This comprehensive inspection took place on 12 and 20 September 2018 and was unannounced on the first day.

Bank House 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. Bank House Care Home is registered to provide care for up to 43 people with either nursing or personal care needs. The home is a large detached building and is situated close to Bury town centre. Accommodation is provided on two floors, accessible by two passenger lifts. The home is on a main road, close to public transport. There is parking area to the side of the property. At the time of this inspection, 40 people were using the service.

Our last comprehensive inspection took place in May 2017 and we found that Bank House Care Home was not meeting all the regulatory requirements, which are the fundamental standards. We found two breaches of the regulations relating to staff training and support and record keeping. The staff training record showed that staff had not received all the basic training they needed to support people safely and effectively. We also saw that records were not always fully maintained in relation to full employment histories of staff on recruitment files, staff meetings, complaints and activities. At this inspection we found that improvements had been made.

At the time of the inspection the home had 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 registered manager was also the registered provider. At the time of this inspection the deputy manager was also in the process of becoming a second registered manager for the home. This process was completed by the end of this inspection. We were told that the registered provider/manager would take responsibility for the administrative running of the home and the registered manager the care people received. The home was also supported by a registered nurse with considerable management experience.

Overall, we found that staff training and supervision and record keeping had improved. The registered provider/manager and new registered manager for care need to ensure that improvements are maintained and sustained.

During our visit we found that although window restrictors were in place they did not meet current guidelines. The registered provider/manager undertook an immediate review of all the windows of the home and informed us 27 would be replaced. We also found that a number of bedroom doors did not have locks on them. This was to be addressed through the new review process with each individual person and appropriate advocate and the outcome recorded.

Staff understood their reporting responsibilities in relation to any abuse and poor practice by colleagues. They were confident that the registered/provider manager would take action to deal with any issues they raised.

Adequate recruitment checks for staff were in place and we saw that there were sufficient numbers of staff available to support people.

Risk assessments were in place, which gave guidance to staff about how to support people and mitigate any risks.

We found that medicines were appropriately managed and the home was clean and tidy throughout. No malodours were detected.

People generally spoke positively about the food they were offered and the chefs. We saw that people were offered plenty of fluids throughout the day.

People had access to healthcare professionals as needed.

The registered provider/manager continues to make ongoing improvements to the environment and facilities.

There was a relaxed and friendly atmosphe

This comprehensive inspection took place on 10 and 15 May 2017 and feedback was given to the registered provider on 19 May 2017.

Our last comprehensive inspection took place on 5 and 7 April 2016 and we found that Bank House Care Home was not meeting all the regulatory requirements, which are the fundamental standards, in relation to the management of medicines, consent, care records, complaints and ensuring that effective systems were in place to monitor and assess the quality of the home.

We asked the provider to send us an action plan to tell us what action they were going to take to make the required improvements. We received an action plan from the service. We returned to the service on 1 November 2016 to check that improvements had been made and found that all the outstanding requirements had been met.

Bank House Care Home is registered to provide care for up to 43 people with either nursing or personal care needs. The home is a large detached building and is situated close to Bury town centre. Accommodation is provided on two floors, accessible by two passenger lifts. The home is on a main road, close to public transport. There is parking area to the side of the property. At the time of this inspection, 31 people were using the service.

We found two breaches of the regulations relating to staff training and support and record keeping. The staff training record showed that staff had not received all the basic training they needed to support people safely and effectively. We also saw that records were not always fully maintained in relation to full employment histories of staff on recruitment files, complaints and activities.

You can see what action we have asked the provider to take at the back of this report.

Staff understood their reporting responsibilities in relation to any abuse and poor practice by colleagues. They were confident that the registered/provider manager would take action to deal with any issues they raised.

The required recruitment checks for staff were in place and we saw that there were sufficient numbers of staff available to support people.

Risk assessments were in place, which gave guidance to staff about how to support people and mitigate any risks.

We found that medicines were appropriately managed and the home was clean and tidy throughout. No malodours were detected.

Records we saw showed that where appropriate mental capacity assessments and deprivation of liberty safeguards authorisations were in place. We saw records that showed that people had given their consent to treatment as appropriate.

Although records showed that not all staff had received the basic training they needed to support people effectively, we also noted that the provider was committed to training in leadership and management for senior staff. Staff had also recently completed the Six Steps end of life care programme

People spoke positively about the food they were offered and the chef. We saw that no-one was kept waiting for their meal at the lunchtime we observed and food was warm when served. We saw that people were offered plenty of fluids throughout the day.

On-going improvements had been made to the environment with decorating and new carpets fitted to the hall landing and stairs and improvements to bathrooms and wet rooms.

We received positive feedback from people who use the service and relatives and friends that we spoke with. There was a relaxed and friendly atmosphere at the home. We saw good interactions between staff and people, as well as friendship groups. There was a lot of laughter.

People who used the service were nicely dressed and their hair appeared well kept. People had their belongings with them on small tables set in front of them, for example, handbags, newspapers, books and sweets. People’s rooms were personalised to their individual tastes.

People had care records in place that gave information about how they were to be supported by staff and their personal preferences.

We

At our last inspection visit on 5 and 7 April 2016 we found that Bank House Care Home was not meeting all the regulatory requirements, which are the fundamental standards, in relation to the management of medicines, consent, care records, complaints and ensuring that effective systems were in place to monitor and assess the quality of the home.

We asked the provider to send us an action plan to tell us what action they were going to take to make the required improvements. We received an action plan from the service.

This inspection was undertaken to check that the provider had made improvements. We found that this was the case and the requirements had been met.

Bank House Care Home is registered to care for up to 43 people with either nursing or social care needs. The home is a large detached building and is situated close to Bury town centre. Accommodation is provided on two floors, accessible by a passenger life. The home is on a main road, close to public transport. There is a parking area to the side of the property. At the time of this inspection 39 people were using the service.

We found improvements had been made to the medicines management of ‘as required’ medicines and also the use of thickeners and prescribed creams.

Records we saw showed that mental capacity assessments had been undertaken by staff and where appropriate deprivation of liberty safeguards authorisations were in place Care records showed that a number of areas for consent to care and treatment had been agreed.

We saw that improvements had been made to the complaints systems and concerns raised by people were now recorded to show what action had been undertaken to resolved the issue. The complaints procedure had been updated and included external organisations that people could go to if they were not satisfied with how their complaint had been handled.

We saw there were a number of audits in place to help monitor risk and quality at the home. However, these would benefit from being developed further to ensure that the information could be retrieved efficiently to give a clear overview of the service. Consideration was being given to expanding the computerised administration system to the care plan system to support the management team.

A number of quality assurance surveys had been sent out to people who used the service, relatives and staff and staff and some responses had been received.

We found that the number of activities available to people had improved and a second activities organiser was due to start work at the home. This would further increase activities available to people to help promote their health and mental wellbeing.

This was an unannounced inspection, which took place on the 5 and 7 April 2016. This was the first inspection at the home for the new provider, who was registered with CQC to take over the service in October 2015.

Bank House Care Home is registered to care for up to 43 people with either nursing or social care needs. The home is a large detached building and is situated close to Bury Town Centre. Accommodation is provided on two floors, accessible by a passenger lift. The home is on a main road, close to public transport. There is a parking area to the side of the property or on road parking. At the time of the inspection there were 36 people living at the home.

The service is managed on a day to day basis by the 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.’

We identified five breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Records did not clearly demonstrate if a person had the capacity to consent to their care and support. They also did not show that people had been appropriately assessed as lacking capacity to demonstrate that decisions had been made in the person’s best interest. This meant people’s rights were not respected or protected.

People were at risk of not receiving the care and support they wanted and needed as staff did not always have clear and accurate information to guide them in the safe delivery of care. One visitor felt some staff did not fully understand the needs of their relative.

We found the overall system in place for managing oral medicines was safe. However clear and accurate records were not maintained to demonstrate people were receiving their prescribed creams and thickeners safely and effectively.

Whilst systems were being developed to monitor the quality of the service, these needed expanding upon and embedding to ensure that checks were robust enough to identify any areas of improvement and evidence these had been acted upon.

An effective system of reporting people’s complaints and concerns was needed to help demonstrate issues were taken seriously and people were confident they were listened to.

Although our observations during the inspection showed there were enough staff available to meet people’s needs, some people told us this was not always the case. We have made a recommendation that the provider considers a formal process for identifying and deploying appropriately staffing levels to meet people’s needs.

We have made a recommendation that the provider explores the opportunities provided so that people are offered meaningful activities to help maintain and improve the quality of their life.

People and their visitors were complimentary about the staff and the care and support offered to their family member. Staff were seen to be polite and respectful towards people, offering assistance when needed.

Opportunities for staff training and development were provided. Staff spoken with confirmed they had completed some training and felt supported by the manager.

We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

We saw people were supported to access health care professionals, such as GP’s, community nurses and dieticians so their current and changing health needs were met.

People were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. We saw that food stocks were good and people were able to