All inspections: Bank House Care Home - Care Quality Commission

We visited Bank House Care home to follow up on concerns identified at previous inspections on 24 and 25 October 2013, 9 April 2014 and 11 June 2014. We had concerns about the infection prevention processes, the quality assurance processes, how staff were supported and the planning of care to meet people's needs. During this inspection we also looked at how the provider managed medication for people. This was because we had received concerns that this was not being done appropriately.

On the day of our inspection there were 19 people living at Bank House Care Home. The inspection team who carried out the inspection consisted of two adult social care inspectors and a pharmacy inspector. During the inspection the team worked together to answer key questions, is the service safe, effective, caring, responsive and well led.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We saw the provider had not improved the level of cleanliness or infection control processes in the home since our last inspection. Issues identified at our last visit on 11 June 2014 and in a local authority infection control visit 24 June 2014 were still present at this visit. For example, we identified there were issues with lime scale build up in sinks, toilets and commode pans. We saw there was not adequate hand washing materials in a sluice room. Some of the bedrooms we visited had an unpleasant odour.

We found that medication was not kept, administered or recorded safely. We saw medication administration record (MAR) charts did not accurately record the medication people were taking. For example, we saw records without the strength of the medication or dosage recorded. We found MAR charts which showed medication as being administered, however we saw the medication was still in the packaging. We found that medication prescribed to be taken as required was recorded on the MAR chart and had been administered once a day. We found that there was no audit system in place to monitor the receipt and disposal of medication. Medication that was no longer required was still available in the medication trolley.

Is the service effective?

The provider has not ensured that staff were adequately supported. We saw since our previous visits 10 out of the 13 members of staff had received an appraisal. We found there was a supervision schedule for all staff to receive supervision on a two monthly basis. However, records showed us that supervisions had not been held as planned.

Is the service caring

During our inspection we observed there was a calm atmosphere in the home.

The provider had completed a survey of people who lived at the service to gather their views on the quality of the service they received. Ten replies had been received and the provider had analysed them to identify concerns. However they had not completed an action plan to address any of the concerns raised by people.

Is the service responsive?

We saw people had risk assessments in place to ensure risks to health, safety and welfare were minimised. However, we saw risk assessments had not been reviewed in a timely manner. This meant changes to people's care needs may not have been taken into account.

We saw that the provider was in the process of changing care plans to a new format and had stopped reviewing the old care plans in July 2014, However, we saw all the old style care plans were still in use. This meant people's care plans had not been reviewed for two months and may not have reflected their current level of need. We saw one person admitted on 8 July, did not have a care plan or risk assessments in place.

Is the service well-led?

The provider did not have an effective quality assurance system in place. They had not identified all the issues which needed action that we found during our inspection. We found they had not taken notice of out inspection reports which identified issues or the local authority infection control team.

Where the provider had identified issues they had not completed action plans to rectify issues. Cleanliness audits identified the same issues were found in August 2014 that had been identified in July 2014.

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.

This inspection took place on 13 April 2015. This was an unannounced inspection.

The last inspection took place 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 17 people living at the home.

At the last inspection on 3 September 2014 we found that the provider was not meeting the standards of care we expect in relation to ensuring people’s care was planned and delivered to meet their individual needs, maintaining appropriate standards of cleanliness and hygiene and did not have appropriate arrangements for the management of medicines. We also found that 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. At our inspection on the 13 April 2015 we found the provider had not made improvements in the areas we had identified.

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.

Staffing levels were not adequate to ensure people’s needs were met in a timely fashion. There were not always enough staff on shift to provide care for people or to maintain clean and hygienic conditions in the home.

In addition, staff had not received training in how to support people and did not receive adequate support from the provider to improve the standard of care they gave to people. Staff had not received adequate training in order to be able to understand people’s needs and how care could be delivered to be more responsive to people’s needs. In particular staff were unable to tell us how they would ensure people were protected from harm as they did not fully understand the types of harm people may be exposed to. Staff did not receive adequate support from the provider to identify areas in their practice where they would benefit from further training.

While staff were polite and respectful to people, they had not always taken the time to get to know people and how they liked their care delivered. In addition, people were not supported to make choices about their individual care needs and care plans did not record people’s communication needs so that they could consulted over their care. No aids to communication were available.

Care was not tailored to meet people’s individual needs and people’s care plans did not include information on how to keep people safe from avoidable harm. Care plans were basic and did not fully record people’s needs. Risk assessments did not identify all the risks people were exposed to and were lacking in detail of the care needed to mitigate the risk. Care was not reviewed after accidents to identify if people’s care needs had changed and more support was needed. Care and support provided by staff was task rather than person centred and did not take account of people’s preferences. We were concerned that people did not have access to meaningful activities either individually or as a group.

The provider did not have effective systems in place to manage medicines. We found that not all medicines could be accounted for and we found widespread 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.

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 and not ensured people’s human rights were protected. Care plans did not record if people were able to make decisions for themselves. For people unable to make decisions for themselves there was no recording if best interest meetings were needed or if a Power of Attorney existed.

People were supported to have adequate hot and cold drinks. Where people needed help to eat this was offered appropriately, however, where people could be more independent this was not always supported by offering appropriate food.

The standard of cleanliness and hygiene did not reduce the risk of infection. The home was not maintained to adequate levels of cleanliness and infection control. The policies in place did not support staff to follow appropriate procedures to reduce the risk of infection. In addition, the provider did not identify infection control risks and therefore audits to improve the quality of infection control were inadequate. Furthermore, processes in place to monitor the cleanliness of the home did not identify on-going issues.

The quality of the decoration in the home was of a low standard and did not support people’s well-being. The provider had not made any improvements to the environment since our last visit. Wall paper was coming of the walls in places and skirting boards and windowsills were cracked. In addition, furniture used was old and had not been maintained to a useable standard, with handles missing.

People living at the home and staff were not activity involved in running the service and no staff or residents’ meetings had taken place since our last inspection. While at our last inspection the provider had asked people to completed a quality assurance survey, at our inspection on 13 April 2015 we saw they had made not improvements to the service in areas where people had identified the service was not meeting their needs.

Systems to monitor the quality of service provided had not identified shortfalls in care.

There was no effective system in place for monitoring the quality of the service provided to people. The provider had undertaken a course in monitoring quality in February 2015 however, they had failed to implement any of their learning in the home.

When we visited Bank House Care Home in 9 April 2014 we identified a number of concerns. We found that infection control processes in the home did not reduce the risk of people getting an infection. We spoke with three members of staff and a visitor to the home. We also found that the home was not well lead and that audits did not identify issues which needed resolving.

We re-visited the service on 11 June 2014 to see what improvements they had made. We spoke with three members of staff and a visitor to the home. The focus of the inspection was to answer two key questions; is the service safe and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Following our last inspection the provider had reviewed and updated their infection control policy, it now covered the required areas and included correct information. However the provider still needed to complete a decontamination plan and an infection outbreak plan.

The provider had improved the standard of cleanliness of the home. We found bedrooms were cleaner and high level areas such as the lamp shades had been dusted.

However, we also saw more improvements were needed. For example, we found one bed where there was a pool of yellow liquid between the air mattress and the foam mattress. We saw some furniture used in the home did not support good infection control. We found a trolley with clean linen on it was stored in the sluice room, which increased the risk of infections being spread to the clean linen.

Is the service well-led?

The provider had a system in place to monitor the quality of service people received. However, it was not effective as not all of the issues we identified at our inspection had been identified by the provider's system. For example, we identified rooms which were in need of decoration which were not included on the provider's improvement plan. We found risks to people's health and safety which had not been identified by the provider's environmental audit. For example, we found two bedrooms had nails sticking out of the wall which people could hurt themselves on. We found issues with the general presentation and appearance of the home had not been identified. For example, we found several rooms where the curtains were not hung properly and one room that did not have a lamp shade.

The provider had not arranged for the annual gas safety check to be completed. The last check had been completed in January 2013 and meant the check was six months out of date at the time of our inspection. This was a serious shortfall and put people at unnecessary risk. We had highlighted the gas safety check had needed completing at our previous visit but the provider had taken no action to address this.

The provider had sent out a questionnaire to people living at the home and their relatives to gain feedback about the quality of the service provided. However, they had not dated the questionnaire or set a date for when they wanted it returned. In a month they had only had two completed questionnaires returned. This meant the provider's systems for gathering people's views about the service were not effective.

There were 18 people living at Bank House Care Home on the day of our visit. We spoke with four people who lived at the home and two relatives who visited the home during our inspection. We also spoke with four staff members during our visit and one staff member by telephone after we had completed the visit. We looked at three care plans and other records about the care people received. We spent time observing care being given by staff.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found-

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act (2005) MCA and Deprivation of Liberty Safeguards (DoLS) although no applications had needed to be submitted.The MCA states that every adult has the right to make his or her own decisions and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom.

There were no effective systems in place to ensure the provider and staff learnt from events such as accidents. This increased the risk of harm to people and failed to ensure that lessons were learnt from mistakes. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from accidents the affect people's safety.

The service was not clean or hygienic. We found several rooms had an unpleasant odour; we saw equipment provided to keep people safe in bed was not adequately cleaned. Commodes were not cleaned effectively. We saw rooms were dirty and records showed cleaning was not being completed regularly. This put people at risk of harm. We have told the provider they must meet the requirements of the law in relation to the cleanliness and infection control processes in the home.

One person told us, 'They are all good attendants. If you want anything you ask and they do it for you. They are brilliant.' Another person told us, 'I get on well with the care staff.' We asked the person if there was enough staff around to meet people's needs. They said, 'Yes, sometimes two come to get me up and sometimes only one comes.' We checked with members of the care staff and the person only required the support of one person to get them up. This meant there were enough care staff to meet people's needs.

Is the service effective?

People's care needs had been assessed and care plans were in place. However we found that care reviews did not always identify changes in people needs and care plans were not updated with any new care needed. We saw people were not always involved when they care plan was reviewed.

We saw the provider had a programme of training for the year to ensure staff received appropriate training. This enabled them to provide effective care for people. However, staff were not supported to raise concerns about the care they provided. There was no appraisal system and staff told us the supervision system did not allow them to raise concerns. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting staff with appraisals and supervision.

Is the service caring?

People were supported by staff who were kind and attentive. We spent time observing care and could see there was a good relationship between staff and people living at the home.

People told us they were happy with the care they received. One person told us, 'I like living here and would not want to be anywhere else. The staff are good to me and I like the food and the care the staff give.' The person also told us, 'They have religious services here every Thursday which I always attend and really enjoy.' Another person said, 'I've been here two years, I wouldn't be anywhere else.'

Is the service responsive?

We saw when care workers raised concerns about people's health needs the provider contacted appropriate health care professionals. On the day of our visit two people had infections. Care staff had identified this and contacted the person's GP for advice.

People told us they knew how to make a complaint if they were not happy with the service they received. One person said, 'I've not complained but I would talk to the XXXX [the provider].' Another person told us, 'XXXX [the provider] comes and asks if we are satisfied. She is quiet but will listen to you.' Both people told us they had never had to raise a complaint.

Is the service well-led?

The service had a quality assurance system. However, not all of the issues we identified at our inspection had been identified by the provider's system. Records showed that not all the issues the provider had identified had been addressed. The system does not ensure that staff were able to provide feedback to the provider, so their knowledge and experience was not being properly taken into account.

We had identified concerns about the effectiveness of the provider's quality assurance systems at our previous visit, however the provider had not addressed all the concerns we had raised and they were not able to show us they had plans in place to identify those concerns.

The provider had not taken any steps to identify what the people living at the home thought about the service they received. Information provided to people about the service they could expect to receive was not kept up to date.

We have told the provider they must meet the requirements of the law in relation to the quality assurances systems in the home.

On the day we visited there were 18 people living at the service. We spoke with three people who lived at the home, and telephoned a number of care workers. We also spoke with the local authority who place people in the home and saw their latest report.

We brought an inspection forwards when we received concerns the home was cold. When we visited on 24 October 2013 a person connected with the provider denyed us access to the premises to complete an inspection. We did check the home was an acceptable temperature for the people living there. We visited again on 25 October when we completed our inspection.

People we spoke with told us they were happy with the care they received. One person told us, 'I can't say anything is wrong at all. We get plenty of food, more than what we want. I very often have a change from what is on the menu it's never a problem.' Another person told us, 'We are happy, we talk about old times.'

The temperature of the home was not maintained at a comfortable level for the people who lived there.

Infection control processes did not fully protect people against the risk of infection.

There were not enough care workers to ensure people's needs were met in the way they preferred. Staff did not receive training and support to ensure people received safe care.

The provider did not have effective systems in place to monitor the quality of the service provided. Risks to people's health and safety were not identified or managed.

At our last inspection on 9 October 2012 we found the provider did not have a policy in place for the protection of vulnerable adults from abuse. In addition, we observed a poor standard of cleanliness in all areas of the home. We saw dirty sinks and carpets that had not been vacuumed. Carpets in the rooms were badly stained and worn.

At this visit we saw the provider now had a safeguarding and whistle blowing policy in place.

We were told a new member of staff had been recruited as a cleaner. We saw the home had been thoroughly cleaned. Carpets were freshly cleaned; sinks and bathrooms were free from stains. In addition, we saw mirrors and windows were clean.

At our last inspection members of staff told us they had not received training about subjects such as health and safety, fire safety, safeguarding adults, moving and handling. On this inspection visit we were able to review a training plan for 2013 which confirmed all mandatory training such as infection control, medicines administration, and safeguarding had been planned for all staff.

At this inspection the registered manager provided action plans which demonstrated a system that monitors quality and risk, and evaluated outcomes. We saw quality audits took place at three month intervals.

We saw that staff were kind and caring. People who lived at the home told us, 'I am very happy here, I feel safe' and 'I couldn't wish for anywhere better.'

As part of our inspection we spoke with a number of staff members. They told us they liked working at the home.

We were unable to find records of any staff training taking place for over a year. Regular staff meetings did not take place.

Although some vacant rooms had been redecorated, we looked in seven people's rooms and found the standard of d'cor was poor and furniture was worn and dirty. We found that carpets were heavily stained and worn.

We looked in the communal bathrooms and found they were dirty and in need of refurbishment. The registered manager told us they would be refurbished.

We were unable to locate the safeguarding policy and members of staff appeared unsure as to the process of reporting abuse.

Archived: Bank House Care Home

All Inspections

3 September 2014

During an inspection looking at part of the service

21 October 2015

During a routine inspection

13 April 2015

During a routine inspection

11 June 2014

During an inspection looking at part of the service

9 April 2014

During a routine inspection

24, 25 October and 5 November 2013

During a routine inspection

24 January 2013

During an inspection looking at part of the service

9 October 2012

During a routine inspection