Archived: Bank House Care Home

Updated 27 November 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 21 October 2015 and was unannounced. The inspection team consisted of two inspectors and a medicines management inspector.

Before the inspection we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. However, the provider did not return a PIR and we took this into account when we made the judgements in this report. We also spoke to the local authority infection control team and contracting team to gather their views on the service provided.

As part of the inspection we spent time observing how care and support was provided for people who lived at the service. This was because some people had difficulties with their memory and were unable to tell us about their experiences of living at the home. In order to do this we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experiences of people who could not speak with us.

As part of the inspection we spoke with the provider, a senior care worker, two care workers, a housekeeper and seven people who lived at the service. We looked at the care plans for four people living at the home. We also looked at medicine administration records, staff training and supervision records and management paperwork related to the running of the home.

Updated 27 November 2015

This inspection took place on 21 October 2015. This was an unannounced inspection.

The last inspection took place on 13 April 2015 and there was also an inspection on 3 September 2014.

The home provides residential care for up to 30 people. The care provided is mainly for older people, some of whom experience memory loss and have needs associated with conditions such as dementia. At the time of our inspection there were 12 people living at the home.

At our previous inspections we found the provider was failing to ensure that people’s care was planned and delivered to meet their individual needs. They had failed to maintain appropriate standards of cleanliness and hygiene and did not have appropriate arrangements for the management of medicines. The provider did not ensure staff were appropriately supported with training and supervision and did not have effective systems to asses and monitor the quality of service provided to people. The provider was not aware of their responsibilities under the Mental Capacity Act 2005 and the environment had not been maintained to an acceptable standard.

At our inspection on 21 October 2015 we found the provider had made improvements in the cleanliness of the home and the number of staff available to provide care to people. In addition we saw the induction provided to new staff helped them provide safe care for people. However, we saw little improvement in the other areas of concern we identified at our previous inspections.

There was a registered manager in place at this home who was also the provider of the service. 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 had not complied with laws which protect people when they were unable to make decisions for themselves. The provider had not fully understood their responsibilities under the Mental Capacity Act 2005 and consequently had not ensured people’s human rights were protected. Care plans did not record if people were able to make decisions for themselves. For people who were unable to make decisions for themselves there was no recording if best interest meetings were needed or if a Power of Attorney existed. No applications for Deprivation of Liberty Safeguards authorisations had been made.

The provider had not effectively addressed our concerns in relation to storing, recording and administering medicines. Some medicines could not be accounted for and there were numerous inaccuracies between records and medicines prescribed and available to administer. Therefore, we could not be assured people’s medicines were being administered as intended by their prescribers.

Risks to people had been identified in their care plans. However, care was not always delivered in line with the care plans. Therefore, people were not fully protected from the risks of receiving unsafe care. In addition, the provider had not ensured accidents were reviewed to see if changes in care were needed to keep people safe.

New staff had received an induction into the home which supported them in their roles. However, training for existing staff had not supported them to have the skills needed to care for people and they did not understand the importance of some information in the care plan. Staff were unable to demonstrate competencies in key areas. A supervision and appraisal programme had been developed and was in the process of being implemented.

People’s malnutrition risk was not always calculated accurately and we could not be sure people received fortified supplements appropriately. In addition guidance from healthcare professionals regarding people’s ability to eat and drink safely was not available to support staff. Systems in place to record people’s food and fluid intake were not effective and staff were unable to tell us when they would raise concerns around nutrition and dehydration.

There has been some improvements to the environment with dementia friendly signage in place and minor improvements to the fixtures, the quality of linen had improved. However, people were still living in rooms where the standard of decoration and furniture was not of an acceptable quality and did not support people’s well-being.

Staff were individually caring to people and ensured people’s dignity was maintained. Staff were aware of how people communicated their care needs. However, the provider and staff did not understand how people living with a dementia communicated their emotional needs.

The provider had taken action in some areas to improve the standard of care people received and had started to gather the views of people living at the home and their relatives. However, in other areas the provider had failed to take suitable action to make care safer for people. In addition, audit systems to identify shortfalls in care were not properly implemented and so areas for improvement were not being routinely identified.

The home was clean and tidy and the staff worked to reduce the risk of infection. However, the provider had not engaged with the local authority to help identify and implement best practice in this area. New domestic staff ensured care staff could concentrate on supporting to people. In addition. new care staff meant that there were always enough care workers to care for people. Staff knew how to raise concerns if they were worried about that a person was at risk of harm. People had been support to access healthcare from their doctors and community nurses.