Archived: Bankfield

Bankfield is a residential care home providing accommodation and nursing care for to up to 47 people over the age of 65 and/or living with dementia. At the time of our inspection there were 15 people using the service.

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

Medicines continued not to be safely managed. Stocks of medicines were not always clearly recorded. As required medicines protocols lacked detail and were not person-centred. One person had missed 10 doses of a medication and had also received too much of another medicine. Some staff had made several medication errors and processes to improve the safe management of medicines were not robust.

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 (published 25 May 2023) and there were breaches of regulations.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the safe management of medicines. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

Follow up

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 ‘Inadequate’ and the service 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.

Bankfield is a residential care home providing accommodation and nursing care for to up to 47 people over the age of 65 and/or living with dementia. At the time of our inspection there were 18 people using the service.

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

People were not always supported safely. Risks were not always identified, assessed, and monitored. Safeguarding processes were not always followed. Accidents and incidents were not always recorded. Recruitment processes were not robust. Agency workers did not have robust checks and inductions recorded. Medicines were not safely managed.

Consent was not legally obtained for care and treatment. Staff did not receive training to safely use the medicines system at Bankfield. Staff were not receiving regular supervision and appraisal. Assessments had not considered people’s cultural needs. One person was left with a drink in front of them for three hours without any prompting to drink it. People had been moved into rooms with less facilities than they previously had and without consultation.

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.

Staff were kind and caring but lacked time to spend with people. There had been multiple staff changes and regular use of agency staff which meant people lacked familiarity. People told us they did not always get a bath as the lift had been broken and the bath was on the first floor. Care records confirmed, people were not accessing the bath.

Care plans lacked detailed information and were not created or reviewed with people and their relatives. No complaints had been formally received by the provider but relatives told us, they had tried to contact the directors but were not responded to. Activities were available and people spoke positively about the activities coordinator. However, we were told, the activities coordinator was often used to fill care shifts.

The provider lacked oversight of the improvements needed to be made in the home. Audits completed had not highlighted the concerning information we found at this inspection in relation to medicines safety, safeguarding, care planning and risk assessing and the recruitment and retention of staff. The manager was not always open and transparent with us and there had been no consultation with people and staff about increases in care fees. The provider had failed to improve over the previous four inspections.

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 (published 14 December 2022). At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 Bankfield on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to person- centred care, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, staffing, fit and proper persons employed and fees at this inspection.

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.

The overall rating for this service is ‘Inadequate’ and the service 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

Bankfield is a residential care home providing accommodation and personal care to up to 47 older people and people living with dementia. At the time of our inspection there were 20 people living at the home.

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

Staff were not always administering medicines safely. Some medicines were being administered too closely together and audits had not identified this. The recording of medicines was not always robust.

Recruitment checks of new staff members were not always safe. Agency staff were regularly used and did not receive an induction to the home. Night staffing levels required reviewing to ensure people's needs are met safety, by trained and competent staff.

Risks to people were not always clearly documented. A safety check on the passenger lift had not been carried out in a timely manner. This was actioned following our inspection. Staff were not following COVID-19 guidance for personal protective equipment.

On commencing the inspection, the care manager denied the inspectors access to the electronic care planning system. Following speaking to the nominated individual, they confirmed they had made the decision to deny inspectors access. We did review electronic care records following a discussion with the registered manager. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests; the policies and systems in the service did support this practice.

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. (Published 16 August 2022) and there were breaches of regulations. At this inspection we found the provider remained in breach of regulations. This service has been in Special Measures since 29 January 2022. During this inspection, not enough improvement had been made and the service remained in special measures.

Why we inspected

We received concerns in relation to staffing and risks to people. As a result, we undertook a focused inspection to review the key questions of safe only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the safe sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bankfield on our website at www.cqc.org.uk.

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 safe care and treatment, staffing and fit and proper persons employed 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 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 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.

Bankfield is a residential care home providing accommodation and personal care to up to 47 older people and people living with dementia. At the time of our inspection there were 22 people living at the home.

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

People were not supported safely. Risks to people were not always robustly assessed and mitigated. Medicines were not safely managed. Accidents and incidents were not always recorded and analysed in a timely manner. An allegation of abuse had not been reported to the Care Quality Commission or the safeguarding team.

People were not supported in their best interests and staff were consenting to care and treatment on the behalf some people living at the home and without authorisation. A person new to the home did not have a thorough pre-assessment of their needs completed prior to admission. Care plans were not always reflective of people’s current needs.

The providers governance processes did not highlight the concerns we found at this inspection. There was a high turnover of staff and staff had highlighted during supervision and feedback that staffing was poor.

People were not always treated with dignity and respect. We observed one person receiving a vaccination in the middle of a busy communal lounge. Another person was left asleep with their dessert on the dining table for a long period of time. People were not always involved in planning their care and reviews of their care. There were times, the communal areas were very loud and not always conducive for people living with dementia. The home was unclean in parts.

Improvements had been made to food and menu choices. Themed food nights were popular with people and the kitchen staff were aware of people who required a modified diet. Activities across the home had improved.

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. (Published 29 January 2022) and there were breaches of regulations. At this inspection we found the provider remained in breach of regulations.

This service has been in Special Measures since 29 January 2022. During this inspection, not enough improvement had been made and the service remained in special measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bankfield on our website at www.cqc.org.uk.

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 person centred-care, consent, safe care and treatment, safeguarding and good governance at this inspection.

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 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 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.

Bankfield is a residential care home located in Bury, Greater Manchester. The home is registered with the Care Quality Commission (CQC) to accommodate a maximum of 47 people. 26 older adults, many of whom lived with dementia and memory problems, were accommodated at the time of this inspection.

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

Whole-service risks, centred around unknown and unmet health and social care needs, were identified at this inspection. The provider had little understanding of people’s baseline health and social care needs. Care records and associated risk assessments were either missing, or contained significant gaps meaning they were unreliable and not fit for purpose. Staff did not have enough underpinning knowledge or insight into people’s needs. No meaningful action had been taken to reduce risks associated with falls management, pressure wound care and a risk of choking.

Infection prevention and control practices were inadequate and did not protect people from the risk of infection, in particular risks associated with COVID-19. Polymerase Chain Reaction (PCR) testing was not completed, instead, an inconsistent system of Lateral Flow Test (LFT) testing had been adopted as custom and practice. No effective system was in place to ensure COVID-19 checks were carried out on arrival at the care home. We were not assured staff had received the appropriate training in respect of ‘donning and doffing’ of personal protective equipment (PPE).

The management of medicines was poor. This included systems for ordering, storing, administration and disposal of medicines. Staff responsible for medicines administration had received training. However, records did not evidence these staff had their medicines competency checked and the home manager was unable to provide any assurances about this.

Systems to ensure people were protected from a risk of abuse were inconsistent and not operated effectively. We were not assured the provider and staff understand their individual and collective safeguarding responsibilities.

There was a significant failure in leadership and management. Systems for audit, quality assurance and questioning of practice were inadequate. There was an absence of meaningful overarching analysis of the already poor governance systems that were in place. There was a failure to identify themes, trends and newly emerging risks, which placed people at an increased risk of harm.

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 overall rating for this service at the last inspection was Requires Improvement, with a rating of Inadequate in the key question of Well-Led (published 04 August 2020). We took enforcement action by serving a Warning Notice for failures of good governance, and we served three Requirement Notices for failures of person-centred care, safe care and treatment, and staffing. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, no tangible improvements had been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to the quality and safety of care, staffing levels - including unskilled and inexperienced staff, medicines administration, and poor leadership and management. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. No new areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

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.

Enforcement

We have identified new and continued breaches of regulations in relation to safe care and treatment, safeguarding, staffing and good governance. 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.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Follow up

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 six 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.

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.

Bankfield is a residential care home, providing personal and nursing care to 34 older people and people living with dementia, at the time of the inspection. The service can support up to 47 people. The home is set across two floors with an accessible garden is in the centre of the home.

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

The provider had not followed the latest guidance to support people to receive visits from their nominated family members during the COVID-19 pandemic. Families felt there had been a lack of communication since the new provider took over the home. The provider did not have processes in place to monitor and improve the service delivered. Audits in place were ineffective and did not highlight the findings from this inspection.

Medicines were not always safely managed. A person who received their medicines covertly did not have the correct guidance in place to support the administration to be safe. People who were at risk of pressure sores and agitation did not always have the risk assessed with actions taken to mitigate the risk from occurring. People and staff felt staffing levels needed improving. The staffing dependency tool did not consider the layout of the building and staff expertise. Further improvements were required to ensure staff were always following best practice in relation to wearing personal protective equipment and clothing. The recruitment of staff was not always safe. We made a recommendation for the provider to improve recruitment processes.

People said the staff team were caring but we were informed of a number of occasions when people had not been supported in a caring and dignified way. This included waiting lengthy times for care and support which resulted in people feeling unhappy about their care. People were also isolated in their room with one person not having any access to stimulation for long periods of time. People felt staff were often too busy and call bells rang for long periods in the home which people told us happened regularly.

Care plans did not always reflect people’s current needs and people and families told us; they had not been involved in care planning. There was a lack of stimulation for people at the home and there was no formal activity timetable. People were supported at the home, should they be at the end of their life. Further work needed to be undertaken to ensure end of life plans were documented for staff to be aware of people’s wishes.

People were supported to eat and drink, however people told us they could not follow a diet of their culture. The registered manager told us, the people were no longer practicing [their religion], and they could have the vegetarian option instead. Staff received training to assist them in carrying out their job role, but further training was required to ensure people’s specific needs were cared for.

People were not always supported to have maximum choice and control of their lives and staff did not always 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.

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 the service under the previous provider was good, published on 18 June 2019.

Why we inspected

The inspection was prompted in part due to concerns received about the management of the home. A decision was made for us to inspect and examine those risks.

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 all key questions sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bankfield on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to person-centred care, safe care and treatment, good governance and staffing 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.