We carried out an unannounced inspection of Bank Hall Care Centre 14, 15 and 28 March 2018.

Bank Hall Care Centre is a care home which is registered to provide care and accommodation for up to 56 older adults and older adults living with a dementia. People in care homes receive accommodation and nursing 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 accommodation is provided in two interlinked premises Bank Hall and Scarlett House. Bank Hall - is a single storey former hospital, which has been adapted to provide residential accommodation. It is registered to accommodate up to 36 older people. All the bedrooms offer single occupancy and 11 have en-suite facilities. There are three lounges two having conservatory areas. There is a separate dining room and a hairdressing ‘salon’. Additional seating is provided in the entrance hallway. Scarlett House - is a two storey purpose built extension linked to the Bank Hall building, but with its own entrance. It is registered to accommodate up 20 older people with a dementia. All the bedrooms are single with en-suite facilities. There is a lounge with a joining dining area and a separate conservatory. A passenger lift provides access to the first floor accommodation. At the time of the inspection there were 27 people accommodated in Bank Hall and 11 in Scarlet House.

At the time of the inspection there was no registered manager at the service. However the manager, who had worked at the service for over 10 years had applied for registration. 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. Following the inspection we were informed the manager had achieved registration with the Commission.

At our last inspection on the 25 and 26 January 2017 the overall rating of the service was ‘Requires Improvement’. We found progress was needed with medicines management, checking systems and provider oversight of the service. We therefore made recommendations on these matters.

During this inspection we found there were no breaches of the regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. Sufficient improvements had been made. However, although we found medicine management processes to be safe, we again found some shortfalls which were in need of attention. We have therefore made a further recommendation on this matter.

During the inspection we were provided with information which gave us some cause for some concern about people’s well-being and safety. These matters were proactively and appropriately responded to by managers; however on writing this report the concerns were still under investigation. We have asked the provider to inform the Commission of the outcome of the investigations.

People told us they felt safe at the service. Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns. Training had been provided on safeguarding and protection matters.

Arrangements were in place to ensure staff were checked before working at the service. We found some checks had not been properly completed. But the area manager took swift action to make improvements.

There were enough staff available to provide care and support for people. Staffing levels were kept under review and changes made to ensure they were sufficient.

Systems were in place to ensure staff received ongoing training and development; action had been taken to monitor and achieve completion of the required training and development.

Arrangements were in place to promote the safety of the premises, this included servicing and checking systems. We

We carried out an unannounced inspection of Bank Hall Care Centre 25 and 26 January 2017. The first day of the inspection was unannounced.

Bank Hall Care Centre is registered to provide care for up to 56 people. It specialises in the care of older people and older people with a dementia and does not provide nursing care. The accommodation is provided in two interlinked premises Bank Hall and Scarlett House. The service is near to Burnley town centre. There are accessible gardens around the premises with garden furniture. There are car parking spaces for visitors.

Bank Hall - is a single storey former hospital, which has been adapted to provide residential accommodation. It is registered to accommodate up to 36 older people. All the bedrooms offer single occupancy and 11 have en-suite facilities. There are three lounges two having conservatory areas. There is a separate dining room and a hairdressing ‘salon’. Additional seating is provided in the entrance hallway.

Scarlett House - is a two storey purpose built extension linked to the Bank Hall building, but with its own entrance. It is registered to accommodate up 20 older people with a dementia. All the bedrooms are single with en-suite facilities. There is a lounge with a joining dining area and a separate conservatory. A passenger lift provides access to the first floor accommodation. At the time of the inspection there were 25 people accommodated in Bank Hall and 18 in Scarlet House.

At the time of the inspection the service was not managed by 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. The area manager, who was previously the registered manager at the service, was providing management cover.

At the previous inspection, we asked the provider to make improvements in relation to risks to people’s well-being, safety and security, assessing and managing risks to individual’s and monitoring and improving the quality of the service provided. We received an action plan from the provider indicating how and when they would meet the relevant legal requirements. At this inspection we found sufficient improvements had been made. People told us they felt safe at the service and they made positive comments about the care and support they experienced at Bank Hall Care Centre.

We found people had mixed views on the availability of staff support. Action had been taken to recruit additional staff and staff work patterns had been reviewed and adjusted to provide people with safe care and support. However, we made a recommendation on ensuring staffing arrangements were effectively monitored and adjusted in a timely way.

There were some good processes in place to manage and store people’s medicines safely. We found some improvements were needed; we have therefore made a recommendation about the management of medicines.

People had mixed views on the quality and variety of the meals provided. We found various choices were available, but some people thought there was a lack of variety. Drinks were readily accessible and regularly offered. We saw some people were not supported with their food in a dignified way; this matter was dealt with during the inspection. However, we made a recommendation on effectively supporting people living with a dementia with meal choices and their nutritional needs.

Recruitment practices made sure appropriate checks were carried out before staff started working at the service. Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns. Staff confirmed they had received training on safeguarding and protection.

The service was working within the principles of the MCA (Mental Capacity Act 2

People told us they were satisfied with the care and support provided at the service. They told us, “It’s nice, I like everything about it” and “They look after us”.

We found people experienced some good care and support. They told us they were treated with respect. However, we found progress could be made in engaging with and occupying people with dementia.

People were getting support with their healthcare needs and they had ongoing attention from health care professionals.

However, we found some progress was needed with care assessments and care planning to make sure people receive effective care and support.

People were being involved as far as possible in planning their care and were enabled to make decisions about matters which affected them. People were encouraged to maintain and develop their independence skills.

People told us they liked the staff. We found arrangements were in place to supervise, support and train staff. However, some arrangements for training needed to be developed.

People said they were satisfied with the clean and comfortable accommodation provided at the service. However, we found some improvements were needed in one shower room.

We observed people’s experience of care and support practices during this inspection. We saw people being supported and assisted by staff in a sensitive and respectful manner.

We found improvements had been made with the staffing arrangements at Bank Hall and Scarlett House. Staffing levels had increased and action was being taken to recruit and train new staff.

However, we found there was low staff morale at the service. There had been several changes in the staff team. Some staff indicated their workloads had increased. This meant there may be a lack of appropriate support for staff to ensure they provide effective care for people using the service.

People told us they were generally satisfied with the care and support they received at Bank Hall Care Centre. They told us, “It’s alright here, I can’t grumble” and “I like it here”. However, we found there were not enough staff at the home which meant people might not be looked after properly.

People were being involved as far as possible in planning their care and were enabled to make decisions about matters which affected them. People were able to maintain their independence skills. However, we found there were not enough opportunities for meaningful activities and interactions.

People were getting support with their healthcare needs and they had ongoing attention from health care professionals. However we found care records were not always up to date and complete, which meant peoples’ needs and choices may not be known and properly planned for.

Most people had no complaints about the services being provided at Bank Hall. They knew how to raise concerns and were confident they would be dealt with.

We found the atmosphere at Bank Hall to be open, friendly and welcoming. One visiting relative told us, “It’s a safe, caring environment”. Another said, “I would give Bank Hall 19 out of 20, they care for people very much”.

People living at Bank Hall said they were satisfied with the care and services they received, that they were enabled to make choices and decisions about matters which affected them. People said, “I like it, I have my own room, I can do what I want” and “I decide if I want to go out, I agree with staff so they know where I’m going and when to expect me back”. They said staff treated them well, that they were enabled to maintain their independence and they were treated with respect.

People said they were getting support with healthcare needs and that they had ongoing attention from health care professionals. They were being supported sensitively with personal care needs. There were instructions and details written in ‘care plans’, so that care workers knew how to provide for peoples’ individual needs and choices.

Most people made positive comments about the catering arrangements. Choice menus were available and specific diets were being catered for. People said “We get good food” and “If you don’t like it you can have something else”.

Positive relationships were being encouraged and it was apparent visitors were being made welcome at the home. People were generally satisfied with the activities on offer.

We received positive comments about the accommodation and facilities provided at Bank Hall. One relative said, “Bank Hall is always kept clean, my relatives’ room is lovely”.

People described the staff as, hard working, kind and helpful. One commented, “They are very good helpers. I was a visitor before I came so I knew all the staff, it really was like home from home”

We carried out an unannounced inspection of Bank Hall Care Centre on 3 and 4 December 2014. Bank Hall Care Centre is registered to provide care for up to 56 people. It specialises in the care of older people and older people with a dementia and does not provide nursing care.The accommodation is provided in two interlinked premises Bank Hall and Scarlett House. The service is near to Burnley town centre. There are accessible gardens around the premises and car parking spaces for visitors.

Bank Hall is a single storey former hospital, which has been adapted to provide residential accommodation. It is registered to accommodate up to 36 older people. All the bedrooms offer single occupancy and 11 have en-suite facilities. There are three lounges, two having conservatories one of which is designated for people who smoke. There is a separate dining room and a hairdressing ‘salon’. Additional seating is provided in the entrance hallway.

Scarlett House is a two storey purpose built extension onto Bank Hall. It is registered to accommodate up 20 older people with a dementia. All the bedrooms are single with en-suite facilities. There is a lounge with a connecting dining area. A passenger lift provides access to the first floor accommodation.

At the previous inspection on 16 May 2013 we found the service was meeting all the standards assessed.

The service was managed by 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.

People told us they felt safe at the service and they made positive comments about the care and support they experienced. However we found some environmental risks had not been identified and assessed. Appropriate action had not been taken to reduce the risks to people’s well-being and safety. We found some records were not, clear up to date or accurate. This meant changes in people’s needs may not always be properly recorded and communicated. We also found there was lack of effective systems to assess, monitor and improve the quality of the service. You can see what action we told the provider to take at the back of the full version of the report.

People indicated there was an open and friendly atmosphere at the service. We found there were some good systems and arrangements in place to promote an efficient day to day running of the service. However, we found the arrangements for leadership; monitoring and support within the RochCare organisation were inconsistent and informal.

Recruitment practices made sure appropriate checks were carried out before staff started working at the service. We found sufficient numbers of staff were on duty. However we were told additional staff were needed at night, we therefore recommended staffing arrangements to be reviewed to ensure there are always sufficient staff duty to respond to people’s needs.

People told us they experienced good care and support. People’s needs were being assessed and planned for before they moved into the service. People were receiving safe support with their medicines. The service had developed good working relationships with health care professionals.

People spoken with indicated they were treated with kindness and compassion. Throughout the inspection we observed staff interacting with people in a kind, pleasant and friendly manner and being respectful of people's choices and opinions. People said their privacy and dignity were respected. However, we did find some improvements with respecting privacy of space and promoting dignity at mealtimes were needed.

During the inspection we observed staff involving people in routine decisions and consulting with them on their individual needs and preferences. However, we found some progress was needed to more effectively screen people’s capacity to make their own decisions.

People were happy with the variety and quality of the meals provided at the service. Support was provided with maintaining a healthy diet in response to individual needs.

People told us how they were keeping in contact with families and friends. Visiting arrangements were flexible. They were satisfied with the arrangements in place for activities, outings and entertainment.

Systems were in place to ensure all staff received regular training, supervision and support. Care workers spoken with understood their role in providing people with effective care and support.

All the people spoken with had an awareness of the service’s complaints procedure and processes. Arrangements were in place to investigate and respond to any concerns raised.