We carried out an inspection of Bankfield House Care Home on 26 and 27 September 2018. The first day of the inspection was unannounced.

Bankfield House is a ‘care home’. People in care homes receive accommodation and nursing or 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. The home is based in the Woodley area of Stockport and can accommodate 30 people over two floors. At the time of our inspection the home was fully occupied.

The home was last inspected on 21 and 22 August 2017, when we rated the service as ‘requires improvement’ overall and in two of the five domains. We also identified two continued breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment and good governance.

At this inspection we found the provider had addressed the previous regulatory breaches, however we identified four new breaches in three of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These are in relation to staffing, safeguarding people from abuse or improper treatment and good governance. You can see what action we asked the provider to take at the back of the full version of this report.

At the time of the inspection the home had a registered manager. 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.

Staff had access to both e-learning and practical training sessions. Although staff spoke positively about the support and training provided, the training matrix revealed gaps in training provision and that some sessions completed were out of date.

The home was not consistently adhering to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. Applications to allow the home to legally deprive people of their liberty had not been submitted for all those who met the requirements, with no clear system in place for determining who required an application and who did not. The best interest process had not been used, where people lacked capacity to consent to care and treatment and did not have a legal representative to make decisions on their behalf.

The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service, however these had not identified the issues we noted during inspection. We also noted some gaps and inconsistencies in records and monitoring charts, which had also not been identified by the home or their governance systems.

People we spoke with told us they felt safe and enjoyed living at Bankfield House Care Home. They had no concerns about the standard of care provided, nor did their relatives or friends with whom we spoke. Staff were knowledgeable about the different types of abuse, how to identify these and report any concerns. The home had appropriate safeguarding policies and reporting procedures in place, and had submitted monthly reports to the local authority for any incidents which had occurred, as required.

Checks had been carried out to ensure staff were suitable to work in a care setting with vulnerable people. Enough staff were deployed to meet people’s needs. The home used a system to determine safe staffing levels, which although complex to use, tallied with the rotas.

The home was clean, well maintained with appropriate infection control processes in place. Staff had access to and wore personal protective equipment (PPE) to prevent the spread of infection. Checks and servicing of equipment, such as f

This comprehensive inspection was carried out over two days on the 21 and 22 August 2017. The first day was unannounced.

We last inspected Bankfield House Care Home in December 2016. At that inspection we assessed the service as inadequate in well-led, requires improvement in safe, effective and responsive and too in caring. At that inspection we identified multiple regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to safe care and treatment, premise and equipment, good governance, staffing and fit and proper persons employed.

The overall rating for this service in December 2016 was ‘Requires improvement’. However, we placed the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

This inspection was to check improvements had been made and to review the ratings. At this inspection we found improvements had been made. However sufficient improvements had not been made in two areas and the service remained in breach of Regulation 12 safe care and treatment and regulation 17 good governance.

Bankfield House Care Home is a privately owned care home located in the Woodley area of Stockport. It is a large detached two-storey building. Accommodation is arranged over two floors accessed via stairs or a lift. The communal areas include the Jasmin lounge leading through to a conservatory and , the Bluebell lounge which are both at the front of the property. The Snowdrop lounge is a quieter lounge and dining area at the rear of the property. In addition to these there is a separate dining room area.

There are safe, well maintained, enclosed gardens to the rear of the property and car parking facilities are available. There are twenty four single bedrooms and three double bedrooms. Eight bedrooms have en-suite shower facilities and a further seven bedrooms have en-suite toilet facilities.

Bankfield House Care Home is registered to provide care and accommodation for up to thirty older people some of whom may also have a diagnosis of dementia. At the time of our inspection twenty eight people were living at the home. .

Since the last inspection a manager had been appointed and had successfully 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.

People living at Bankfield House Care Home, their relatives, and staff spoke highly of the service. For example one relative stated “It gave me peace of mind that [My relative] is being well looked after and well fed, when [My relative] was at home it was a worry as they didn’t eat properly.” One person living at Bankfield House Care Home said “I feel safe as there are people around me who can help me.”

As stated above during this inspection we found improvements had been made since the last inspection. However we found that robust systems had not yet been fully implemented to monitor all aspects of the quality and safety of the service being provided.

We found gaps in the recording of cooked food temperatures prior to meals being served, in addition to this we found gaps in the fridge and freezer temperature recordings and saw that some food had been opened and stored in the fridge without a date opening being recorded. This meant that people could be at risk of possible food poisoning if food was not being stored or serviced at the correct temperature.

Attention was paid to people’s diet and people were supported to eat and drink in a way that met t

This inspection was carried out over three days on the 19, 20 and 21 December 2016. Our visit on 19 December 2016 was unannounced.

At the last inspection on 10, 11 and 12 May 2016 we rated the service as requires improvement overall. At that inspection we identified eight regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to medication administration, consent, staff training, recruitment, people’s safety and good governance.

This inspection was to check improvements had been made and to review the ratings. At this inspection we found that although improvements had been made in some areas sufficient improvements had not been made and the service remained in breach of the regulations. These were in relation to safe care and treatment, premises and equipment, good governance, staffing and fit and proper persons employed.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Bankfield House Care Home is a privately owned care home located in the Woodley area of Stockport. It is a large detached two-storey building. Accommodation is arranged over two floors accessed via stairs or a lift. The communal areas include the Jasmin lounge leading through to a conservatory, the Bluebell lounge which are both at the front of the property, and the Snowdrop lounge which is a quieter lounge and dining area at the rear of the property and a dining room.

There are safe, well maintained, enclosed gardens to the rear of the property and car parking facilities are available. There are twenty four single bedrooms and three double bedrooms. Eight bedrooms have en-suite shower facilities and a further seven bedrooms have en-suite toilet facilities.

Bankfield House Care Home is registered to provide care and accommodation for up to thirty older people some of whom may also have a diagnosis of dementia. At the time of our inspection twenty eight people were living at the home. .

The service did not have a registered manager in place. The home had been without a registered manager since August 2015. 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 were told by one of the directors that recruitment procedures to the post were currently in progress.

During this inspection we identified multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

As found at the previous inspection in May 2016, some medicines continued not to be managed safely. We found there were gaps in the recording of some prescribed creams which meant there was a risk that creams had not been applied when required, which could have resulted in unnecessary discomfort to the person.

We found at the previous inspection in May 2016 recruitment processes required improvements to ensure only suitable staff were employed. During this inspection we saw in one file that a member of staff had taken up post since the last inspection and had commenced employment before all the necessary safety checks had been undertaken. This meant there was a risk of unsuitable people being employed to work with vulnerable groups of people.

Although we saw some improvements had been made we found that staff were

This inspection was carried out over three days on the 10, 11 and 12 May 2016. Our visit on 10 May 2016 was unannounced.

We last inspected Bankfield House Care Home on 24 September 2014. At that follow up inspection we found that the service was meeting the regulations we assessed.

Bankfield House Care Home is a privately owned care home located in the Woodley area of Stockport. It is a large detached two-storey building. Accommodation is arranged over two floors accessed via stairs or a lift. The communal areas include the Jasmin lounge leading through to a conservatory, the Bluebell lounge which are both at the front of the property, and the Snowdrop lounge which is quieter lounge and dining area at the rear of the property and a dining room.

There is safe, well maintained, enclosed garden to the rear of the property and car parking facilities are available. There are twenty seven single bedrooms and three double bedrooms, although at the time of this inspection only was being used as a double room. Fifteen bedrooms have en-suite facilities.

Bankfield House Care Home is registered to provide care and accommodation for up to thirty older people some of whom may also have a diagnosis of dementia. At the time of our inspection there were twenty eight people living in the home.

The service did not have a registered manager in place. The home had been without a registered manager since August 2015. 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.

During this inspection we identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Some medicines were not managed safely. We found there were gaps in the recording of prescribed creams which meant there was a risk that creams had not been applied when required, which could have resulted in unnecessary discomfort to the person.

We had concerns in relation to staff supervision because staff were not receiving supervision on a regular basis, which meant that staff were not being appropriately guided and supported to fulfil their job role effectively.

Recruitment processes required improvements to ensure only suitable staff were employed.

We saw there was a risk of cross infection because hoists and hoist slings were not clean and there was inappropriate storage of the hoist slings.

Some of the routine safety checks had not been undertaken for example checks of the means of escape, window retractors and nurse call bells. In addition there was no evidence that fire evacuation drills had been undertaken. This meant the provider could not be sure the service was safe.

People's care records contained conflicting information and although they had been reviewed some plans of care had not been rewritten in over two years. This meant there was risk that people could receive inappropriate care.

Staff spoken with understood the need to obtain consent from people using the service before a task or care was undertaken. However there were gaps in the recording of consent and consent for some people had not been appropriately obtained.

Some systems were in place to monitor the quality of service people received however they we not robust and due to the shortfalls we found during our inspection they require improvements.

Just prior to this inspection it came to the attention of CQC that an allegation of abuse had been made which had not been referred to the local authority safeguarding team as set out in Multi Agency Policy for Safeguarding Adults at Risk but ha

We carried out this inspection to follow up on concerns we found during our previous inspection on 5 August 2014. During that inspection we found records relating to medicines were insufficient to ensure people's safety and medicines were not stored securely, allowing the possibility of mishandling or misuse.

During this inspection we spoke with the senior carer supervisor on duty, one of the providers and looked at records relating to medication administration.

We considered the evidence collected under this outcome and addressed the following question, is the service safe?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

During this inspection visit we saw there were appropriate arrangements in place to manage people’s medicines safely which were administered in line with prescribed treatments. However was saw there were gaps in the recordings of some prescribe creams.

An inspector and a pharmacy inspector visited this service on 5 August 2014 to carry out an unannounced inspection. Prior to our visit we looked at all the information we hold on this service to help us to plan and focus on our five questions: is the service safe; is the service effective; is the service caring; is the service responsive; and is the service well led?

The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them, a visitor, a healthcare professional and from looking at records.

Is the service safe?

During this inspection visit we observed that people were treated with respect and dignity by the staff and people told us they felt safe living in Bankfield House Care Home.

Each person had an individual care file that included risk assessments and a care plan that described how to meet people’s individual care needs.

From information we hold on this service we know that the registered person had not referred concerns to the local adult safeguarding team in a timely manner. This meant that any investigation into such concerns may be delayed and people might be left at risk. During this inspection visit we saw that actions had been taken to address the shortfall and helped to ensure that this did not happen again. We know that further concerns had been appropriately referred since then. At the time of this inspection there were three on-going safeguarding investigations being investigated by the local authority.

All the medicines people needed were available in the home. The receipt and administration of medicines was recorded, allowing medicines to be accounted for. We saw a member of staff administer medicines in a kind and respectful way. However, records relating to medicines were insufficient to ensure people’s safety. Medicines were not stored securely, allowing the possibility of mishandling or misuse.

Is the service effective?

Prior to people being admitted into the home the manager visited people to carry out an assessment of their needs to ensure the home could meet all of those assessed needs. The manager said that if possible people were encouraged to spend some time at the home having lunch and meeting staff and other people living at the home before a decision was made about moving in.

Staff told us told us that the staff team all worked well together and provided a high standard of care.

Is the service caring?

The atmosphere in the home felt relaxed and friendly. From our observations we saw that care staff had a good understanding of people's individual needs and personalities. We saw that staff were kind and sensitive in their approach to people.

We observed that people looked well cared for and were appropriately dressed.

All of the people we spoke with who were living at the home indicated that they were happy and had everything they needed.

Is the service responsive?

We saw that where appropriate the service had accessed advice and care from other health care professionals. For example we saw evidence of visits from the GP, chiropodist, optician and, the district nurse and we saw that people attended hospital appointments when required. This meant the provider sought relevant professional advice and guidance appropriately.

We saw there was a complaints procedure in place which was also included in the ’residents information pack and statement of purpose’. We were also told that each person using the service had received a copy of the procedure which was also included in the staff handbook. We also saw that a copy of the complaint procedure was wall mounted in the main reception and was next to the singing in book. The visitor we spoke with confirmed that they had not made a complaint but knew what to do if they felt a complaint was necessary.

We looked at the records of complaints made which showed that everything had been documented and investigations and responses to the complaints were carried out within the specified timelines. This meant that people could be confident that their complaints were listened to and dealt with effectively.

Is the service well-led?

The service was led by a manager that is registered with the Care Quality Commission.

The manager was described by staff as approachable and supportive.

We saw there were systems in place to monitor the service quality and identify risk. This would help to ensure that people received a safe and effective service.

During our previous inspection on 29 April 2013, we had some concerns that appropriate records were not being kept by the service in relation to the care plans for people. Following that inspection the service had given us an action plan to show us the improvements they were going to make.

During this inspection we looked at a sample of care plans. We saw that significant improvements had been made and peoples care plans contained sufficient, up to date, accurate information.

During this inspection we spoke with seven people who lived at the home, four visitors, two visiting healthcare professionals and the homes director. People we spoke with told us that they were happy and had no complaints. Some of the comments we received were: “I enjoy it here, it has a nice atmosphere and is very pleasant,” “We are well looked after, the staff are absolutely marvellous” and “They always ask you what you want, I can well recommend it.”

During our observations on the day of this inspection we saw staff providing care and support to people in a respectful way. We observed good interactions between the staff and people living in the home.

The atmosphere in the home felt calm and relaxed. We saw people living at the home chatting to staff and each other in a warm and friendly manner.

During this inspection we did have some concerns about the lack of detail in people’s care plans. This meant that people’s safety and well being may not always be protected.

We spoke with seven people who were living at the service during our visit and one relative. Their comments overall were positive about the care received. They told us they liked living at the service and used words to describe it such as: “I have everything I need”; “The food is very good. We have an activity lady she’s not here everyday but she visits twice a week and organises things like exercises”; “We have everything we need”; “Couldn’t want for more” and “I’m very happy here. I have no complaints.”

The service had (CCTV) cameras in the building. The cameras showed people living at the home using the lounge and dining room monitored by televisions. The manager was on holiday and the staff on duty were unable to produce any records to show that people had been consulted about the ongoing use of (CCTV) cameras. People’s rights regarding privacy are breached if they are being monitored without their permission.

We observed the support that was being given to people living at the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. Staff were friendly and respectful to the people they were supporting.

We had contacted the local authority contracts team for Stockport Social services. They gave updated information regarding the reviews carried out of medications at this service.

Comments included: "Wonderful", "I think it’s great", “the staff are smashing”, "everyone is so jolly”, “I love it here” , “everyone is very nice”, “we get up and go to bed when we please”, “nothing at all to complain about” “the food is very nice”, “clothes are brought back washed and ironed”, “can have visitors every day”, "it is very nice not difficult to settle in at all”, “I have no complaints they look after us very well”.