers resignation. Records had not been maintained to show clear oversight of the management and service, so areas of improvement were identified and acted upon. Systems and processes to safeguard people from harm also needed improving. Effective systems to communicate and support staff, residents and their relatives needed embedding to help improve communication and service delivery.

We received mixed feedback from people and their relatives. We were told staff were kind and caring. However, people and their relatives were concerned due to the high turnover of staff and the impact this had on meeting people’s needs. The nominated individual was actively trying to recruit staff to the current vacancies.

We found medicines including controlled drugs were not always managed safely across the home. People had not always received timely intervention and support in relation to their health care needs. Care plans and assessments did not fully reflect their individual needs, wishes and preferences. There was not sufficient detail to guide staff in supporting people with specific mental and physical healthcare needs.

People had not been involved and consulted with about their care and support. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service needed to be improved. Individual and group activities and opportunities needed exploring so people were offered variety to their day.

Robust recruitment processes were not in place ensuring information received was accurate and relevant checks had been completed prior to new staff commencing employment. Sufficient numbers of staff were available with regular agency staff utilised to cover current vacancies.

Environmental and hygiene standards needed to be improved. The nominated individual was aware further domestic staff were required. Infection prevention and control procedures were not in line with guidance. Testing of staff and the wearing of masks in line with national COVID-19 guidance for care homes was not always followed.

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 3 June 2021).

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 the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to the management and administration of people’s medicines, staffing levels, standards of care and support, management and oversight of the service and visiting arrangements. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We also 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.

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 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 and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

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 will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the management and administration of medication, need for consent, safeguarding, care planning and access to health care support, health and safety, recruitment and good governance at this inspection.

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

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

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.

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.

Bank House Care Home is registered to provide care for up to 43 people with either nursing or personal care needs. The home is a large detached building and is situated close to Bury town centre. Accommodation is provided on two floors, accessible by passenger lift. The home is on a main road, close to public transport. There is parking available to the side of the property. At the time of this inspection, 38 people were using the service.

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

Since the last inspection the service has had a change in ownership in September 2020. The manager had only recently commenced employment in March 2021. They acknowledged a comprehensive governance system needed implementing and embedding to provide a thorough oversight of the service.

Robust recruitment processes had not been carried out by the previous management team. The manager acknowledged improvements were needed and was implementing new documentation to evidence a thorough process was followed.

Government guidance in relation to COVID-19 was being followed and arrangements had been made to facilitate family visits. We were assured systems were in place to help manage the control and spread of infection. However, the home did not have enough cleaning staff to increase its cleaning programme further. The manager had raised this with the provider.

Risk assessments and monitoring records were in place to help guide staff as well as assist in identifying and responding to people’s changing needs.

The provider made sure all checks on premises and equipment took place at the appropriate time. A maintenance worker had been employed to carry out general repairs and maintenance checks. The provider had implemented a refurbishment plan outlining further improvements to be made to the environment over the coming year.

Suitable arrangements were in place in relation to safeguarding people from harm and the management and administration of people’s prescribed medicines.

People and their visitors gave positive feedback about their experiences. They spoke highly of the staff describing them as dedicated, caring and attentive. People and their relatives liked the recent improvements made to the home, which made it more pleasant and comfortable.

We observed good interactions between staff and people. Our discussions with staff showed they knew people well and had a strong commitment to keeping them safe and well.

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 19 November 2018)

Why we inspected

The inspection was prompted in part due to concerns received about staffing arrangements, medication management, risk management and infection control practice due to COVID-19. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 improvements. Please see the well-led section of this full report.

Enforcement

We have identified two breaches in relation to recruitment procedures and management systems evidencing clear oversight of the service at this inspection.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bank House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Bank House Care Home is registered to provide care for up to 43 people with either nursing or personal care needs. The home is a large detached building and is situated close to Bury town centre. Accommodation is provided on two floors, accessible by two passenger lifts. The home is on a main road, close to public transport. There is parking area to the side of the property. At the time of this inspection, 40 people were using the service.

Our last comprehensive inspection took place in May 2017 and we found that Bank House Care Home was not meeting all the regulatory requirements, which are the fundamental standards. We found two breaches of the regulations relating to staff training and support and record keeping. The staff training record showed that staff had not received all the basic training they needed to support people safely and effectively. We also saw that records were not always fully maintained in relation to full employment histories of staff on recruitment files, staff meetings, complaints and activities. At this inspection we found that improvements had been made.

At the time of the inspection the home 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.

The registered manager was also the registered provider. At the time of this inspection the deputy manager was also in the process of becoming a second registered manager for the home. This process was completed by the end of this inspection. We were told that the registered provider/manager would take responsibility for the administrative running of the home and the registered manager the care people received. The home was also supported by a registered nurse with considerable management experience.

Overall, we found that staff training and supervision and record keeping had improved. The registered provider/manager and new registered manager for care need to ensure that improvements are maintained and sustained.

During our visit we found that although window restrictors were in place they did not meet current guidelines. The registered provider/manager undertook an immediate review of all the windows of the home and informed us 27 would be replaced. We also found that a number of bedroom doors did not have locks on them. This was to be addressed through the new review process with each individual person and appropriate advocate and the outcome recorded.

Staff understood their reporting responsibilities in relation to any abuse and poor practice by colleagues. They were confident that the registered/provider manager would take action to deal with any issues they raised.

Adequate recruitment checks for staff were in place and we saw that there were sufficient numbers of staff available to support people.

Risk assessments were in place, which gave guidance to staff about how to support people and mitigate any risks.

We found that medicines were appropriately managed and the home was clean and tidy throughout. No malodours were detected.

People generally spoke positively about the food they were offered and the chefs. We saw that people were offered plenty of fluids throughout the day.

People had access to healthcare professionals as needed.

The registered provider/manager continues to make ongoing improvements to the environment and facilities.

There was a relaxed and friendly atmosphere at the home. We saw good interactions between staff and people. People and their relatives spoke positively about the care they received from the staff team.

People who used the service were nicely dressed and their hair appeared well kept. People had their belongings with them on small tables set in front of them, for example, handbags, newspapers, books and sweets. People’s rooms were personalised to their individual tastes.

People had care records in place that gave information about how they were to be supported by staff and their personal preferences.

Activities were available for people to join in if they wanted to.

There was a complaints procedure on display. The procedure included information about other organisation they could contact if they were not satisfied with the outcome of their complaint.

No concerns were raised with us by the local authority quality assurance and safeguarding teams or clinical commissioning group (CCG).

Our last comprehensive inspection took place on 5 and 7 April 2016 and we found that Bank House Care Home was not meeting all the regulatory requirements, which are the fundamental standards, in relation to the management of medicines, consent, care records, complaints and ensuring that effective systems were in place to monitor and assess the quality of the home.

We asked the provider to send us an action plan to tell us what action they were going to take to make the required improvements. We received an action plan from the service. We returned to the service on 1 November 2016 to check that improvements had been made and found that all the outstanding requirements had been met.

Bank House Care Home is registered to provide care for up to 43 people with either nursing or personal care needs. The home is a large detached building and is situated close to Bury town centre. Accommodation is provided on two floors, accessible by two passenger lifts. The home is on a main road, close to public transport. There is parking area to the side of the property. At the time of this inspection, 31 people were using the service.

We found two breaches of the regulations relating to staff training and support and record keeping. The staff training record showed that staff had not received all the basic training they needed to support people safely and effectively. We also saw that records were not always fully maintained in relation to full employment histories of staff on recruitment files, complaints and activities.

You can see what action we have asked the provider to take at the back of this report.

Staff understood their reporting responsibilities in relation to any abuse and poor practice by colleagues. They were confident that the registered/provider manager would take action to deal with any issues they raised.

The required recruitment checks for staff were in place and we saw that there were sufficient numbers of staff available to support people.

Risk assessments were in place, which gave guidance to staff about how to support people and mitigate any risks.

We found that medicines were appropriately managed and the home was clean and tidy throughout. No malodours were detected.

Records we saw showed that where appropriate mental capacity assessments and deprivation of liberty safeguards authorisations were in place. We saw records that showed that people had given their consent to treatment as appropriate.

Although records showed that not all staff had received the basic training they needed to support people effectively, we also noted that the provider was committed to training in leadership and management for senior staff. Staff had also recently completed the Six Steps end of life care programme

People spoke positively about the food they were offered and the chef. We saw that no-one was kept waiting for their meal at the lunchtime we observed and food was warm when served. We saw that people were offered plenty of fluids throughout the day.

On-going improvements had been made to the environment with decorating and new carpets fitted to the hall landing and stairs and improvements to bathrooms and wet rooms.

We received positive feedback from people who use the service and relatives and friends that we spoke with. There was a relaxed and friendly atmosphere at the home. We saw good interactions between staff and people, as well as friendship groups. There was a lot of laughter.

People who used the service were nicely dressed and their hair appeared well kept. People had their belongings with them on small tables set in front of them, for example, handbags, newspapers, books and sweets. People’s rooms were personalised to their individual tastes.

People had care records in place that gave information about how they were to be supported by staff and their personal preferences.

We found that the number of activities available to people had improved though staff thought further improvements could be made. Two activities organisers had been employed since our last inspection but neither had stayed in post. However, during our inspection we noted that the home had worked with a local primary school to recognised dementia awareness week. This gave people who used the service an opportunity to participate in the local community.

There was a complaints procedure on display. The procedure included information about other organisation they could contact if they were not satisfied with the outcome of their complaint. A record of complaints was kept. However, the complaints records were kept in a hardback book rather than individually, which means they did not meet data protection guidance.

People told us that the provider who was also the registered manager continued to make many improvements to the home.

We saw there were a number of audits in place to help monitor risk and quality at the home.

Consideration was still being given to expanding the computerised administration system to the care plan system to support the management team.

The service was aware that their annual quality assurance surveys were due to be sent out to people who used the service, relatives and staff.

We asked the provider to send us an action plan to tell us what action they were going to take to make the required improvements. We received an action plan from the service.

This inspection was undertaken to check that the provider had made improvements. We found that this was the case and the requirements had been met.

Bank House Care Home is registered to care for up to 43 people with either nursing or social care needs. The home is a large detached building and is situated close to Bury town centre. Accommodation is provided on two floors, accessible by a passenger life. The home is on a main road, close to public transport. There is a parking area to the side of the property. At the time of this inspection 39 people were using the service.

We found improvements had been made to the medicines management of ‘as required’ medicines and also the use of thickeners and prescribed creams.

Records we saw showed that mental capacity assessments had been undertaken by staff and where appropriate deprivation of liberty safeguards authorisations were in place Care records showed that a number of areas for consent to care and treatment had been agreed.

We saw that improvements had been made to the complaints systems and concerns raised by people were now recorded to show what action had been undertaken to resolved the issue. The complaints procedure had been updated and included external organisations that people could go to if they were not satisfied with how their complaint had been handled.

We saw there were a number of audits in place to help monitor risk and quality at the home. However, these would benefit from being developed further to ensure that the information could be retrieved efficiently to give a clear overview of the service. Consideration was being given to expanding the computerised administration system to the care plan system to support the management team.

A number of quality assurance surveys had been sent out to people who used the service, relatives and staff and staff and some responses had been received.

We found that the number of activities available to people had improved and a second activities organiser was due to start work at the home. This would further increase activities available to people to help promote their health and mental wellbeing.

Bank House Care Home is registered to care for up to 43 people with either nursing or social care needs. The home is a large detached building and is situated close to Bury Town Centre. Accommodation is provided on two floors, accessible by a passenger lift. The home is on a main road, close to public transport. There is a parking area to the side of the property or on road parking. At the time of the inspection there were 36 people living at the home.

The service is managed on a day to day basis by the 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.’

We identified five breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Records did not clearly demonstrate if a person had the capacity to consent to their care and support. They also did not show that people had been appropriately assessed as lacking capacity to demonstrate that decisions had been made in the person’s best interest. This meant people’s rights were not respected or protected.

People were at risk of not receiving the care and support they wanted and needed as staff did not always have clear and accurate information to guide them in the safe delivery of care. One visitor felt some staff did not fully understand the needs of their relative.

We found the overall system in place for managing oral medicines was safe. However clear and accurate records were not maintained to demonstrate people were receiving their prescribed creams and thickeners safely and effectively.

Whilst systems were being developed to monitor the quality of the service, these needed expanding upon and embedding to ensure that checks were robust enough to identify any areas of improvement and evidence these had been acted upon.

An effective system of reporting people’s complaints and concerns was needed to help demonstrate issues were taken seriously and people were confident they were listened to.

Although our observations during the inspection showed there were enough staff available to meet people’s needs, some people told us this was not always the case. We have made a recommendation that the provider considers a formal process for identifying and deploying appropriately staffing levels to meet people’s needs.

We have made a recommendation that the provider explores the opportunities provided so that people are offered meaningful activities to help maintain and improve the quality of their life.

People and their visitors were complimentary about the staff and the care and support offered to their family member. Staff were seen to be polite and respectful towards people, offering assistance when needed.

Opportunities for staff training and development were provided. Staff spoken with confirmed they had completed some training and felt supported by the manager.

We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

We saw people were supported to access health care professionals, such as GP’s, community nurses and dieticians so their current and changing health needs were met.

People were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. We saw that food stocks were good and people were able to choose what they wanted for their meals.

Relevant information and checks were completed when recruiting new staff. This helps to protect people who use the service by ensuring that the people they employ are fit to do their job.

Staff had access to procedures to guide them and had received training on what action to take if they suspected abuse.

A programme of redecoration and refurbishment was in place to enhance the standard of accommodation and facilities provided for people. Hygiene standards were maintained to help minimise the risks of cross infection and checks were made to the premises and servicing of equipment. Suitable arrangements were in place with regards to fire safety so that people were kept safe.

Information in respect of people’s care was held securely ensuring confidentiality was maintained.