The Bancroft Residential Home Limited (‘The Bancroft’) 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 registered to provide accommodation for up to 32 people, including older people and people living with dementia.

We inspected the service on 21 and 23 November 2017. The first day of our inspection was unannounced. On the first day of our inspection there were 30 people living in the home.

There were two registered managers who shared responsibility for the running of the home. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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.

In July 2016 we conducted our first comprehensive inspection of the home and rated it as Requires Improvement. On this inspection we were pleased to find the provider had taken action to address the shortfalls identified at our last inspection and the rating is now Good.

Staff worked well together in a mutually supportive way and communicated effectively, internally and externally. Training and supervision systems were in place to provide staff with the knowledge and skills they required to meet people’s needs effectively. There were usually sufficient staff to meet people’s care and support needs without rushing, although the registered managers agreed to give this further review in the light of some feedback we received. Staff provided end of life care in a sensitive and person-centred way.

Staff were kind and attentive in their approach. People were provided with food and drink of good quality that met their individual needs and preferences. The physical environment and facilities in the home reflected people’s requirements. People were provided with physical and mental stimulation appropriate to their needs.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. Systems were in place to ensure effective infection prevention and control.

The registered managers were well known to, and respected by, everyone connected to the service. They had taken action to address the areas for improvement identified at our last inspection. A range of audits was in place to monitor the quality and safety of service provision. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm. There was evidence of organisational learning from significant incidents and events. Formal complaints were rare and any informal concerns were handled effectively.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had been granted DoLS authorisations for seven people living in the care home and was waiting for a further 10 applications to be assessed by the local authority. Staff understood the principles of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people. Decisions that senior staff had been made as being in people’s best interests were documented correctly.

The Bancroft Residential Home Limited is registered to provide accommodation for up to 32 older people requiring nursing or personal care, including people living with dementia.

We inspected the home on 12 July 2016. The inspection was unannounced. There were 30 people living in the home on the day of our inspection.

There were two registered managers who shared responsibility for the running of the home. A manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had submitted DoLS applications for 19 people living in the home and was waiting for these to be assessed by the local authority.

We found some areas in which improvement was needed to ensure people were provided with safe, effective care and that the provider’s regulatory responsibilities were met in full.

We found that the management of people’s medicines was not conducted safely in line with good practice and national guidance. We also found that audit and quality monitoring systems were not consistently effective and that the provider had failed to notify us of a significant issue relating to the safety and welfare of someone living in the home.

In other areas, the provider was meeting people’s needs effectively.

Staff knew how to recognise signs of potential abuse and how to report any concerns. Staff also had a good understanding of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people.

Staff worked closely with local healthcare services to ensure people had access to specialist support whenever this was required. People’s risk assessments were reviewed and updated to take account of changes in their needs.

There was a rich variety of activities and events on offer, organised and facilitated by an award-winning activities co-ordinator. People were provided with food and drink of good quality.

There was a warm and welcoming atmosphere in the home and staff provided kind, person-centred care.

There were sufficient staff to meet people’s care needs and staff worked together in a friendly and supportive way. The provider supported staff to undertake their core training requirements and encouraged them to study for advanced qualifications.

The registered managers demonstrated an open and responsive management style and provided strong, values-led leadership to the staff team.

The registered managers maintained a high profile presence in the home and encouraged people and their relatives to come directly to them with concerns. Any formal complaints were well-managed.

A single inspector carried out this inspection. At the time of the inspection, there were 31 people using the service. We talked with six of these people and four relatives. We looked at five people’s care records and observed care being provided. We talked with three care staff and the two managers. We examined the documentation related to quality audits and staff training.

This helped us to answer the questions below:

Is the service safe?

People told us they felt safe at the home. They had confidence in the staff caring for them and the managers.

Safeguarding policies were in place and staff understood their role in safeguarding the people they supported. Staff had attended safeguarding training and recent supervision sessions had focused on safeguarding issues.

Risk assessments were in place to identify the risks to the people using the service and provide staff with action to take to reduce these risks. We saw there was evidence of learning from an incident which had occurred, in relation to the assessment of risk with hot drinks and the increased supervision of people at risk when drinks were provided.

Is the service effective?

People’s care and support needs were assessed and care plans were in place to ensure care and support was provided in response to their individual needs and wishes.

Staff were provided with the training and supervision necessary for the provision of safe and effective care.

Relatives we spoke with confirmed they were no restrictions placed on them visiting their relatives at any time and said that staff communicated well with them, keeping them informed as necessary.

Is the service caring?

We saw staff had good relationships with people using the service and interacted with them in a caring and professional manner, preserving their dignity.

We observed staff encouraging people to eat and drink and checking with them to ensure they were given choices..

People’s interests, hobbies and preferences were identified and where possible activities organised to take account of these.

Is the service responsive?

The service cooperated well with other professionals and services, to ensure care was provided in response to people’s changing needs. Staff acted on the advice of visiting professionals and implemented care in line with their recommendations.

Staff were alert to the signs of ill health and ensured people had access to health services as necessary.

People using the service were asked to complete a twice yearly satisfaction survey. The results of these were analysed and changes introduced as a result, to improve the quality of the service provided.

Is the service well led?

Systems were in place to monitor and assess the quality of the service provided.

Staffing levels were regularly reviewed to take account of changes in the needs of people using the service.

The managers were actively involved in the care and support of people using the service and they were well known to people and their relatives. As a result, people felt they could speak to them at any time and they told us they were confident that any issues or concerns would be addressed.

There were 28 people living at the Bancroft of the day we visited. We spent time observing care, spoke to people living in the home and spoke to staff.

We spend time observing care and saw there was a warm caring relationship between people living at the home and the care staff. One person told us, “It’s good to live here. You do what you want and everyone looks after you. The food is good and there is plenty of it.” We observed breakfast and could see it was a pleasant experience for people.

We saw people were able to get up and receive care at a time that suited them.

Records showed the provider had worked in co-operation with other services. For example, care plans recorded people were seen by their GP, the community nurses, an optician and the chiropodist.

We saw the home was decorated to an appropriate standard. All the communal areas and facilities were accessible to people with restricted mobility.

Staff received appropriate training, supervision and appraisals to provide safe care to people.

Records showed people living at the home had been asked for their views on the service on February 2013. We reviewed the results and comments showed people were happy with the care they received. One person had commented, “I am happy that I can discuss any issues with the staff and management.”

On the day we visited there were 30 people living at The Bancroft Residential home. We spoke with three people who lived at the home, one relative two members of staff and the manager. 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 to us.

We saw staff were supportive and encouraging when helping people with a variety of daily tasks. Meal times were calm and relaxed with a choice of food.

People we spoke with were positive about the care and support they received. One person told us, “I don’t get up till 10am, they bring me breakfast in bed.” They also told us, “I’m quite happy with things here.” A relative told us, “I like everything, the way they look after her. I can’t fault them. Staff are good and there is always people around.”