West Bank Care Home is registered to provide accommodation and personal care for a maximum of ten people who have mental health needs. At the time of our inspection there were six people living at the home.

The service did not have a registered manager in post since it was run by a sole provider. However, the provider employs two care managers to manage the service on a day to day basis. 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.

West Bank 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.

This inspection took place on 23 October 2018 and was unannounced. Our last inspection took place on 12 December 2016 and at that time we found a breach of Regulation 20A (Requirement to display performance assessments) of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff told us they had regular safeguarding training, and they were confident they knew how to recognise and report potential abuse. However, we found the provider had not always reported safeguarding incidents to the Commission as required.

Overall, people’s medicines were managed safely and people told us they received their medicines at the right time. However, we found staff administering medicines had not completed competency assessments. This was not in line with National Institute for Health and Care Excellence (NICE) guidance. In addition, no protocols were in place for medicines prescribed on a 'As required' (PRN) basis.

There were enough staff to support people when they needed assistance and the provider followed a robust recruitment procedure to ensure only people suitable to working in the caring profession were employed. Suitable arrangements were in place to make sure staff were trained and supervised.

People’s needs were assessed before they moved into the home. However, the assessment documentation we looked at was not sufficiently detailed and did not show how the provider concluded the staff team had the necessary skills and resources to meet people’s needs.

Each person had a care plan in place which provided staff with the information required to provide appropriate, care treatment and support. People’s care and support was kept under review and where appropriate, they were involved in decisions about their care.

The atmosphere in the home was relaxed and from our observations, it was clear staff knew individual people well and were knowledgeable about their needs, preferences and personalities.

There was a limited range of leisure activities for people to participate in, including both activities in the home and in the local community. However, more could be done to ensure people enjoyed a full and active life. People told us they enjoyed the meals provided and were involved in menu planning.

Most risk assessments were well completed. However, in one person’s records we found the risk assessment relating to smoking was not sufficiently detailed and had not considered all the risk factors. In addition, the fire risk assessment and evacuation plan required updating.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act 2005 (MCA).

We saw the complaints policy was available. The policy detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received.

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Our inspection of West Bank Care Home took place on 12 December 2016 and was unannounced. At the previous inspection in March 2016 we found the provider was not meeting the regulatory requirements in relation to respecting people's dignity, training, maintaining a safe environment, medicines management of 'as required' medicines and having systems and processes in place to assess, monitor and improve the quality of the service. We took enforcement action and this inspection was to check improvements had been made.

West Bank Care Home is is registered to provide nursing and personal care for a maximum of ten people who have mental health needs. At the time of our inspection there were seven people living at the service.

At the time of our inspection, the service was managed by two care managers. Due to the provider being registered as an individual, the service does not require a registered manager to be in place. 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 the service had made improvements since our last inspection. However, we would need to see these sustained over a period of time and other improvements made before reviewing our rating above 'requires improvement'.

People told us they felt safe with the care and support they received. Staff had received safeguarding training and understood how to report any concerns.

Medicines were safely managed and 'as required' medicines protocols were in place.

Accidents and incidents were minimal. However these were appropriately documented with actions taken and included in the audit process.

The premises was well maintained and clean; daily audits were in place with actions seen to be taken where required. However, we noted radiator covers still needed to be put in place.

Risk assessments were present in people's care records to mitigate risks to people living at the service. Care records were detailed, up to date and pertinent to the person's care and support needs. People had signed consent to their plans of care.

The service was acting within the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberties Safeguards (DoLS).

People told us they enjoyed living at the service and staff were kind and caring. Sufficient staff were employed to keep people safe and staff were recruited in a safe manner. Training was mostly up to date.

The atmosphere at the service was calm and relaxed and staff knew people's care and support needs well.

The service was supporting people's health care needs and we saw a range of multi-disciplinary team involvement.

People told us they enjoyed the food. We saw people's nutritional needs were met, appropriate referrals made and action plans put in place when someone was assessed at nutritional risk.

Activities were planned according to individual preferences and people were looking forward to the planned Christmas festivities.

Evidence was in place of improvements to the audit process with actions seen to be taken as a result of these.

Staff meetings had taken place and staff told us they were happy working at the service.

Resident meetings had been held as well as quality questionnaires completed by people living at the service.

The provider needed to have better communication systems in place in case of emergency as well as increased provider support to the service.

The service had not displayed the rating from the previous inspection at the premises or on its website. This was a breach of regulation.

You can see what action we told the provider to take at the back of the full version of the report.

We inspected West Bank Care Home on 24 and 30 March 2016 and the visit was unannounced. Our last full inspection of this service took place in June 2013. At that time, we found the provider was not meeting the regulations in relation to staffing and safe management of medicines. We took enforcement action and made two further visits to check that improvements had been made.

West Bank Care Home is a privately owned care home for adults who are living with a mental illness. The home is registered to carry out the regulated activity accommodation for persons who require nursing or personal care. Nursing is not provided. The home is registered to accommodate a maximum of ten people. There are eight bedrooms, one of which is shared. There is a dining room and lounge on the ground floor and a communal bathroom on the first floor.

At the time of our inspection the person managing the service was not registered with the Care Quality Commission.

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.

People who used the service told us they felt safe with the care they were provided with.

We found the home had not been maintained safely and standards of décor, furnishings and cleanliness were poor. For example there were no window restrictors in place, water at several outlets was running at a temperature which could have caused scalding and the call system was not working. Several areas of the home were not clean. We found this was a breach in regulation as the premises were not clean or well maintained.

Systems for managing medicines required some improvement as there were no protocols in place fro medicines prescribed on an 'as required or PRN basis. We found this was a breach in regulation.

Recruitment processes were robust and checks were completed before staff started work to make sure they were safe and suitable to work in the care sector. Staff told us they felt supported by the manager and that training opportunities were good. However we found staff had not received practical training in moving and handling people. We found this was a breach in regulation.

We found staff friendly and helpful and there was a nice atmosphere in the home. People who lived at the home told us they liked the staff.

We found the poor environmental standards demonstrated a lack of respect for the dignity of the people who lived at the home. We found this was a breach in regulation.

There were enough staff on duty to make sure people’s care needs were met and people were able to follow their choices in their daily routines.

We saw little evidence of people being supported in engaging in independent living skills

People had access to healthcare services as they were needed.

We found the service was meeting the legal requirements relating to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

People who lived at the home and staff spoke positively about the manager who was described as supportive and caring. We found them to be knowledgeable about their role. However, although some quality assurance systems were in place, the systems were not effective as they had failed to identify and rectify the significant issues we found at this inspection. We found this was a breach in regulation as there was not good governance.

Overall, we found significant shortfalls in the service provided to people. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

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

Services in special

At our previous visit in November 2013 we found that the service was not protecting people who lived in the home against the risks associated with medicines. Following that visit we issued the provider with a Warning Notice in respect of the non-compliance with regulation 13. We carried out this visit to check whether appropriate arrangements were now in place for the safe management of medicines. We found significant improvements had been made and overall we found medicines were now being safely and appropriately managed.

We checked the medicines records and stocks of nine people who used the service. We spoke with three people living in the home and whilst nobody was able to discuss their medicines in detail with us; no-one expressed any concerns about how their medicines were handled.

During our inspection on 2 July 2013 we found the registered care provider was not fully compliant with the Essential Standards of Quality and Safety. The registered care provider replied to us on the 26 July 2013 and should have told us about the improvements they were making to enable them to become compliant. The provider wrote to us and told us they would take action to ensure they were compliant. We carried out this inspection to see if they had taken action to become compliant with the standards.

As a result of this inspection a safeguarding alert was made to the City of Bradford Adult Protection Unit.

During the visit we had the opportunity to speak with three people who used the service. Everyone told us they were very happy with the care and support provided at West Bank. People who used the service said they were involved in discussions/decisions about their care needs and were kept informed about any changes. One said "I would not want to leave here I love it here."

Everyone said staff were approachable and supportive. People said the food was good and the home was warm and comfortable. People told us they could make choices and decisions about how they wanted to spend time at the home and staff encouraged them to be fully involved in making decisions about their care and treatment.

During the visit we had the opportunity to speak with two people who used the service. Everyone told us they were very happy with the care and support provided at West Bank. People who used the service said they were involved in discussions/decisions about their care needs and were kept informed about any changes. One said "I came here for three months and I'm still here years later." Everyone said the staff were approachable and supportive. People said the food was very good and the home was warm and comfortable.

We could not establish if there was adequate fire prevention between the kitchen situated in the cellar and the dining room directly above the kitchen on the ground floor. We also had concerns about the number of night staff and the fact that they had slept throughout their shift, even tough 24 hour cover was needed at the home.

Of the people spoken to who use services at West Bank Care Home, they said they were happy living at the home and the staff treated them well.