Archived: Banbridge House

The registered provider, who also managed the home on a day to day basis, died unexpectedly in December 2016. Since this time their personal representative has taken responsibility for the home and an acting manager has been put in place to oversee the day to day running of the service. This is in accordance with Regulation 21 Care Quality Commission (Registration) Regulations 2009.

This inspection was an unannounced focussed inspection carried out by an inspection manager and one inspector.

Commissioners of the service and other health and social care professionals had expressed concerns about the standards of care people were receiving. The inspection was undertaken to check whether people were receiving safe and effective care and support. It also looked at how the home was being led and managed since the death of the provider.

The last inspection of the home was carried out in June 2016. At that inspection the service was rated as Requires Improvement and two requirement notices were issued. At that inspection we found the provider had not taken adequate action to ensure all areas of the home were clean and properly maintained. We also found the provider did not have adequate systems in place to assess, monitor and improve the quality and safety of the service provided. At this inspection we found some minor improvements had been made in standards of cleanliness and maintenance but there were still no systems to monitor quality.

At this inspection we found further concerns;

The service was not following safe recruitment procedures to make sure people were protected from being cared for by unsuitable staff. This could place people at risk of abuse.

People’s medicines were not always stored, administered and recorded in a way that made sure they received the correct medicines at the correct time. One person had been given the wrong medicine on three occasions and we found a quantity of out of date medicines which had not been returned to the pharmacy.

People were not being supported by staff who had up to date training to enable them to effectively support people. Staff had not received training in health and safety issues, such as fire safety or moving and handling for a number of years. This meant staff did not have up to date knowledge about how to promote people’s safety.

Banbridge House is a care home which is registered to provide care to up to 19 people. The home specialises in the care of older people. At the time of this inspection there were nine people living at the home.

The registered provider manages the service on a day to day basis. 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 last inspection of the home was carried out in August 2014. At that inspection the service was rated as Requires Improvement. We found that improvements were needed to ensure people had access to activities and social stimulation. We also found improvements were needed to ensure that quality assurance systems were formalised to make sure that any areas for improvement were addressed and the home took account of good practice guidelines. At this inspection we found that although there was evidence that improvements had been made these had not been sustained to ensure positive changes for people using the service.

Although the provider monitored standards on an informal basis there were no systems in place to ensure ongoing improvements. This meant that if the manager was absent there would be no systems for other staff to follow to ensure people received a consistent standard of care and support. There was no structured activity programme which meant people who were unable to occupy themselves had limited opportunities to take part in social activities.

Standards of maintenance and cleanliness were poor which could possibly place people at risk of the spread of inspection. Many communal areas of the building were worn and required decoration to ensure they provided a pleasant and safe environment for people. Some equipment used to support people was not hygienically clean or had not been serviced in accordance with recommendations.

There was a small stable staff team who knew people well and were able to provide care that respected each person as an individual. Staff training was not always kept up to date which could place people at risk of not receiving the most effective care to meet their needs.

There were sufficient numbers of staff to support people in a calm and unhurried manner and to spend time socialising. People spoke highly of the staff who supported them and said they were always kind and friendly. People were very relaxed with staff and the provider.

There was a complaints procedure on display but everyone said they would speak directly to the provider if they were unhappy with any aspect of their care. People felt confident that any issues highlighted would be resolved.

There was a homely and comfortable atmosphere where people were able to make choices about their day to day lives and visitors were always made welcome. One person said “You can do as you like within reason.” Where people were unable to make decisions for themselves staff knew how to support people and protect their legal rights.

People’s physical and mental health was monitored by staff and people had access to specialist healthcare professionals according to their individual needs. Care plans showed how risks to people’s health or well-being were assessed and how staff supported people to minimise risks.

People received their medicines safely at the prescribed times. Staff kept clear records of all medicines at the home.

People had the support they required to meet their nutritional needs and were offered choices of food. People were happy with the food served at the home. One person said “Food here is always nice.” Another person told us “Very nice food and always tasty.”

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

There were 11 people living in the home at the time of our inspection visit. We saw that people were supported to continue their chosen daily routines, some quietly sitting in the company of others in the front lounge area of the home. Others were out and about in the local community. We did not speak to people directly about the outstanding areas of non-compliance we were following up. We spoke with two staff who were on duty at the time. We looked at the care records for three people, employment records for three staff and a sample of records relevant to the management and the administration of the service.

There were 14 people living in the home at the time of our inspection visit. We observed activities in the home and how life was like for people living in the home. We did not speak to people directly about the outstanding areas of concern. We spoke with two staff who were on duty at the time. We looked at the care records for two people and the records relevant to the management and the administration of the service.

We identified during this inspection that there were some changes and improvements had been put in place to meet these concerns seen at the inspection in March 2013. However, there remained gaps in how the service managed its records and record keeping which had the potential to put people at risk from not receiving the support they required in line with best practice.

The people we spoke with told us that they were able to live their lives as they wished and they were happy at the home. One person told us 'it is my home.' We observed that some of the people we met although were unable to comment fully about their experiences living in the home appeared to be relaxed and comfortable. We saw that people had good relationships with staff and staff showed they had a good understanding of their needs. People told us they were very happy with staff. They told us they could speak to them if they had any worries and they thought there were always enough staff on duty. People did not express any concerns that staff were not skilled or experienced enough to meet their needs.

We identified during this inspection that there were areas of improvement required to maintain people's safety and welfare. These were in regard to the care and welfare of people, cleanliness and control of infection, management of medicines, recruitment of staff and record keeping. We implemented compliance actions for the provider to meet these standards.