Archived: Bankhouse Care Home

Updated 10 February 2017

We carried out this focussed 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.

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.)

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

Prior to the inspection we reviewed information the Care Quality Commission (CQC) holds about Bankhouse Care Home. This included any statutory notifications, adult safeguarding information and comments and concerns. In addition we contacted the local commissioning authority to gain their views of the service provided. This helped us plan the inspection effectively.

As part of the inspection we spoke with six people who received care and support from Bankhouse Care Home and two relatives. We spoke with the registered manager, two quality managers, the deputy manager, two qualified nurses, the activities coordinator and two care staff.

We looked at a range of documentation which included six care records and two staff files. We also looked at a range of audits. As part of the inspection we viewed a sample of medication and administration records.

Updated 10 February 2017

We carried out an unannounced focussed inspection of this service 13 June 2016. At this inspection breaches of legal requirements were found. After the focussed inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this focused inspection in December 2016 to check that they had followed their plan and to confirm that 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 Bankhouse Care Home on our website at www.cqc.org.uk

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.