CQC report explained · a residential care home
What the CQC found at Bank Close House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Some risks were not always passed on to staff, and care plans and fire evacuation plans were not always updated when people's needs changed. One person's low sugar diet had not been identified by the cook, and boxed medicine stocks were not properly checked.
- Effective?
- Good
- This key question was not inspected at this visit. The previous rating was used in calculating the overall rating.
- Caring?
- Good
- This key question was not inspected at this visit. Relatives nevertheless gave positive comments about kind and caring staff.
- Responsive?
- Good
- This key question was not inspected at this visit. The report noted a lack of daily activity options and limited contact for relatives during an outbreak.
- Well-led?
- Requires improvement
- There was no registered manager, although a quality manager or manager from another location was present daily. Audits and governance systems existed but had not fully identified or embedded all the improvements needed.
What inspectors found, April 2022
Requires Improvement; inspectors found kind care and enough staff, but gaps in risk records, medicines checks and management remained.
This was an unannounced inspection on 10 March 2022. Inspectors reviewed five care records, medicine records, staff files and management records. They spoke with staff, relatives and a health professional.
The home had made improvements since the last inspection, but they were not yet consistent. Inspectors found enough staff and generally safe medicine administration. However, some risks were not shared clearly, boxed medicine stocks were not checked properly, and care plans were not always updated when people's needs changed.
The home was rated Requires Improvement overall, with Safe and Well-led also rated Requires Improvement. The inspection only looked at those two areas. The other three ratings were carried over from an earlier comprehensive inspection because no concerns were identified in them at this visit.
Staffing levels
Inspectors found enough staff to support people's needs. The provider used regular agency staff when its own staff were absent.
“The provider had ensured the required levels of staff to support people's needs.” from the report
Kind care
Relatives spoke positively about the care and described staff as kind, patient and familiar with people's individual needs.
“Relatives we spoke with told us staff were kind and caring.” from the report
Medicine administration
Inspectors found that medicines were generally administered safely. Staff had received medicine training and competency checks.
“Medicines were overall administered safely, and staff had received training and competency checks.” from the report
Infection control arrangements
The home had suitable supplies and arrangements for infection control, including PPE, testing and an up-to-date policy.
“There was a good supply of PPE located around the home for easy access.” from the report
Partnership working
The home worked with health professionals and contacted them when people had health concerns.
“The provider and staff had established working partnerships with other professionals such as GP's, district nurses and speech and language therapists to support people to access healthcare when needed.” from the report
Risk information was not always shared
seriousSome identified risks were not passed on to staff. One person's low sugar diet was missed, and care plans did not always reflect changed needs.
“One person required a low sugar diet due to their diabetes. The cook had not identified this need and we reviewed the food charts which showed the person was consuming sugary meals.” from the report
Medicine stock checks
seriousMedicine administration was generally safe, but boxed medicine stocks were not checked against records. This meant errors or a person running out of stock might not be identified.
“This meant any errors would not have been identified or the person could run out of stock, as the amount had not been regulated.” from the report
No registered manager
needs fixingThere was no registered manager at the time of inspection. Management support was provided daily, but leadership and quality systems were not yet consistent.
“There was currently no registered manager, however the provider had ensured a manager from their other locations or quality team was present and supporting on a daily basis.” from the report
Training records
needs fixingThe training matrix had gaps, including fire safety and moving and handling. The provider said this was partly a recording problem, but records still needed to be corrected and kept up to date.
“For example, fire safety nine out of 16 staff had not completed this training and for practical moving and handling six out of the 16 had not received this training.” from the report
Activities and family visits
needs fixingPeople did not always have daily activities. During an outbreak, relatives had limited contact and essential care givers had not initially been considered.
“People were not always supported to receive choices about their daily activities.” from the report
- 01How do you now make sure changes in a person's needs are promptly added to every relevant part of their care plan?
- 02How are low sugar diets and other important dietary needs checked before meals are served?
- 03How do you check boxed medicine stocks against administration records, and how often is this done?
- 04Who is currently responsible for managing the home, and how are quality checks kept consistent while there is no registered manager?
- 05What daily activities are now available, and how will you support essential care givers to visit during an outbreak?
This was a focused inspection of Safe and Well-led prompted by concerns about infection control and management support; the other ratings were carried over from the previous comprehensive inspection. This explanation was written from the published report of 22 April 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, August 2021
Rated Requires Improvement; the home had improved and left special measures, but safeguarding, communication and management oversight were still not reliable.
Inspectors carried out an unannounced focused inspection on 29 June 2021. They checked Safe and Well-led, reviewed care, medicines, staffing and management records, and spoke with staff, relatives and health and social care professionals.
There had been clear progress since the previous inspection, including better risk assessments, safer medicines management, infection control and staff recruitment. However, safeguarding concerns were not always identified or reported properly. Inspectors also found concerns about staffing levels, personal care, communication with relatives and activities.
The home was still in breach of Regulation 17, Good Governance, because improvements were not fully established or sustained. Its overall rating improved from Inadequate to Requires Improvement, and it was no longer in special measures.
Risk management
Inspectors found that risks were now assessed and managed more fully, including falls, health needs and COVID-19 isolation.
“Risks to people were now fully assessed to mitigate or managed risk effectively in order to keep people safe.” from the report
Medicines
Medicine records and stock levels checked by inspectors were correct overall. Prescribed creams were used as directed with body maps to guide staff.
“Medicine administration records were completed correctly and the stock we reviewed was in accordance with the required medicine levels to meet peoples prescribed needs.” from the report
Staffing assessment
needs fixingThe dependency tool recorded most people as having low needs, but inspectors found it did not always match the support people required. Staff also said there were not always enough staff during the day.
“We reviewed some of these people and discussed their needs with the staff and found the dependency tool had not always reflected the support the people required.” from the report
Communication with relatives
needs fixingRelatives said they often had to chase the home for information. Some did not receive timely information about visiting rules during the pandemic.
“Staff are not particularly good at contacting us. It's more about us having to chase things up.” from the report
Personal care
needs fixingSome relatives raised concerns about people's cleanliness, clothing and access to baths or showers. Inspectors found some people had long gaps between this support.
“I do have to sometimes ask them to make sure [name] is clean and tidy. They don't seem to have enough baths or showers.” from the report
Management oversight
seriousAudits had improved, but checks were not consistent and important events were not always notified. This was a continuing breach of Regulation 17.
“Systems were not embedded or provided us with the assurance of being sustained with continued oversight and improvement.” from the report
Activities and involvement
needs fixingPeople had limited interaction beyond care tasks. The activities worker had been moved to care duties because of staff shortages.
“People in the lounge had limited interaction or engagement in an activity with exception of care tasks.” from the report
- 01How do you now identify, record and investigate unexplained injuries or other safeguarding concerns?
- 02How do you check that the dependency tool reflects each person's actual care and staffing needs?
- 03What system is in place to keep relatives informed promptly about incidents, visiting arrangements and complaints?
- 04How often do people receive baths or showers, and how are missed or delayed opportunities followed up?
- 05What has been done to make management audits, notifications and daily environmental checks consistent and sustainable?
This was a focused inspection of Safe and Well-led only; the other key question ratings were carried over from previous comprehensive inspections. This explanation was written from the published report of 5 August 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Bank Close House
6 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- April 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2021Requires improvementSafe: Requires improvementWell-led: Requires improvement
- January 2021Inspected but not ratedWell-led: Inspected but not rated
- December 2020Inadequatedown from GoodSafe: InadequateWell-led: Inadequate
- April 2019Goodup from Requires improvementSafe: GoodWell-led: Requires improvement
- January 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- June 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2014
Report published without a new overall rating.
- March 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 10 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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