We rated Bank House as requires improvement because:

• The provider had not sufficiently addressed all concerns from the previous CQC inspection in January 2018. Concerns remained around medicines management, particularly practices in relation to controlled drugs.

• Clinical leadership at the service had not been consistent. Governance processes, including clinical audit, did not ensure that omissions in clinical practice were identified and acted upon. The service did not have clear frameworks about what should be discussed at all levels of the organisation.

• Staff did not always use recognised rating scales correctly to assess and record severity and outcomes with clients. Staff did always fully complete rating scales, and did not always complete withdrawal rating scales to the frequency directed by the admitting psychiatrist.

• Staff did not always record client physical observations to the frequency directed by the admitting psychiatrist and did not always record them correctly to ensure that monitoring of physical health during detoxification was effective.

• Staff used a standardised approach to care planning that did not always meet all client need, and did not support clinical practice in the service. We also found that staff did not keep care and treatment records in good order. We found information without complete client identifiable information, without the name and position of the recorder, and incorrectly filed.
• Staff did not always report all incidents that affected the health, safety and welfare of clients using the service. Agendas for staff and clinical meetings did not include feedback and learning from incident investigations as something that would always be discussed.

• The service did not make personal alarms available to staff, or have an effective system in place for clients to summon assistance to their rooms in an emergency.

However:

• The provider had acted to make improvements to address many of the concerns raised by the previous CQC inspection in January 2018. We saw that psychiatrists now made a physical examination of clients entering the service, and medicines reconciliation practices had been established. The service had purchased an automated external defibrillator and medicines fridge.

• The service used a clear model of recovery. The therapy programme provided clients with psychological therapies recommended by the National Institute for Health and Care. Staff and clients contributed to the development of recovery plans that were personalised, recovery focussed and addressed a range of needs.

• Clients using the service spoke positively about their experiences. Clients felt involved in their care and could provide feedback on the service they received.

• All areas of Bank House were maintained and provided a good standard of accommodation. Clients could choose single or shared rooms, and the service complied with good practice guidance on gender separation. Clients reported the quality of food was good.