Our inspection took place on 8 January 2018 and was unannounced. At our last inspection in December 2016 we rated the service as ‘requires improvement’ overall and identified a breach of the regulation relating to need for consent. At this inspection we found the provider had made improvements and were no longer in breach of regulation.

Bankfield Manor Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 registered to accommodate 25 but, due to changing double occupancy bedrooms to single occupancy, the home now has a maximum capacity of 21 people. At the time of our inspection there were 17 people using the service including one person who was in hospital. There was a registered manager in post. They were relatively new to the position having been registered for only four months. 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.

Systems were in place to promote people's safety and to review with them if they felt safe. We found the home was well maintained although we noted more thorough cleaning was required in some areas. We saw accidents, including near misses, and incidents were managed appropriately and reviewed to see if risks could be mitigated. Staff understood how to identify and report any potential abuse.

Staff were recruited safely and told us they received regular training and effective support.

We noted particular times of day when care staff were engaged in duties other than care which impacted on their availability to people. Although we did not observe people being put at risk, the provider said they would take action to address this.

Improvements had been made relating to capacity and consent. However we noted family members were sometimes involved in decisions where it was not clear this would be the person's wish.

People were able to choose how and where they spent their time, and lifestyle choices were respected. People had access to appropriate recreational and social activities and equipment was available for people living with dementia to occupy their time.

A new research based menu was in place and people said they enjoyed the food and had choice. The cook had good knowledge of people’s nutritional needs.

We saw staff and people who used the service knew each other well, and we saw examples of caring practice during our inspection. Equality and diversity principles were well embedded in the culture of the home.

Care plans were detailed, person centred and up to date. There was some evidence of people being involved in their care planning but this was not evident for everybody.

There were systems in place to ensure complaints were managed appropriately, and people told us their concerns were dealt with well.

There was a robust system in place for auditing quality and safety within the service.

Staff and people who used the service felt it was well-led, and we saw the registered manager and provider were a visible presence in the home and clearly knew people well.

Systems were in place for people to voice their opinions and we saw the provider shared results of surveys and plans for development with people involved in the home. We saw examples of actions taken to improve the service as a result of feedback.

We inspected this service on 15 December 2016.

The last inspection took place on 11 April 2016 when we rated the service as ‘requires improvement’ and found the service was in breach of one regulation relating to staff recruitment.

Although the service is registered to provide care and support for up to 25 people the maximum capacity of the home is 21. All of the bedrooms are single and nine have en-suite toilet facilities. There are two lounges and a dining room on the ground floor and an enclosed garden area at the front of the building. Accommodation is arranged over two floors, which can be accessed using a passenger lift in the main building, or a stair lift in the extension. On the day of the inspection there were thirteen people living at the home and one person was in hospital.

There was 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.

We found, staff were being recruited safely and staffing levels were appropriate to the needs of the people living at the home. Staff were supported to make sure they received the training they needed to be effective in their role.

Systems were in place to make sure people were safe and staff understood how to identify and act on any allegations of abuse. Overall systems for managing medicines were safe.

Environmental safety checks were completed appropriately and adaptations had been made to meet the the needs of people living with dementia.

People who used the service told us they liked the staff and found them kind and caring. We saw staff were kind and patient with people.

We found better systems were needed to make sure the service was working in line with the legal requirements relating to Deprivation of Liberty Safeguards (DoLS) and staff needed more training to better their understanding of this.

People told us they liked the meals and work had been done to make sure the diet was suitable to the nutritional needs of the people living at the home.

People’s healthcare needs were being met and systems were in place to make sure people received their medicines safely and appropriately.

People engaged in activities on a daily basis with dementia friendly materials available to people although no structured programme was in place.

Complaints were investigated and responded to although improvements were needed to make sure investigations were thorough and objective.

A range of checks and audits were in place with analysis and actions taken. However audits had not always picked up issues where actions were needed.

Regular staff meetings were held and people's opinions of the service were sought through annual surveys.

We found one breach of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations. You can see what action we asked the provider to take at the back of this report.

We inspected Bankfield Manor Care Home on 11 April 2016 and the visit was unannounced. Our last inspection took place on 2 and 29 September 2015. At that time, we found the provider was not meeting the regulations in relation to dignity and respect, safe care and treatment, safeguarding service users from abuse and improper treatment, receiving and acting on complaints, good governance and staffing. We told the provider they had to make improvements and found on this inspection the necessary improvements had been made.

Bankfield Manor Care Home is registered to provide accommodation and personal care for older people, including people living with dementia. Although the service is registered to provide care and support for up to 25 people the maximum the home will take is 21. All of the bedrooms are single and nine have en-suite toilet facilities. There are two lounges and a dining room on the ground floor and an enclosed garden area at the front of the building. Accommodation is arranged over two floors, which can be accessed using a passenger lift in the main building, or a stair lift in the extension. On the day of the inspection there were nine people living at the home and two people were in hospital.

There has not been a registered manager at the service since December 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. A new manager has been recruited and they are in the process of registering with CQC.

Staff told us the new manager was providing them with leadership and support and wanted the best for people using the service. They were also keen to tell us about the improvements which had been made since our last inspection.

People who used the service told us they felt safe with the care they were provided with. We found there were appropriate systems in place to protect people from risk of harm.

Recruitment procedures were in place and checks were being completed before staff started work, however, gaps in employment were not always being explored. Staff told us they felt supported by the manager and that training opportunities were good. They liked the training sessions the provider was holding and found the discussions helped them to gain a better understanding of the various topics. People we spoke with told us they liked the staff. We found staff friendly and helpful and there was a nice atmosphere in the home.

There were enough staff on duty to make sure people’s care needs were met and some activities were on offer to keep people occupied . The provider is aware they will need to increase staffing levels as more people move into the home.

The home was well maintained and homely. People’s bedrooms were personalised and we found everywhere was clean and tidy.

We found people had access to healthcare services and these were accessed in a timely way to make sure people’s health care needs were met. We found some improvements were needed to make sure the medication system continued to be managed safely.

On the day of our visit people looked well cared for. We saw staff speaking calmly and respectfully to people who used the service. Staff demonstrated they knew people’s individual preferences and what they needed to do to meet their care needs.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS), but all staff needed to be aware of who had a DoLS in place and of any conditions which had been applied to make sure people’s rights were protected and promoted.

There was a complaints procedure in place and the manager made contact with relatives every month to discuss any improvements they wished to see.

We saw systems had been introduced to monitor the qualit

The inspection took place on 12 January 2015 and was unannounced. There were 14 people living at the home at the time of the inspection.

At the last inspection on 15 & 23 September 2014 enforcement action was taken due to breaches in regulations which related to the care and welfare of people who used the service, the safety and suitability of the premises, cleanliness and infection control and quality assurance. There were four other breaches in regulation which related to meeting people’s nutritional needs, staff recruitment, staffing numbers and supporting workers. At this inspection we found significant improvements had been made to meet the relevant requirements. However; they need to be sustained and developed further to make sure people consistently receive high quality care.

Bankfield Manor is a residential care home situated in the Boothtown area of Halifax. The home provides accommodation, personal care and support for up to 25 older people. Accommodation at the home is provided over two floors, which can be accessed using a passenger lift in the main building and a stair lift in the extension.

The service should have a registered manager but did not have one at the time of this inspection. 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.

The provider had introduced a range of audits to ensure standards were improved and then maintained. For example, checks were done to make sure staff were up to date with training on safe working practices. We also saw checks on mattresses and cushions were in place and old or damaged mattresses and cushions had been replaced. However there were no medication audits and we found that medication was not always managed safely. Accidents and incident were monitored but not frequently enough to enable the provider to identify possible trends and take action to reduce risk in a timely way.

The home was clean and hygienic and concerns about maintenance which had been identified at the last inspection had been addressed.

People told us they felt safe. There were enough staff to meet people’s needs. The right checks were done before new staff started work to make sure they were suitable to work in a care setting.

Staff had received a lot of training since the last inspection to help make sure they had the right skills and knowledge to meet people’s needs and induction training was provided to new staff.

People who lacked capacity were not always protected under the Mental Capacity Act 2005 and the service was not meeting the requirements of the Deprivation of Liberty Safeguards.

People’s care needs were assessed and there were care plans in place to show how they were supported to meet their needs. The care plans had information about people’s needs and preferences and we saw some evidence that people or their representatives had been involved in planning their care. People told us they enjoyed the food and we saw the choice and quality of food had improved since the last inspection. People had access to a range of NHS services to support them to meet their health care needs.

People told us the staff were kind and caring and this was confirmed by our observations throughout the day. We saw staff chatting with people and engaging them in activities. People told us staff respected their privacy and dignity.

The complaints procedure was displayed but complaints were not always recorded.

We found four breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.

The inspection visit was carried out by one inspector. During the inspection, they spoke with the home manager, a senior care assistant, a care assistant, the cleaner, three people who lived at the home and three regular visitors, two of whom were relatives. The inspector also looked around the premises, observed staff interactions with people who lived at the home, and looked at records.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was clean and hygienic. However, we found people may not be protected from the risk of infection because appropriate guidance had not been followed. We have asked the provider to make improvements.

We also found parts of the premises and grounds were not being adequately maintained. We have asked the provider to make improvements.

There were enough staff on duty to meet the needs of the people who lived at the home.

One visitor, who was a friend, told us, “They seem to have plenty of staff around and they’re always friendly. He’s enjoying the meals.”

Is the service effective?

We looked at three people’s care files we saw their individual needs were assessed thoroughly and care and support was developed from an assessment of their needs.

One person’s care records showed they had recently been in hospital and had returned to the home with weight loss and pressure sores. Their care records showed the pressure sores were now healed and they were gaining weight.

People were provided with a healthy nutritionally balanced diet to support their health, this protected people from the risks of inadequate nutrition and dehydration.

Is the service caring?

People were supported by kind and attentive staff who obviously knew people well. We saw that care assistants were patient and encouraging when supporting people.

The manager told us, “The care here is 150%, I really can say that.”

The three visitors we spoke with all told us they were very happy with the care provided at the home. One person’s relative told us, “He seems to like it here and he’s doing better than he was at home. He’s been playing dominoes and socialising more.”

The visitor who was a friend told us, “The staff here are always friendly. He’s enjoying the meals.”

The care assistants we spoke with told us they felt confident the service provided to people who lived at the home was good and they had a good staff team.

When we looked around the home we saw people’s bedrooms had been personalised and contained personal items such as family photographs.

Is the service responsive?

We saw from the care records that people’s needs had been assessed before they moved into the home. Records confirmed people’s preferences, interests and life histories had been recorded. The care, treatment and support provided at the home met their individual needs.

People had access to appropriate activities and were supported to maintain relationships with their friends and relatives.

Is the service well-led?

The home manager told us they had been in post since June 2013 and were applying to the Care Quality Commission to become the registered manager at the home.

Staff we spoke with told us they felt well-supported by the new manager. One of them said, “The manager is really lovely; very approachable and encouraging.”

However we found people were not protected against the risks of inappropriate or unsafe care because the provider did not have an effective system to assess and monitor the quality of service people received. We have asked the provider to make improvements.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

During our visit we spoke with four people living at the home, two relatives, two staff, the acting manager and the provider.

The two care workers we spoke with felt confident the care provided to the people living at the home was good. They told us they felt well-supported by the acting manager and provider. They said they felt confident about raising any personal or work-related issues with them.

One relative we spoke with said their mother had lived at the home for nine years and they felt the care was very good. They told us “If there are any problems they always put things right; they are straight on with it.” The second relative we spoke with was also very pleased with the care provided. They said “We’ve been quite happy with the care, they seem to jolly her along.”

The four people living at the home all told us they felt safe living there. They told us the food was good and they got plenty of choices about their daily living. One person told us, “I have a lovely bedroom, I can’t grumble there. It’s a nice place altogether – yes, I’m very happy here.” Another person said, “I enjoy living here, the staff are fine. I’ve never had to complain. You can play games if you want; I like noughts and crosses.”

Many of the people living at the home were unable, due to complex care needs, to comment on the service they received. Two people told us that they like living at the home and that the staff are very good and kind.

People told us that generally they were happy at the home and that the staff are very good. Two people said that they would like to stay in bed longer in a morning. All of the people we spoke with said that the food is very good.

This inspection took place on 2 and 24 September 2015 and both visits were unannounced. At the last inspection on 12 January 2015 we found four breaches in regulations which related to safe care and treatment, need for consent, receiving and acting upon complaints and good governance. The provider sent us an action plan for the breaches which told us improvements would be made by 30 May 2015.

At this inspection we found continued breaches of regulations which related to safe care and treatment, receiving and acting upon complaints, good governance and further breaches in relation to dignity and respect, safeguarding service users from abuse and improper treatment and staffing.

Bankfield Manor is a residential care home situated in the Boothtown area of Halifax. The service provides accommodation, personal care and support for up to 25 older people and people living with dementia. Accommodation at the home is provider over two floors, which can be accessed using a passenger lift in the main building and a stair lift in the extension. At the time of our visit there were 10 people living there as the provider had agreed a voluntary suspension on admissions with the local authority until improvements had been made.

The service has 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.

There were areas of the home which were not clean or safe. Some of the furniture was not suitable for the people using the service and some equipment did not have the necessary safety certificates in place.

The medication system was not well managed and there was no assurance people were receiving all of their medication as prescribed by their doctor.

People told us they felt safe and staff understood how to report any concerns about people’s care and support.

We found staff were being recruited safely, however, we found there were not enough always enough staff to make sure people’s needs were met or to keep the home clean. Although the staff training matrix showed staff training was mostly up to date, staff understanding of infection prevention procedures, for example, was poor in practice. Formal supervisions and appraisals were not up to date.

The registered manager, who was cooking on both days of our visit, had a good understanding of people’s food preferences and we saw good stocks of branded food items in the fridges, freezer and stock cupboards. People told us the meals were good.

We found staff were not always following the advice they had been given by health care professionals, which meant people were not receiving support in the safest way. Care plans were in place but had not always been updated to reflect people’s current needs. Some of the interactions we saw between staff and people using the service were not respectful.

Concerns and complaints were not always being recognised and dealt with effectively. One person identified a number of things they were not happy with and these had not been addressed either through the care planning process or through the complaints procedure.

Information about people using the service was not stored securely, which meant they were not assured information about them would be kept confidential.

When we inspected the service in September 2014 and January 2015 we found breaches of regulations. The provider assured us they would make the required improvements following both visits, however, again on this inspection we identified continued breaches of regulations. The service lacked leadership and the quality systems in place were not effective in identifying areas for improvement or driving up the standards in the service. The office was chaotic and records were difficult to find or did not exist. On the second day of our inspection the provider and registered manager told us the manager would be ‘standing down’ as the registered manager and taking on the catering.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate in any of the five key questions it will no longer be in special measures.