The inspection visit took place on 17 and 18 July 2018. The first day of the inspection was unannounced. This meant people living at Bankhouse Care Home, their relatives, the registered manager and staff working there didn’t know we were visiting.

Bankhouse 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.

Bankhouse Care Home is registered to accommodate up to 52 people who have nursing needs or people living with dementia. The home comprises of two general residential and nursing units and a unit for people living with dementia. All accommodation is located on the ground and first floor. At the time of the inspection there were 40 people who lived at the home.

There are a range of communal rooms, comprising of three lounges, and two dining rooms. There is a garden area with seating for people to use during the summer months. Car parking is available at the home.

The service had a registered manager 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.

Bankhouse Care Home has been inspected before but this is the first time it has been inspected since it changed legal entity. Since the last inspection Bankhouse Care home has a new registered provider and we do not refer to the locations previous inspection history.

During this inspection we found the registered provider failed to consistently ensure documentation and support met people’s nutrition and hydration needs.

This was a breach of Regulation 14 HSCA RA Regulations 2014 (Meeting nutritional and hydration needs). The registered provider had not done all that was reasonably practicable to offer guidance, encouragement and help to people to eat as appropriate.

We noted there were times when staff did not consistently have an appreciation of people’s individual needs around privacy and dignity.

This was a breach of Regulation 10 HSCA RA Regulations 2014 (Dignity and respect). People were not treated with dignity and respect at all times.

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

We looked at staffing at Bankhouse Care Home. We were told people were safe and deployment was structured. We received mixed feedback on staffing levels. We have made a recommendation about this.

We looked at the storage, administration and documentation around medicines. Records we looked at did not consistently guide staff on how to manage people’s ongoing health conditions. We have made a recommendation about this.

Care plans we looked at did not always contain information to guide staff in the delivery of responsive care to meet people’s needs. We have made a recommendation about this.

We saw evidence of activity events that had taken place and of scheduled events. Information around daily scheduled activities did not reflect what we saw during our inspection. We have made a recommendation about this.

We found the service did have clear lines of responsibility and accountability. The manager was supported by a deputy manager who shared the responsibility of managing the home.

We spoke with the manager about consultation with people and relatives. Care plans showed involvement from people and relatives. Senior management visited the home regularly and met with people and relatives as part of their role.

The staff had daily handover meetings to share up to date information on people. They also had formal staff meetings.

We looked at recruitment procedures to ensure people were supported by suitably qualified and experienced sta

We carried out an unannounced comprehensive inspection of this service on 17 May 2017 with announced visits on 18 May and 09 June 2017. After that inspection, we received concerns in relation to the safe care and treatment of people who lived at the home. As a result, we carried out a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bankhouse Nursing Home on our website at www.cqc.org.uk

We carried out an unannounced focused inspection of the service on 27 September 2017. During this inspection, we looked at evidence related to the Safe and Well-led areas of the inspection process.

Bankhouse Care Home is registered to accommodate up to 52 people who have nursing needs or people living with dementia. At the time of our inspection, 39 people were living at the home. The home comprises of two general residential and nursing units and a unit for people living with dementia. All accommodation is located on the ground and first floor. There are a range of communal rooms, comprising of three lounges, and two dining rooms. There is a garden area with seating for people to use during the summer months. Car parking is available at the home.

The home had a manager who is registered with the Care Quality Commission. 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.

At the last inspection on 15, 18 May and 09 June 2017, we rated the service as Requires Improvement. We found medicines were managed safely. We saw people received their medicines in safe way, at the time they needed them. However, we saw some advice from a pharmacist was not documented. We also saw a cream chart was not available. We made recommendations regarding these concerns.

During this inspection, we noted staff responsible for assisting people with their medicines were trained to ensure they were competent and had the skills required. Medicines were safely kept and appropriate arrangements for storing medicines were in place. Documentation related to the administration of creams and medicines were in place.

At the last inspection, we asked people for their opinion on the staffing levels at the home. We received mixed feedback. We saw one person required support and there were no staff available. We discussed this with the registered manager who amended the rotas to include additional staff at peak times. We made a recommendation regarding the staffing provision at the home.

At this inspection, we found staffing levels were suitable with an appropriate skill mix to meet the needs of people who used the service. The organisation of staff throughout the home was planned so staff knew their role and responsibilities and which unit they would be working on.

During this inspection, we noted staff had received safeguarding training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

Care plans were in place detailing how people wished their care to be delivered. Risk assessments had been completed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided. There was written evidence that indicated staff were supporting people as identified within their risk assessments.

The provider had recruitment and selection procedures to minimise the risk of inappropriate employees working with vulnerable people. Checks had been completed prior to any staff commencing work at the

carried out an unannounced focussed inspection of this service 07 December 2016. At this inspection a breach of legal requirements was found. After the focussed inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this comprehensive inspection in May 2017 to check they had followed their plan and to confirm that they now met legal requirements.

This comprehensive inspection took place on the 15, 18, May 2017 and the 09 June 2017. The first day was unannounced.

Bankhouse Care Home is registered to accommodate up to 52 people who have nursing needs or people living with dementia. The home comprises of two general residential and nursing units and a unit for people living with dementia. All accommodation is located on the ground and first floor. At the time of the inspection there were 42 people who lived at the home.

There are a range of communal rooms, comprising of three lounges, and two dining rooms. There is a garden area with seating for people to use during the summer months. Car parking is available at the home.

The home has a manager who is registered with the Care Quality Commission. 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.

At the focussed inspection of Bankhouse Care Home in December 2016 the service was rated as ‘requires improvement’ overall, with ‘requires improvement’ ratings in three of the key questions ‘is the service safe?’ ‘is the service responsive?’ and 'is the service well – led?’ We identified a breach of Regulation 12, (Safe care and treatment) as medicines at the home were not managed safely.

During the comprehensive inspection carried out in May and June 2017, we found medicines were managed safely. We saw people received their medicines in safe way, at the time they needed them. We saw some advice from a pharmacist was not documented. We have made a recommendation regarding this. We also saw a cream chart was not available. We have made a recommendation regarding this.

We asked people their opinion on the staffing levels at the home. We received mixed feedback. During the inspection we saw one person required support and there were no staff available. We discussed this with the registered manager who amended the rotas to include additional staff at peak times. We have made a recommendation regarding the staffing provision at the home.

We checked to see there were appropriate recruitment procedures at Bankhouse Care Home. We found staff were checked to ensure they were of suitable character before they started work at the home and references were obtained. This helped ensure only suitable staff were employed.

Staff told us they received training and supervision to enable them to fulfil their role. Staff said they enjoyed the training and further training was available if this was required. We viewed documentation which evidenced staff received supervision and training.

People we spoke with gave us mixed feedback regarding the meals provided at the home. Some people told us they considered the food could be improved. Other people told us they liked the meals provided. We discussed this with the registered manager who said they responded to feedback from people in order to improve the meals provided.

We asked people if they felt safe. People told us they did. One person said, “I feel safe here.” We saw staff supported people in a safe way. We observed one person being supported with their mobility. The person was supported in accordance with their care plan which helped ensure their safety.

During the inspection we spent time in all areas of the home. We did this to observe the interactions between people who lived at