This inspection took place on 25 and 28 September 2018. The first day of the inspection was unannounced. We informed the registered manager that we would be returning on the second day of the inspection. 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.

Banksfield 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.

Banksfield Nursing Home is a detached, two storey, purpose built care home registered to provide Nursing and Residential Care to a maximum of 42 service users. The service consists of a 20-bedded unit on the ground floor, providing general nursing and residential care to male and female service users. On the first floor, nursing and personal care is provided to a maximum of 22 people who live with dementia.

There were 39 people who lived at the service at the time of the inspection.

During this inspection we found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safeguarding service users from abuse and improper treatment, safe care and treatment, staffing, need for consent, meeting nutritional and hydration needs, person centred care and good governance. We also found one breach of the Care Quality Commission (Registration) Regulations 2009, in relation to notification of other incidents.

Our last inspection of Banksfield Nursing Home was carried out on 8 December 2015. At that time we rated the service as overall 'good' with the effective domain being 'requires improvement'. There were no breaches of the regulations at that time. At this inspection the rating had deteriorated to overall 'requires improvement'.

This is the first time the service has been rated Requires Improvement.

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

The service had procedures in place for dealing with allegations of abuse and showed us the guidelines they followed from Lancashire County Council when they make a judgement in relation to raising a safeguarding alert. However, we found two incidents that had not been referred to the local authority in line with the providers policy for safeguarding.

We observed staff undertake unsafe practice in relation to dealing with behaviours that challenge and when we looked at the staff training matrix we saw that staff had not received suitable training to ensure that they could meet the needs of people who lived with dementia.

Staff told us that they felt confident to whistle-blow and we observed the management team engage with staff, people who lived at the service and visitors across both days of the inspection.

We looked at people's care records and found inconsistencies in how the service managed individuals' risk. For example, people at risk of choking were not always suitably risk assessed and this meant that people's personal safety was compromised.

We looked at the care records for a person who lived on the dementia care unit and found they had not been suitably assessed and care plans had not been completed to show the support they required. This placed the person at risk of receiving inadequate and unsafe care. We found that the providers admission procedure was not always fully carried out, one person had not been suitably risk assessed and care plans had not been formulated to reflect what care and support they required 13 days after they were admitted.

We found that medicine management was good in relation to stock control and recording when a person had been administered their medicines. We

Banksfield Nursing Home is a detached, two storey, purpose built care home registered to provide Nursing and Residential Care to a maximum of 42 residents.

The home consists of a 20 bedded unit on the ground floor, providing nursing and residential care to male and female residents over the age of 65 years. On the first floor, known as the Cadley Suite, nursing and personal care is provided to a maximum of 22 people who live with Dementia.

The last inspection of the service took place on 10th October 2013. During that inspection the service was found to be compliant with all areas assessed.

This inspection took place on 8th December 2015 and was unannounced. We were assisted throughout the inspection 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.

There were 41 people who used the service at the time of the inspection.

We found people were provided with safe and effective care. Staff had a good understanding of people’s care needs and any risks to their safety or wellbeing.

Staff took appropriate action to deal with any concerns about the health, safety or wellbeing of people who used the service.

The registered manager and staff worked well with community professionals to ensure people received the care they required.

There were effective arrangements in place to help ensure that people’s medicines were safely managed.

People’s care was planned and provided in accordance with their personal needs and wishes. People described a kind and caring staff team, who treated them with respect and dignity.

People felt involved in their own care or the care of their loved ones. People felt able to express their views and raise concerns about their care or the general running of the home.

The rights of people who were unable to consent to any aspects of their care were protected because the registered manager worked in accordance with the relevant legislation.

Staff were carefully recruited to help ensure they had the suitable skills, knowledge and character to provide safe, effective care. There was a comprehensive training plan in place and staff received regular supervision.

There were effective arrangements in place which enabled the registered manager and provider to monitor safety and quality across the service. Where areas for improvement were noted, these were acted upon and followed up.

The environment was safely maintained. Some areas were seen to be decorated and furnished to a good standard. However, other areas were in need of improvement as they were tired and shabby. The registered manager had an action plan in place to address these areas. When complete, this would help to ensure people who use the service enjoy a good standard of accommodation.

We spoke with a number of people during this inspection. Those we spoke with included six people who used the service or their relatives. We also consulted six staff members and four external professionals, including social workers and health care specialists.

The feedback we received from people was very positive. Everyone we spoke with felt that there had been significant improvements in all aspects of the service. One relative said, ‘’The place is unrecognisable. There seems to be more staff and it’s much cleaner.’’ A professional commented, ‘’The manager has worked very hard and really turned things around. I find them very responsive and keen to move forward.’’

As part of the inspection we consulted the Local Authority contracts monitoring department, who told us that they had been monitoring standards closely at the home and were satisfied that all the improvements they had previously requested of the home, had been made.

Residents and relatives that we consulted expressed satisfaction with their (or their loved one’s) care. Their comments included:

‘’This is a good place, they are doing a good job!’’

‘’They have been great! Absolutely great! I visit every day and I feel like they are my family.’’

‘’I have had a very difficult year. I couldn’t have got through it without Val (the manager) and the staff here. They have been a huge source of support for me.’’

This inspection was to follow up on major concerns identified at a previous inspection in November 2012. The major concerns identified were in relation to the care and welfare of people using the service, safeguarding people from abuse, infection control and standards of cleanliness and hygiene. As a result of our findings in November 2012, three warning notices were issued requiring the provider to make significant improvements within a specified timescale.

During this inspection we assessed the progress made by the provider in relation to the warning notices. We found that some minor improvements had been made, but that there were a number of issues still outstanding that had not been addressed.

This was a follow up inspection to assess whether the service had made improvements against compliance actions we set following an inspection in July 2012. During the previous inspection we identified concerns in relation to the care and welfare of people who use services, arrangements for safeguarding people from abuse, cleanliness and infection control, record keeping and processes for assessing and monitoring the quality of service provided.

During our visit we spoke with a number of residents and some visiting relatives. We received some positive feedback from people about the service. These comments included;

‘’(Name removed) has come on in leaps and bounds since she came here. We are really pleased!’’

‘’I think that they really care here. That is the difference.’’

‘’There are some great carers. They are very kind.’’

We saw some examples of improvements that had been made since the last inspection. These included increased efforts on the part of the new manager to involve residents and families in the running of the home and the resurrection of an activities programme for residents.

Whilst the feedback we received during our visit was generally positive, we had also received a number of concerns from other professionals and relatives since the last inspection.

During this inspection we found evidence that the service had failed to take action to meet compliance actions that we set in all the areas we inspected.

We met a number of residents during our visit to the home. The majority of residents we met were not able to tell us about their experiences of living at Banksfield.

One resident we spoke with told us he was generally satisfied with the service provided. He said he found most carers to be very nice. However he did also tell us that he found some carers talked between themselves when providing his personal care, he said he found this frustrating.

We spoke to close relatives of four people who live at the home and received some very positive feedback. People said that they felt welcome to visit the home at any time and comfortable during their visits.

People told us that they found the staff and the manager approachable and helpful. One person said ‘’I have raised a few minor issues in the past and they have always been sorted out straight away.''

We asked people if they felt the home kept them updated and if they felt involved in their loved one’s care. People told us they felt this was the case. One family member commented ‘’I know that they will always get in touch with me if anything happens. They are good like that.’’ Another person said ‘’When my relation went in they asked me lots of questions about her and the care she needed.’’

In discussion, people also spoke highly of staff and the manager. Comments we received included;

‘’They (the staff) seem very competent. I visit every night, I can see that nothing phases them.’’

‘’They are a really nice bunch of people.’’

‘’The manager seems a really good guy. He always does anything I ask and that goes for all the staff also.''

We spoke with a number of residents and a visiting relative and received some very positive feedback about the service.

People told us that they were happy with all aspects of the service provided at Banksfield and spoke highly of staff and managers.

One relative told us that she and other residents and relatives had been involved in choosing the wallpaper for the lounge which was due to be decorated. She told us that she felt the manager always involved people in decisions such as these.

The relative went on to tell us ‘’I cannot fault this home in any way. The care is excellent. I am here every day and I see how they work. They really take time to listen to the residents.’’

We met several residents during our visit. People we spoke with were complimentary about the home and spoke highly of the manager and staff. One resident said ''This is a good place. They care here.'' Another resident told us that he felt lucky to live at Banksfield. He said ''There are not many places as good as this one!''

Some people we met were not able to make specific comments but we noted that they looked happy and relaxed in their surroundings and appeared to get along well with carers and the manager.

We carried out this inspection to follow up on warning notices we served in February 2013, relating to; the care and welfare of people who use services, safeguarding people who use services from abuse, cleanliness and infection control and assessing and monitoring the quality of service provision. We also inspected some additional areas in relation to staffing and medicines management.

We consulted a number of people who lived at the home, some relatives and also some visiting professionals. The majority of people we spoke with told us they had seen a number of improvements at the home in various areas. People told us that they had seen particular improvements in recent weeks.

Comments we received included;

‘’There have been some great improvements. There are lots of new faces and I think that it is a good thing.’’

‘’The place had sharpened up a lot.’’

‘’I went to a meeting with the new manager, these are going to be every month now. I think that is a good idea.’’

‘’I am thrilled. I am so pleased with the way things are progressing.’’

‘’The manager definitely seems to know what she’s doing. She’s bringing people in that do as well. They’ve brought three new nurses in, who seem very good.’’

‘’I cannot believe the difference in this home in the last four weeks.’’

We found evidence that there were a number of improvements in the areas we inspected. However, we also noted that there were further areas still to be addressed.