About the service:

Bank Close is a care home that provides personal care for up to 27 people. The accommodation is across two sites joined by a glass walkway. The main building contains communal spaces which include two lounges, a dining area and a conservatory. There are several bathrooms and toilets throughout the two buildings. Bedrooms are in the upstairs of the main building and in the adjoining building. At the time of the inspection there were 23 people using the service.

People’s experience of using this service:

At our last inspection we identified some areas which required improvement in relation to audits. At this inspection we saw some improvements had been made, however we found that these did not always offer the necessary information. This could have an impact on the care people received following an accident or incident as trends had not been identified. We found an error in the medicines, this had not been identified by the medicine audit. Audits were not consistently completed which raised concerns that the provider did not always have a robust system of quality monitoring.

People were supported by staff who know how to report any concerns and protect people from harm. There were enough staff to support people’s needs and staff had been recruited safely. Staff had received training for their roles and this was ongoing to keep up to date with any changing guidance. Risks to people had been assessed and where appropriate, measures put in place to reduce the risks. The environment had been made safe and there were measures to reduce the risks of infections. People’s medicine was managed safely and when events or incidents had occurred lessons were learnt and improvements made.

There was a homely feel and areas of the home had been refurbished. People were able to be part of the decision making in respect of the colour of the carpets in the home and what food they wished to be included on the menu. Dietary needs had been catered for and refreshments were available with snacks throughout the day. Health care was an integral part of the support provided and we saw that referrals had been made to a range of professionals. Any guidance they provided had been included and followed. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were treated with kindness and compassion. Their needs were respected and they were able to choose how they spent their day. People’s information was stored in accordance with confidentiality laws. Some people continued to access their spiritual needs from visiting churches to the home.

The care plans covered all aspects of people’s care. The details included individual’s care needs, any risks and their preferences. Staff felt supported and the provider had introduced new systems which supported the care plans to be more accessible and detailed. Information was available in different formats to support people’s understanding. The environment had been refurbished and people were able to personalise their own space. There was an opportunity to engage in interests and hobbies.

There was a registered manager who understood the requirements of their registration. The complaints policy was in place and people felt confident in raising any concerns. We had received notifications about events and incidents so we could monitor the action the provider had taken.

The registered manager had engaged in local partnerships to ensure people received a good experience with their health and well-being.

Rating at last inspection: Requires Improvement (Published January 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection which was ‘Requires Improvement.’ At this inspection we found the required improvements had been made and we have rated the home overall as ‘Good’.

Follow up: We will con

We inspected this home on 4 December 2017. At our last inspection in June 2015 we found the provider was meeting all the regulations and we rated the home overall Good. However we rated the section welled as Requires Improvement as the provider had not always been pro-active in determining service improvements for people’s care. At this inspection we saw that these improvements had not been made and further improvements have been identified.

Bank Close Care Home is a care home. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Bank Close accommodates 27 people, at the time of our inspection there were 25 people using the service.

The service had a registered manager in post. 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.

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; the policies and systems in the service did not always support this practice. We have made a recommendation about decision specific assessments to support people when they lack capacity.

There were not always sufficient staff to support people’s needs, this meant people often waited for their personal needs to be met. Risk assessments had not been completed to reflect individuals safety and considerations ion how to reduce the risks associated with the environment or people’s needs.

The environment did not always reflect measures to reduce infections. However staff used their protective equipment effectively. Some people were not supported to be independent when they received their meals. The rooms used for the dinning and lounge areas were crowded and did not support people being able to use these rooms freely or to have relatives join them. There was limited signage around the home to support people’s to make choices or provide them to orientation.

People’s care plans were not up to date and did not reflect their identified needs. People’s aspirations and aspects which affected them as an individual had not been included in the planned care. People’s choices in response to end of life care had not been completed and their wishes documented to so that their wishes could be followed.

Audits had been completed, however they had not always been used to consider trends and to drive improvements or reduce people’s risks. There was a mixed response to the support people, relatives and staff received from the manager and provider. Complaints had been responded to, but the actions taken had not been followed up to ensure the complaint had been resolved.

Staff had developed caring, respectful relationships with the people they supported. People’s privacy was observed and consideration was shown to people to support their dignity. Relatives and friends were welcomed to visit freely.

Staff had been recruited safely and they knew how to protect people from the risk of abuse. The staff had received training for their role and felt the training provided them with knowledge and skills. Referrals had been made to health professionals and there was a proactive approach to ensuring people’s health needs had been met. Medicine was stored and administered safely, to meet peoples prescribed needs.

People’s feedback had been sought and this was planned to be repeated. There had been some partnership working with local organisations, which included schools, churches and health professionals. People received some stimulation to support them to remain active, however it was identified some people would like more opportunities to

This inspection took place on 20 November 2014 and was unannounced.

Accommodation and personal care is provided at this location for up to 27 older adults. At our visit, 17 people were living in the home. There is a registered manager at this 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.

At our last inspection in February 2014, we found one breach of regulation in relation to safeguarding people from harm and abuse. This was because key staff did not always understand their responsibility to report any suspected or witnessed incidents to the appropriate external authorities. Following that inspection the provider told us what action they were going to take to rectify the breach and at this inspection we found that improvements were made.

At this inspection we found the service was not consistently well led. The provider was not always pro-active in determining service improvements for people’s care. The registered manager carried out checks of the quality and safety of people’s care. However, many of the service improvements that were either planned or in progress were requested by the local authority service commissioner and not initiated by the registered provider. Results of the provider’s checks relating to people’s health status, such as accidents and incidents, were not always formally analysed to check for any trends or patterns, that may inform improvements for people’s care.

People felt safe in the home and they were happy living there. People and their relatives knew who to speak with if they had any concerns or worries about their care. We found that improvements had been made since our inspection in February 2014 to further protect people from harm and abuse. This meant that staff knew and understood how to report abuse and they were provided with guidance and training for this.

Potential or known risks to people’s safety were identified before they received care and they were usually reflected in people’s written care plans, which staff followed and understood. Action was being taken to make sure that all people’s risk assessments and care plans were kept up to date and accurately maintained. This helped to mitigate any risks to people from receiving unsafe care.

Staffing arrangements were sufficient for people’s care needs to be met. The provider’s arrangements for staff recruitment were robust and helped to make sure that staff would be suitable to work with people receiving care.

Emergency plans were in place for staff to follow, such as in the event of a fire alarm or loss of energy power supplies. Reports of recent visits from the local fire and environmental health authorities, found satisfactory arrangements for fire safety and food hygiene and handling at Bank Close House.

People’s health care needs were met in consultation with relevant health professionals when required. People were supported to maintain a balanced diet in a way that met with their assessed needs and choices. Staff supported people safely and effectively and they promoted people’s choice and control for their care. For example, with their mobility, meals and nutrition. People’s medicines were safely managed and arrangements were in place to enable people to retain and administer their own medicines, should they choose to do so.

Staff mostly received the training and support they needed. Improvements were being made to address staff training gaps and to introduce staff champions for dignity, nutritional and dementia care.

Staff understood and followed the Mental Capacity Act 2005 to obtain people’s consent or appropriate authorisation for their care when required.

People were happy with their care and felt that staff treated them with respect and kindness and that they maintained their dignity, privacy, choice and independence. People and their relatives were appreciative of and appropriately involved and informed in the care provided, which met with people’s needs and wishes. Staff knew people well and had good relationships with them and with relatives or representatives. Staff supported people to maintain their known daily living preferences and personal routines and their interests and beliefs, which were shown in their written care plans.

People received prompt assistance from staff when they needed it. People were informed how to raise any concerns or complaints and their views about the service and those of their relatives were regularly sought. Findings from these were often used to improve people’s experience of their care and daily living arrangements.

People, their relatives and staff found the registered manager accessible and approachable and were positive about some of the changes being made to improve people’s experiences of their care and the upgrading to one of the main lounges.

Arrangements were in place for the management and day to day running of the home. Staff understood their roles and responsibilities and the provider’s aims and values for people’s care, which they promoted. Staff, were all confident to raise any concerns they may have about people’s care. The provider’s policies and procedures supported and informed them to do so when required.

There were 21 people using the service at the time of this inspection. We spoke with four people, two visitors, three staff and the acting manager.

People and staff we spoke with told us they were pleased with improvements made at the home. One person said, “It’s a different spirit altogether. There’s more to do now and the staff are happier.” Staff told us, “The atmosphere is a lot better” and, “It’s better organised now and things are getting done.”

We found that people’s dignity and privacy were usually respected and their needs were usually met. There was a more structured approach to providing activities for people to take part in, although we did not see any organised activities during our visit.

Staff we spoke with knew what they should look out for and report regarding adult abuse. However, more than half of the staff had not received training about vulnerable adults or had not received this training in the last year. This meant that staff may not know how to identify, report and respond appropriately to suspected or actual abuse.

There were new systems in place to assess the risk of and to prevent and control the spread of infection. We saw that the systems were being operated effectively to ensure people lived in a clean and hygienic environment.

We found there were usually enough staff with the right skills to meet the needs of people using the service.

We have carried out three inspections of Bank Close House in 2013, in August, October and November. In August we found the provider was not meeting nine of our standards. We took action to require the provider to meet the standards.

Our action included serving four warning notices on the provider, requiring them to be compliant with the relevant regulations by 2 October 2013. We visited on 8 and 14 October to check if the provider was compliant with the relevant regulations. We found that the provider had achieved compliance with one of the regulations but was still not meeting the other three. We met with the provider on 25 October 2013 and they assured us that they were now compliant with the relevant regulations.

At this inspection in November 2013 we found that the provider had made some improvements and introduced new systems regarding cleanliness and infection control. They were not fully compliant with the regulation, but the measures they had taken had reduced the impact and risks for people using the service.

We found that the provider had made improvements to the premises and had achieved compliance with the regulation about the premises. They had introduced systems to monitor the safety and condition of the home.

We found that the provider had achieved compliance with the regulation about records. They had taken appropriate action to ensure that records were stored securely and could be located promptly when needed.

There were 26 people using the service at the time of this inspection. We spoke with ten people who lived in the home, three relatives, four staff and the acting manager. We observed the experience of people who could not communicate their views to us.

People we spoke with told us they were treated with respect. One person said, “The staff are always polite with me and everyone else here.” We saw that staff were courteous and friendly to people in the home. However, we found that people’s views were not always respected or acted on.

We found that care was not always planned and delivered to meet people’s needs, including their social and psychological needs. People told us they were bored and were offered little stimulation. One person said, “It’s just the TV or sleeping, really.”

We found a lack of systems to ensure the cleanliness of the home and to prevent and control infection. We saw areas and items in the home that were not adequately clean.

The home and grounds were not sufficiently well maintained to ensure that people lived in an environment that promoted their wellbeing.

People told us there were not always enough staff to meet their needs. They said, “They’re a lovely bunch, but we want more of them!” We found that the planned staffing levels were regularly not achieved.

Records were not always accurate or up to date. Archived records were not kept securely and could not be located easily when required.

We found that people using the service and their representatives had been asked for their views about their care and they were acted on. We saw that the people had been asked their views about the meals and the range of activities provided. Action had been taken that reflected people’s views.

We found that the systems in place for identifying, assessing and managing risks relating to the health, welfare and safety of people using the service were more effective than at our previous inspection. Audits had been carried out and action had been taken where risks or issues were identified.

We found that there had been no incidents since our last inspection that required reporting to the Care Quality Commission. However, we found that staff were generally more aware of the requirement to report incidents.

People told us they liked the staff and we observed that staff treated people in a respectful and sensitive manner. However, we found that people's privacy and dignity were not always respected. For example, people who shared rooms were not provided with curtains or screens to ensure their privacy if they wished.

People told us, “I’m comfortable here”, and, “They look after us”. We found that people's needs were assessed. However, we found that the planning and delivery of care did not always meet the person’s individual needs and or ensure the welfare of the person. For example, we found gaps and lack of detail in people's care plans and we found that care plans and risk assessments were not always kept up to date.

Most people told us they enjoyed the meals. We found that people were provided with suitable food and drink and appropriate support from staff to meet their needs. However, we found that people were not always given appropriate choices at mealtimes to ensure their preferences were met.

We saw that people were asked for their views about the service provided. However, we found that the system for assessing and monitoring the quality of the service provided did not include regularly asking for the views of others, such as staff and the relatives of people using the service.

There were 22 people living in the home at the time of this review. We spoke with four people to gain their views of the service. Some people in the home had limited communication abilities and so we could not interview them to find out their views. However, we were able to observe their mood and behaviour and how they interacted with staff. We also spoke with three relatives or friends of people in the home.

People told us "I'm well looked after" and "I'm happy enough here".

Two of the relatives we spoke with said they were involved in planning and reviewing the person's care.

We observed good interactions between people in the home and staff. Staff showed care and concern for people and treated people with respect. We found there was a relaxed and friendly atmosphere in the home.

One person told us they were happy and settled in the home. Two other people said "It's alright here". Two people told us that the staff “are very nice – they’ll do anything for you” and that the staff are “nice and friendly”. One person said “most of the staff are alright”.

There were 20 people at Bank Close House at the time of this inspection. We spoke with people using the service, visitors and staff. We also spoke with the acting manager, the regional manager and the provider.

When we inspected Bank Close House in August 2013, we found concerns regarding the cleanliness, hygiene and maintenance of the home. We also had concerns about how records were kept and found that important events had not been reported to CQC as required. We served four warning notices on 4 September 2013 requiring the provider to be compliant with the relevant regulations by 2 October 2013.

At this inspection we found that appropriate action had been taken to ensure certain events were reported to CQC as required. However, the provider was still not meeting the essential standards of cleanliness and hygiene, maintenance of the premises, and keeping records.

We found that there were no effective systems in place to prevent and control the spread of infection. We found numerous areas of the home and items of equipment where appropriate standards of cleanliness and hygiene were not maintained.

We found that some improvements had been made to the premises. However, the provider had not put appropriate measures in place to ensure the adequate maintenance of the home.

We found that improvements had been made to people’s care records. However, no changes had been made to improve the storage and organisation of archived records.