Bank House Residential Care Home

Bank House Residential Care Home is a residential care home providing personal care to up to 33 people. The service provides support to older people and people who were living with dementia. At the time of our inspection there were 23 people using the service.

People’s experience of the service and what we found

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 did not support this practice. Deprivation of Liberty Safeguards (DoLS) were not in place for everyone who needed them.

Risks to people had not been fully identified and care plans lack information or contained conflicting information on how to keep people safe.

Medicines were not always well managed, and staff did not understand the difference between crushing a medicine to make it easier for a person to swallow and administering medicines covertly.

Audits were not always effective in identify concerns and driving improvements. Areas of the environment were in need of redecoration.

There were enough staff to meet people’s needs and they received appropriate training. Staff knew how to safeguard people. However, new staff needed their safeguarding training prioritised in their induction. People’s nutritional needs were met safely. The home was clean and tidy.

The registered manager learnt from incidents and took action to keep people safe.

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 (5 June 2018).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘All inspection reports and timeline’ link for Bank House Residential Care Home on our website at www.cqc.org.uk.

During the inspection we found there was a concern with the application of the Mental Capacity Act 2005 to protect people’s rights so we widened the scope of the inspection to include effective.

Enforcement

We have identified breaches in relation to the management of risk, the safe management of medicines, supporting people's rights under the Mental Health Act 2005 and the governance of the service.

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.

Bank House Residential 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.

Bank House Residential Care Home accommodates 30 people in one adapted building. The home is registered for provide care for older people or people living with dementia. There were 19 people living at the home on the day of our inspection.

When we inspected in June 2017 we found that the provider was not administering medicines in a safe manner and the provider was in breach of the regulations. At this inspection we found that medicines were stored and administered safely. Medicine records were accurate and allowed for the management of medicines to be audited. The provider had made the necessary improvements in the management of the medicines and was no longer in breach of the regulations.

There was a registered manager for the 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.

At the previous inspection the service was rated as requires improvement, at this inspection the provider and registered manager had made the improvements needed and the home was rated as good.

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.

Risks to people were identified and equipment and care was planned to keep people safe. People were offered a choice of food and the meal was personalised to their individual likes. Where needed appropriate equipment was in place and modified texture diets were available to people who needed them. People were supported to access drinks throughout the day.

There were enough staff to meet people’s needs and recruitment checks ensured that they were safe to work with people living at the home. Staff received training and support to ensure that the care provided reflected best practice and met people’s needs. Staff had received training in keeping people safe from abuse and were able to describe the actions they would take if they had concerns over people’s safety.

Staff were kind and caring and knew people’s background, relatives and their likes and dislikes. This supported them to provide care which was centred around people’s individual needs. Activities were provided to keep people entertained and connected with the world. People were encouraged to join in activities to increase their social interactions.

Care plans reflected people’s needs and people had been involved in planning their care. People’s end of life wishes had been recorded and partnership working with external agencies kept people pain free at the end of their lives.

People knew who the registered manager was and were happy to raise concerns with them. The audits in place were effective at monitoring the quality of care that people received and ensured that changes were made when needed. People were supported to give their views on the care they received.

The home provides residential care for up to 30 people. The care provided is for adults of all ages, some of whom experience memory loss and have needs associated with conditions such as dementia. At the time of our inspection there were 18 people living at the home.

There was a registered manager for the 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.

“We carried out an unannounced comprehensive inspection of this home on 21 December 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the safe storage and administration of medicines.

We undertook this focused inspection to check that they had followed their plan and to check if they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bank House Residential Care Home on our website at www.cqc.org.uk”

At this inspection we found the provider had not made all of the improvements needed to meet the regulations.

Medicines were not kept secure while they were being administered and some medicines were kept in a cabinet in the dining area which was not locked. Medicine details had been handwritten on the Medicine Administration Records (MAR) and no double check had been completed to ensure the information transferred was correct. There was a lack of clarity were the administration of as required (PRN) medicines should be recorded and there was a lack of guidance around the homely remedies people could take. Systems to ensure that there were medicines available for people when needed were not robust and medicines audits had not identified concerns.

The home provides residential care for up to 30 people. The care provided is for adults of all ages, some of whom experience memory loss and have needs associated with conditions such as dementia. At the time of our inspection there were 24 people living at the home.

The provider had purchased the home in April 2016. While owned by the previous provider the home was failing to provide acceptable levels of care for people or to maintain the environment to an acceptable standard. Following the purchase the provider identified an experienced manager to lead the home and improve the quality of care people needed.

There was a registered manager for the 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.

The provider was not meeting the legal requirements in relation to the management of medicines in the home. They had not ensured that medicines were stored or administered safely and that records relating to medicines were accurate or complete. You can see what action we told the provider to take at the back of the full version of the report.

Care plans contained the information needed to provide safe care for people. However, they lacked the personal information needed to support staff to provide care tailored to people’s individual needs. Risks to people’s safety had been identified and care was planned to keep people safe though there were some concerns about the night staff’s adherence to the care plans.

There were enough staff to meet people’s needs and they had received appropriate training and support. Staff knew how to keep people safe from harm and were happy to report any concerns about people’s safety to the registered manager or external organisations. Most staff were kind and caring although there were some concerns relating to the attitude of the night staff.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. The registered manager was aware that they needed to apply for DoLS for some people living at the home but had not yet submitted the application. Staff were aware of the mental capacity act and gained consent from people before providing care. Where people were unable to make decisions about their care, decisions had been made in their best interest by staff, family and healthcare professionals.

The home was clean and staff followed infection control processes to keep people safe from cross infection. Many of the bedroom and communal areas had been decorated and were bright cheerful places in which to spend time.

The provider had effective systems in place to monitor the quality of care they provided and the environment. The registered manager had created an open culture where people and staff felt they were able to approach the registered manager and raise concerns.