Bankfield House Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Systems were in place to gather information regarding people’s health and care needs, but care plans and risk assessments were not always up to date and did not consistently assess all known needs for people. Where people needed their health monitoring in relation to nutrition or repositioning, observation results were not always clearly recorded or monitored in accordance with people’s assessed needs. In addition, care plans or risk assessments did not clearly document when and how risks were to be escalated. We found concerns with people's consent to care. People were not always adequately supported to safely eat and drink and we identified a breach of regulation relating to people’s nutrition and hydration.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s needs were not always effectively assessed, reviewed and managed. We did not see evidence that people and their families were involved in assessment or reviews of each person’s needs.

The home manager told us staff needed to be aware of people’s care needs and ensure staff read people’s care plans. Staff told us they could not see people’s care plans and risk assessments on their hand held devices; however, the home manager told us staff could go into the office to read the care plans on the computer.

People’s assessments were not always up to date and we found some assessments had not been reviewed for some months. The frequency and quality of assessments was inconsistent. This meant that people’s care plans may not be up to date and reflective of their current needs.

People did not always have access to a drink. On the morning of both days 1 and 2 of our site visits, we found most people did not have access to drinks in their bedroom. It is a requirement of regulations that people always have access to water. Although people spoke positively about the food provided, they were not always getting the correct support regarding the type of food provided and the level of support needed to eat and drink safely. At the start of the inspection, the home manager told us only one person required assistance from staff to eat their meals. However, during our observations at mealtimes, we found there were multiple people who needed assistance to eat. There was not enough staff at mealtimes to provide the safe support people needed. We saw that people had to wait too long for their food and drink or received a poor level of support. We observed one person, who required full assistance to eat, wait for their food and when staff brought their food, they assisted them to eat only 4 forkfuls before leaving the room. The person then began to eat their food with their hands as they were unable to use cutlery. Another person, who had recent weight loss, was served their food after most people had already eaten and it was placed in front of them untouched for several minutes before a staff member came to help them eat their food. This person’s records demonstrated they had lost 7 kilograms in 3 months; however, no referral to a healthcare professional had been made regarding this weight loss. We found people’s nutritional and hydration needs were not adequately met and identified a breach of regulation.

We found that staff could have their meals at the home and they fed back that the quality of the food was good. We spoke with kitchen staff about their knowledge around people’s individual dietary requirements. They told us only one person had a modified diet; however, there was no information recorded in the kitchen about people’s dietary requirements and there was no information about IDDSI levels for food and drink for staff to refer to. We found the menus were decided by the provider at their other care home and given to kitchen staff at Bankfield House. Although the kitchen staff told us they would change the menu for individual preferences, there was no evidence that people living at the home had been involved in deciding what was on their menu.

We found assessments were in place for people, such as Waterlow and MUST; however, we found these were not consistently reviewed to ensure they were current and accurately reflected people’s needs. Where assessments denoted on-going monitoring was required, monitoring of these tasks were not always recorded. We found one assessment findings meant a person should be weighed weekly due to their consistent weight loss; however, we found this person was only weighed monthly.

People told us they had access to the home’s GP who visited weekly. We did not receive any negative feedback from people about how staff, teams and services worked together as they were not aware of additional healthcare input into their care and they had not been involved in discussions about this. One person told us they had their own dentist.

The home manager told us they worked with a variety of associated health care agencies. They told us they had access to the mastercall system, district nurse teams and the local pharmacy supplier.

One visiting professional told us they did not currently have concerns about the care and support people receive at Bankfield House and they had seen some improvements more recently.

People at the home who needed additional support with their healthcare needs received additional support from the community district nurse teams. For example, the administration of insulin or wound care. However, we found where a person was at risk of continued weight loss, no referral had been made to a relevant healthcare professional.

People were supported to access vaccinations by the home’s GP. However, we found several family members had given permission for people to have these vaccines without the legal powers in place to do so. During our inspection we noted one person was showing signs of illness in a communal area. We observed the person for a period of time and their presentation did not improve. We reported our concerns to the home manager. The home manager completed medical observations and a GP visited the home the same day as a result of the observations outcome. The person was suffering from an infection and required antibiotics; however, this deterioration in the person’s health had not been identified by anyone at the home prior to our intervention.

The home manager gave us an example of how a person was supported by the home’s GP to improve the management of their condition, through the use of antibiotics and a medication review. The home manager told us they ensured staff got people up out of bed every day unless it has been advised by district nurses that the person should stay in bed. However, our observations of people receiving timely attention in terms of access to medical attention and having their conditions monitored.

People were not always supported to live healthier lives as systems and processes were not robust to ensure staff identified and escalated concerns about people’s health needs. Monitoring charts were not always completed or accurately recorded meaning there was a risk that any deterioration in people’s conditions would not be noted and acted upon. People were not supported to eat and drink enough and this placed them at the risk of harm.

We did not receive any feedback from people about improving outcomes. We did not see evidence in care documentation that people’s aspirations and details of any specific outcomes they would like to achieve had been recorded. We observed one person had been assessed as at high risk of skin breakdown and required a pressure cushion; we monitored this person throughout the day and found they were not using a pressure cushion.

We asked the home manager for examples of where positive outcomes for people had been achieved. They gave us an example where a family were reluctant for their relative to have a referral made by the GP to a support service. The home manager worked with the family and achieved a positive outcome.

The service did not always effectively monitor people’s care and treatment to continuously improve it. Where people were assessed as needing monitoring, these actions were not always in place. Where monitoring was in place for people, this was not always comprehensively completed and there was no formal, robust escalation process in place to ensure that improvements in people’s health were attained. Therefore, not all people received effective monitoring of their risks to achieve positive outcomes.

People gave us mostly positive feedback about how staff treated them regarding consent. One person told us, “They [staff] help me get dressed in a morning and help me to choose what to wear. They are very good.” However, another person’s response was mixed and commented, “The staff are mostly polite and ask me what I want but like I said, some are a bit bossy.” We saw that staff were mostly polite; however, it was evident they did not always ask consent of people before providing care. We observed instances where people had actions done to them without staff first asking for consent, for example, staff placed clothes protectors on people without first asking for consent. We also observed staff did not always knock on people’s door before entering.

The home manager told us if a person could not consent to their care and treatment that they would go to the family for consent. The home manager had sent an email to family members to request they give consent to enable people to be vaccinated. Some of the family members did not have power of attorney for health and welfare but consent was still used to vaccinate these people. This meant people may have received medical treatment without legal consent attained.

We had concerns about consent to care and there was a lack of information in care documentation about mental capacity assessments. We found that consent forms were not signed or had been signed by staff without the authority to do so, and there was no best interest meetings evidenced in care plans. I asked the management team if signed consent forms, or evidence of best interest decisions, were held anywhere else, for example, in a paper file, and the area manager informed us these were not in place and that they are aware this is something that they need to address. This meant there was no evidence to support that people had been involved in any decisions about their care or had consented to the care and support they received at Bankfield House. We were not assured that relevant capacity assessments had been carried out and where necessary a best interest decision had been made involving the relevant people. This meant the service was not working within the Mental Capacity Act 2005.