Archived: Bankhouse Care Home

This focussed inspection was carried out on the 07 December 2016 by one adult social care inspector and a medicines inspector and was unannounced.

Bankhouse Care Home is registered to accommodate up to 52 people who have nursing needs or people living with dementia. The home comprises of two general residential and nursing units and a unit for people living with dementia. All accommodation is located on the ground and first floor. At the time of the inspection there were 47 people who lived at the home.

The home has a manager who is registered with the Care Quality Commission. 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 last inspected Bankhouse Care Home in June 2016. We identified breaches of two regulations. We found timely care planning had not taken place when responsibility for care and treatment was shared with other health professionals. We also found medicines were not managed safely. These were breaches of Regulation 12 (Safe care and treatment.) We identified that care records were not contemporaneous, accurate or reflective of people's needs and quality assurance systems were not operated effectively to ensure risks were addressed and improvements made. These were breaches of Regulation 17 (Good Governance.)

At the last inspection on the 13 June 2016 we issued a warning notice for the breaches we found. We did this to make sure the registered provider took action to make improvements. We were provided with an action plan which detailed how the registered provider intended to ensure improvements were made. The action plan recorded improvements would be made by September 2016.

We undertook this focused inspection to check they had followed their plan and to confirm they now met legal requirements. During this inspection carried out on the 07 December 2016 we found some improvements had been made. We saw care records were reflective of the care and support people received. We also found information was shared with other health professionals and care planning documentation reflected health professional’s instructions. Staff were knowledgeable of the care people required and told us the registered provider had made changes to the way documentation was completed. They explained this helped ensure documentation was accurate and up to date.

We found significant improvements had been made in the safe management of medicines, however further improvements were required to ensure medicines were managed safely. During this inspection on the 07 December 2016 we found creams were not always stored safely and further detail was required in ‘prn protocols.’ These are documents which provide guidance to staff on when and how to administer medicines. We also found two people had not had their medicines administered due to insufficient stock at the home and medicines were being crushed without staff having the authority or information that it was safe to crush specific tablets. In addition we found there was no record of the times each person was given their individual medicines, such as analgesia. This was a breach of Regulation 12 (Safe care and treatment.)

We discussed staffing with people who lived at the home, the registered manager and relatives. People told us they considered there were sufficient staff available to meet people’s needs and they received help quickly. One person who lived at the home commented, “Staff always make sure I have my call bell and come very quickly if I need help.” One of the relatives we spoke with said they considered more staff were required. They explained they considered there had been no negative impact on the care of their family member and they were discussing their concerns with the registered manager.

We reviewed staff files and found there were processes in place to ensure staff were recruited safely. People we spoke with told us they felt safe and staff we spoke with were able to explain the processes to follow if they believed someone was at risk of harm or abuse. These processes were displayed within the home to support staff to do so.

We reviewed documentation which showed risk assessments were carried out to identify individual risks to people who lived at the home. Written plans were in place to manage these risks.

We saw evidence that audits were carried out to identify if areas of improvement were required. The registered manager reviewed accidents and incidents as they occurred and a report was compiled to identify people who were at risk of falls. This was passed to the registered provider’s quality team. Audits were carried out on care records, medicines and the environment. We found the medicines audit was not always effective as it did not always identify when improvements were required. We have made a recommendation regarding this.

We viewed documentation which evidenced people were able to attend ‘residents and relatives’ meetings. People told us they were able to do so.

Staff we spoke with spoke highly of the registered manager. They told us the registered manager had sought their views regarding the way in which to improve care documentation. Staff explained they considered the registered manager to be supportive and they could approach them to discuss any concerns. Relatives we spoke with also told us they found the manager to be approachable.

We could not improve the rating for responsive from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

You can see the action we told the provider to take at the back of the full version of the report.

This focussed inspection took place on the 13 June 2016 and was unannounced. This means we did not give the registered provider prior knowledge of our inspection.

Bankhouse Care Home is registered to accommodate up to 52 people who have nursing needs or people living with dementia. The home comprises of two general residential and nursing units and a unit for people living with dementia. All accommodation is located on the ground and first floor. At the time of the inspection there were 42 people who lived at the home.

There are a range of communal rooms, comprising of three lounges, and two dining rooms. There is a garden area with seating for people to use during the summer months. Car parking is available at the home.

The home has a manager who is registered with the Care Quality Commission. 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 comprehensive inspection of Bankhouse Care Home in November and December 2015 the service was rated as ‘requires improvement’ overall, with ‘requires improvement’ ratings in three of the key questions ‘is the service safe?’ ‘is the service responsive?’ and 'is the service well – led?’ We identified a breach of Regulation 12, (Safe care and treatment) as medicines at the home were not managed safely. We also identified a breach of Regulation 17, (Good Governance) as care records were not contemporaneous, accurate or reflective of people’s needs. In addition, quality assurance systems were not operated effectively to ensure risks were addressed and improvements made.

We carried out this focussed inspection in June 2016 to check improvements had been made.

During the focussed inspection carried out in June 2016, we found two occasions where information was not shared promptly with external health professionals to allow timely care planning to take place. This was a breach of Regulation 12 (Safe care and treatment.) During the inspection we became aware of an occurrence at the home. We are considering our response to this.

We noted there were ineffective quality monitoring systems in place as improvements were not being made. This was a continued breach of Regulation 17, (Good Governance.)

We viewed care records to ascertain the care and support people received. We noted care records did not always contain accurate and sufficient information to ensure people’s needs were met. The records we viewed did not always contain an accurate reflection of care interventions provided. This was a continued breach of Regulation 17, (Good Governance.)

We found medicines were not safely managed and people did not always receive their medicines as prescribed. This was a continued breach of Regulation 12 (Safe Care and Treatment.)

You can see what action we told the provider to take at the back of the full version of the report.

People told us they were happy living at Bankhouse Care home and they found staff to be kind and thoughtful. They told us if they required support, staff came quickly. However we were also told staff were not always able to meet their immediate needs and would arrange to come back to them in order to help them. This was confirmed by speaking with staff.

We spoke with people who lived at the home. They told us they could express their views and were involved in making decisions about their care. They told us they felt listened to when discussing their care needs. Staff confirmed to us they also involved relatives, where possible to ensure people received the right care and support.

We spent time in all areas of the home, including the lounge and the dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it. We spoke with people about the care and support they received. They said they were happy living at the home and said that staff were polite and kind.

We looked at how the service was being staffed and reviewed staff training and supervision. We saw there was sufficient staff on each shift with a range of skills and experience. Staff told us they felt supported, had regular meetings with their manager, and their training was kept up to date.

There were a range of audits and systems in place to monitor the quality of the service being provided.