Bannow Retirement Home 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.

Bannow provides care and support for up to 26 older people most of whom are living with dementia. The care needs of people varied, some people had complex dementia care needs that included behaviours that challenged. Other people's needs were less complex and required care and support associated with old age, mild dementia and memory loss. Most people were fully mobile and able to walk around the service unaided. At the time of this inspection there were 19 people living at the home.

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.

At our last inspection in November 2017, the service was rated requires improvement. We asked the provider to take action. The provider submitted an action plan saying what they would do to meet the legal requirements in relation to the breaches we found. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. At this inspection we found that the breaches of Regulation 11 we previously found, in relation to the provider not acting in accordance with legal requirements in seeking consent, had been met.

We found that the breaches of Regulation 12 we previously found, in relation to the provider not ensuring the safety of people by assessing the risks to their health and safety, had also been met.

We found that the provider had also met the breaches we found in relation to Regulation 17 where the provider had not ensured that good governance had been maintained and that systems were not fully in place to monitor and improve the quality and safety of the service provided.

We also found that the breaches of Regulation 18 we previously found, in relation to the provider not ensuring that staff were given the appropriate support to carry out their duties, had been met. The provider had also met the second breach of Regulation 18 in relation to not previously ensuring that sufficient numbers of suitably qualified staff were deployed.

Whilst improvements had been made to people’s in-house activities, this was not consistent for everyone. Some people were not receiving the stimulation and social engagement that they needed to improve their quality of life. We identified this as an area of practice that continues to need improvement.

The provider and registered manager had made improvements to the governance and systems to monitor and improve the quality of service provided. Although the actions taken were evident and ensured that the provider was no longer in breach of the regulation, the improvements were not yet fully embedded and sustained. Therefore, this remains an area of practice that needs improvement.

We observed some good caring practices and engagement between staff and people. However, we observed some practices where staff did not always ensure people’s dignity was maintained. This is an area of practice that needs improvement.

People told us they felt safe living at the home. People were protected from abuse by staff who understood their role in keeping people safe. The safeguarding adults’ policy was up to date so staff had up to date information to refer to about how to keep people safe from abuse. Staff we spoke with understood how to keep people safe from abuse.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems

Bannow Retirement 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.

Bannow provides care and support for up to 26 older people most of who are living with dementia. The care needs of people varied, some people had complex dementia care needs that included behaviours that challenged. Other people’s needs were less complex and required care and support associated with old age, mild dementia and memory loss. Most people were fully mobile and able to walk around the home unaided. At the time of this inspection there were 23 people living at the home.

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.’

This comprehensive unannounced inspection took place on 7 and 10 November 2017. Bannow was last inspected in October 2016 and was rated Good. We brought this inspection forward to follow up on concerns raised by whistle-blowers and because there had been a high number of safeguarding referrals. ‘Whistleblowing’ is when a worker reports suspected wrongdoing at work. Officially this is called, ‘making a disclosure in the public interest.’ We originally planned to carry out a focussed inspection but during our inspection we changed from a focused to a comprehensive inspection.

In recent months we received concerns from two whistle blowers (WB). During our inspection we received concerns from a third WB and following our inspection we received further concerns from another WB. Concerns included a lack of cleanliness, poor moving and handling and poor care. We looked at some of the concerns raised and asked the provider to carry out an investigation of the remaining concerns. We found some of the concerns were substantiated and some the provider had already addressed.

We found there was a lack of consistent and strong leadership or provider oversight. We identified areas of record keeping that needed to improve to document more clearly the running of the home. For example, in relation to incident records. Improvements were needed in relation to auditing as a number of areas we identified had not been picked up as part of regular monitoring. This included auditing in relation to care planning and cleanliness. Staff morale was low, staff did not receive regular supervision and did not feel supported. There were also some shortfalls in the management of medicines prescribed on an ‘as required’ basis, in relation to monitoring of catheter care, and in consideration of risks when caring for people whose behaviour can challenge. We saw some practices did not demonstrate a caring approach was always used.’ We made a recommendation to expand the dementia friendly activities available.

Information regarding Deprivation of Liberty Safeguard (DoLS) and mental capacity were not detailed in care plans. (A DoLS is used when it is assessed as necessary to deprive a person of their liberty in their best interests and the methods used should be as least restrictive as possible).

Staff did not have all the information they needed to understand why some people had restrictions in place and this left the potential for some people to have been unnecessarily restricted.

Whilst on the first day of inspection the environment was not clean, staff morale was low and there was a tense atmosphere. There was a marked difference on our second day. The environment was clean, staff were positive and there was a calm and pleasant atmosphere. Staff spoke about it having been a difficult year but were keen and eager for change and were positive a

Bannow Retirement Home provides care and support for up to 26 older people most of who are living with dementia. The care needs of people varied, some people had complex dementia care needs that included behaviours that challenged. Other people’s needs were less complex and required care and support associated with old age, mild dementia and memory loss. Most people were fully mobile and able to walk around the home unaided. At the time of this inspection there were 23 people living at the home.

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.

This comprehensive unannounced inspection took place on 06 and 10 October 2016.

Staff had a good understanding of the risks associated with supporting people. They knew what actions to take to mitigate these risks and provide a safe environment for people to live. They understood what they needed to do to protect people from the risk of abuse. Appropriate checks had taken place before staff were employed to ensure they were able to work safely with people at the home.

The registered manager and staff had completed training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They had assessed that some restrictions were required to keep people safe for example, the front door was locked, there was a sensor on the stairs and stair gates on each floor, the use of bed rails for some people and lap straps on wheelchairs. Where this was the case referrals had been made to the local authority for authorisations.

There were safe procedures for the management of medicines. People had access to healthcare professionals when they needed it. This included GP’s, dentists, community nurses, opticians and dentists.

People were asked for their permission before staff assisted them with care or support. Staff had the skills and knowledge necessary to provide people with safe and effective care. Staff received regular support from management which made them feel supported and valued. They were encouraged to develop their skills and take on additional responsibilities.

The registered manager was approachable and supportive and took an active role in the day to day running of the service. Staff were able to discuss concerns with them at any time and know they would be addressed appropriately. Staff and people spoke positively about the way the service was managed and the positive culture.

The home had recently recruited an activity coordinator. This was a new role and at the time of inspection the role was evolving. Each person’s needs and wishes were being assessed and it was hoped that this role would be an asset to people and to the home. There was a variety of activities offered and this was under continual review to ensure that people’s needs were met.

Staff were kind and caring, they had developed good relationships with people. They treated them with kindness, compassion and understanding. Staff supported people to enable them to remain as independent as possible. They communicated clearly with people in a caring and supportive manner. We received very positive feedback from relatives and visiting professionals about the care provided.

When we inspected this service in June 2013 we found that there were no effective systems in place to assess and monitor the quality of service provided. The provider told us that they would ensure these shortfalls were addressed. This inspection was carried out to follow up on the progress made by the home in relation to this essential standard.

We found that the home had put in place new systems for monitoring the quality of service provision. The new systems were working well and records demonstrated that the home was continually reviewing and improving upon the service it provided.

During our visit we noted environmental issues that caused us to look more closely at that essential standard. We saw that measures had been put in place to address problems caused by a broken boiler. Due to the increased risks in relation to fire safety a referral was made to the fire service.

Most people using the service had complex needs which meant they were not able to tell us their experiences. Those who could speak to us told us that they were well cared for and that staff looked after them well. They said that the portable heaters worked well and they had not been cold. One person told us, “I don’t feel the cold. I don’t put my heater on in the mornings. I put it on in the evenings if I need to.”

We used a number of different methods, as stated above, to help us understand the experiences of people using the service, because people using the service had complex needs which meant they were not able to tell us their experiences.

Those who could speak with us told us that they were looked after well. One person said “By and large the staff are very good, I don’t bother with activities, I watch others.” We spoke with a relative of one person who told us, "We can't fault the home in any way, my mum has settled in well and the home are good at keeping us informed of her progress."

We observed staff interacting positively with people and noted that staff took time to speak with people individually over the course of the afternoon. Where appropriate, specialist advice and support, was obtained.

Overall, we found that care plans clearly documented the needs of people and how they should be met.

Staff roles in relation to cleaning were clear. The home was generally clean. Although there were a number of systems in place to monitor the quality of the care and environment, records did not fully demonstrate that they were effective.

We used a number of different methods, including SOFI, to help us understand the experiences of people using the service, because people using the service had complex needs which meant they were not able to tell us their experiences.

Those who could speak with us told us that they were looked after well. One person said, "The food is good and we have a choice.” Another person said “The staff are good to us.”

We observed staff interacting positively with people. Where appropriate, specialist advice and support was obtained.

There were sufficient numbers of staff on duty and staff felt well supported. Staff were clear about what they should do if they suspected abuse. We noted shortfalls in record keeping which meant that the home was not always able to demonstrate that care was provided in line with people’s assessed needs.