Bank House Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to Good. This meant people were safe and protected from avoidable harm.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager continued to identify and support areas of learning. Staff development was monitored by the registered manager during the daily walkaround. This included observations of staff practice. Where poor practice had been identified, this had been formally addressed by the registered manager.

The registered manager reviewed accidents and incidents to help identify areas of learning within the team. In addition, specific areas of training as well as focused supervision sessions had been provided exploring specific areas of support to help improve care practice, such as; moisture lesions, covert medicines and dysphagia. The registered manager acknowledged this was an area which required further development, addressing the gaps in training as well as provide further opportunities for continuous learning and to help embed good practice.

Staff were said to provide the care and support people wanted and needed. People and their visitors told us, “Staff know the care needs of [relative], they know everything about everyone” and “They [staff] know what they are doing. There’s no problem with the care, they look after me and I like it.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. We were made aware of one person who was being supported to move to alternative accommodation. Due to their complex support needs, the registered manager was ensuring a comprehensive handover of care was undertaken, including the new team spending time with the person, to ensure a smooth transition.

People’s care needs were continually monitored. Where necessary, referrals were made to outside agencies for additional advice and support. The registered manager said working relationships with the community nursing team had greatly improved, so that people’s changing needs were promptly met. The service had, however, encountered some difficulties in accessing GP support. Weekly visits made by the physician associate linked to the doctors surgery was no longer provided proving access to the GP more difficult. The registered manager was trying to address this with the surgery.

Systems were in place to help safeguard people from abuse and protect their rights. Staff were guided by policies and procedures as well as relevant training. Most people we spoke with said the home was a safe place. One person said, “I am safe, double safe.” People’s visitors also commented, “When I go home I feel that [relative] is secure. I complemented staff as it’s so good” and “It’s safe, it’s a big relief.”

The registered manager was aware of her responsibilities to report safeguarding concerns as well as ensure lawful restrictions were in place. Applications to deprive people of their liberty (DoLS) were submitted to the local authority in a timely manner. Care records also reflected where people lacked the mental capacity to make decisions for themselves. Where necessary, ‘best interest’ decisions were made involving relevant parties, so people’s wishes and feelings were considered, and their rights were upheld.

Staff spoken with confirmed safeguarding, Mental Capacity Act (MCA) and DoLS training were provided as part of the e-learning programme. Staff were also completed workbooks in MCA to check their understanding.

Plans were in place to help monitor and manage areas of identified risk. Where able, people and those important to them, were involved in the development of their plans. Records were kept under review, reflecting people’s current and changing needs. Relevant referrals were made where additional support or equipment was required to help promote people’s safety.

People we spoke with felt staff supported them safely when assisting them with the aid of a hoist. We observed staff carrying out moving and handling support, offering encouragement and reassurance. People we spoke with told us, “They know what they are doing when they use the hoist” and “I use a standing hoist, which works well.”

Audit and checks were completed in areas of risk to people. These included falls, pressure care, accidents and incidents and nutritional risk. Any action required was recorded and signed off by the registered manager when completed.

Internal and external checks continue to be made to ensure the premises and equipment are adequately serviced and maintained. We noted portable appliance testing (PAT) was not up to date. The registered manager said testing equipment was now available, and maintenance staff confirmed they were in the process of completing all tests.

Work had been carried in the large lounge providing a more comfortable area for people to relax. However, the registered manager acknowledged considerable investment was needed to enhance the physical environment and furnishings throughout the home. Work required was discussed with the provider and included within the homes improvement plan.

Sufficient number of staff were available. Staff were safely recruited, and a programme of training was provided to enable them to carry out their role and responsibilities.

The registered manager used a dependency tool to determine the numbers of staff required to meet people’s needs. This was kept under review, so people’s current and changes needs were met. However, we received a mixed response from people. Some people felt more staff were needed, whilst others felt staff were responsive to requests for help. We were told, “There is not enough staff, sometimes I have to wait as I need two staff” and “I get the attention when I need it, I don’t have long to wait.”

Current vacancies were being recruited to. The registered manager was being assisted by an agency, commissioned by the local authority, in the recruitment of temporary and permanent staff. Relevant recruitment checks had been completed, including additional checks for international workers. We advised the registered manager of further checks to satisfy themselves of those working under sponsorship with another provider.

A programme of induction, training, and support was in place. Staff undertook both e-learning and face to face training. Workbooks were also completed to check staff knowledge and understanding. A review of training records showed that some staff had gaps in their training. Agency staff did not receive an induction on commencing work at the service ensuring they were aware of their role and procedures to follow in the event of an emergency or incident. The registered manager agreed to implement this.

Records also showed themed supervisions had been held to discuss areas of practice following recent concerns. However, these did not evidence any meaningful discussion with staff about their own performance or address shortfalls in training. The registered manager acknowledged a more formal system of supervision and appraisal was needed to help support staff and monitor performance.

Hygiene standards within the home had improved. Work required following an inspection by the health protection team had been addressed. The service had a designated housekeeping team who took responsibility for cleaning and laundry. Audits and checks were undertaken to ensure standards were maintained.

Information was in place to guide staff in safe practice. This was supported by a programme of training. Staff also had access to personal protective equipment (PPE) to help minimise the spread of infection. We observed staff wearing aprons and gloves when carrying out specific tasks.

Improvements had been made in the management and administration of people prescribed medicines and were no longer in breach of the regulation.

An electronic recording system had been introduced to record the administration of people’s prescribed medicines. This system helps to minimise medication errors and provides real-time medication alerts at the times people need their medicines. The registered manager was continuing to work with the service provider and supplying pharmacist to develop the system further, provide clear information in the method of administration as well as further training and support for staff responsible for the administration of people’s medicines.

We found medicines were stored safely in the treatment room. However, staff were reminded topical creams kept in people’s bedrooms should be stored out of reach. The registered manager was also introducing a medication book, ‘safe and legal’, which would include additional information such as temperature checks and the handling of keys for the treatment room. Audits and checks were completed and actions identified had been acted upon. For example; stock checks of controlled drugs.