Bankfield Manor Care Home

People’s experience of using this service and what we found

People felt their relatives were safe. When we asked about this one relative said, “Yes (relative) is (safe). They take measures to keep (them) safe because (person) wasn’t safe at home”.

Systems were in place to safeguard people from the risk of abuse. People received their medication as prescribed by staff who had been appropriately trained. Risks to people were effectively managed through person centred risk assessments and care planning.

Safe infection prevention and control (IPC) practices were in place to minimise the risk of spread of infection. The provider had given additional support to staff to help them understand the vaccine for COVID-19.

Systems in place to monitor the service were effective in identifying and addressing areas that required improvement. There was a positive culture at the service. People were happy with the support their relatives received. People were kept up to date about any changes about the service and their relative.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 2 February 2018).

Why we inspected

This inspection was prompted through our intelligence monitoring system and receipt of information of concern. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service remains as good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bankfield Manor on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

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.

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 quality of the service. We saw these were identifying areas for improvement and action had been taken to address any shortfalls which had been identified. People using the service and relatives were being consulted about the way the service was being managed and their views were being acted upon. We concluded as the audits were relatively new the provider needs to ensure the development of their quality systems continues so they can be assured the service is being well managed and developed in line with best practice.

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

The first day of the inspection was carried out by two inspectors between 4pm and 8.30pm. The second day of the inspection was carried out by the same two inspectors and an expert by experience; the two inspectors visited the home between 7am and 5.30pm and the expert by experience visited the home between 9am and 5.30pm. Both inspection visits were unannounced. Before the visit the lead inspector spoke with the local authority contracts department about care at the home. They also reviewed the report from most recent contracts performance and quality site visit.

During the inspection, the inspection team spoke with the acting manager, the provider (who was also the owner), the previous registered manager, two visiting healthcare professionals, seven care workers, one domestic assistant, six people who lived at the home and three relatives, who were regular visitors. The inspectors also looked around the premises, observed staff interactions with people who lived at the home and looked at records. They looked at six people's care records, five staff recruitment files, five staff training files and documents and policies relating to the management of the home. There were 17 people living at the home on the first day of the visit and 16 on the second day.

In this report the name of a registered manager appears who was not in post and not managing the regulated 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.

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?

The service was not safe. People were not protected from abuse and avoidable harm. There were insufficient numbers of suitably qualified and trained staff to meet people's needs and people were cared for in an environment that was not safe, secure, clean, hygienic or well maintained. The home had a malodour throughout on both visit days.

Emergency procedures at the home were not robust and staff who worked at the home were not aware of what to do in the case of an emergency. Some of the equipment at the home was found to be unsafe or out of order.

Following our visit we made individual and whole service safeguarding referrals to the local authority so that someone independent of the service could consider the issues. We also made referrals to the fire service, infection prevention and control and environmental health. We discussed our findings with the local authority contracts department who commission the care for 14 of the people at the home.

Is the service effective?

The service was not effective.

Records showed the majority of the care staff at the home were not up to date with the training required to carry out their work. Staff were not receiving regular supervision to monitor their performance and development needs. All staff had received an appraisal during March and April in 2014.

People were not all getting sufficient quantities of nutrition and hydration to meet their needs and several people had lost significant amounts of weight. The quality and choice of food offered to people at the home did not promote people's health and well-being.

There was evidence of referrals and involvement of external healthcare professionals where people needed extra support to meet their needs. However, people's care, treatment and support at the home did not always achieve good outcomes or promote a good quality of life for the people who lived there.

Is the service caring?

The service was not always caring.

Some people and relatives told us they were happy with the care provided at the home, others told us their care, treatment and support needs were not being met.

People's views and experiences were not always taken into account in the way the service was provided and delivered in relation to their care.

From our observations, and from speaking with staff, people who lived at the home and relatives, we found most staff knew people well and were aware of their care and support needs. Staff interactions were observed to be kind and caring.

Is the service responsive?

The service was not responsive.

Staffing levels, and the inappropriate deployment of staff, meant people's needs were not always being met. A number of staff had left or were leaving and this meant there were regularly gaps on the rotas which needed to be filled at short notice.

Activities at the home were limited to what could be provided by the care staff. We saw care workers engaging some people in activities; however other people who lived at the home were seen to spend long periods without any engagement by staff.

We saw limited evidence of involvement, consultation and communication with people who lived at the home, relatives and staff. Feedback given by people who lived at the home about the food and menu choices had not been acted upon. People and relatives told us they had never been asked their opinion about the care at the home.

Is the service well-led?

The service was not well-led.

The previous registered manager had left the home in July 2014 and an acting manager had been in post since 14 July 2014. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. The acting manager had not applied to become the registered manager; they told us they 'Wanted to get things right' before they submitted their application.

The provider's quality assurance processes and systems for monitoring and improving the service had not been carried out on a regular basis since June 2013. Audits carried out were infrequent and did not follow a schedule. Accidents and incidents were not properly recorded and acted on and there was no analysis of incidents.

The leadership and management of the home did not have systems in place to assure the delivery of high quality, person centred care. The provider did not support learning and innovation or promote an open and fair culture.

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.

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.'