Banbury nursing home continues to require improvement. Management says actions have been taken swiftly

The Care Quality Commission (CQC) has rated Banbury Heights Nursing Home as ‘requires improvement’. The home received the same rating last summer after concerns were raised.

The CQC returned to the home in March. Their subsequent report said people were still not always protected from risk of harm, as risks were not always managed safely. They found systems and processes were still not always effective in identifying and mitigating concerns. And they found fault with the oversight of medicines and health concerns.

Banbury Heights Director, Charles Taylor said: “The inspection result wasn’t the outcome we and the team had been working towards, sadly.

“We were disappointed with the Requires Improvement rating we received from CQC, particularly as it only reviewed a small proportion of the care we deliver under their new inspection system.

"Whilst we had worked hard to improve the home, the inspector on the day found further improvements they wanted us to make in our care delivery. Since the inspection in March we have been working hard with the regulator to deliver improvements and have rectified all the issues identified in the report.

"We are currently trying to get CQC back to review the improvements and believe that we would achieve a ‘Good’ rating were they to visit today.”

Inspectors gave Banbury Heights an overall rating of Requires Improvement. This rating applied to the Safe and Well Led aspects of the inspection. They gave a ‘Good’ rating to Effective, Caring and Responsive elements of provision.

They said: “At this inspection we found people were still not always protected from the risk of harm as their risks were not always managed safely.

"We found concerns with the management of people’s diabetes and medicine management. This resulted in a continued breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

"There were sufficient staff to support people and effective safeguarding systems, processes and practices in place. Staff completed safeguarding training and those we spoke with understood their role in keeping people safe. All staff knew how and where to report concerns to.”

The inspectors found the provider had safeguarding policies and procedures in place. When harm had occurred, the provider had informed the relevant people and investigations had been completed.

“People told us they felt safe and most people stated staff responded to their needs. One person said, ’ they regularly check on me; if I fall they come running’. However, some people told us that it could take time for staff to respond to their call bells. One person said, ‘I can be impatient occasionally and will attempt to visit the toilet independently, due to the delay in responding to my call bell’. This put the person at risk of falling.

“Although staff stated risks were identified and mitigated, not all staff could tell us what strategies were implemented. For example, when people could not use call bells, staff did not have clear instructions on how often to check the safety of the person. Staff told us they ‘regularly’ checked on people.”

During their observations inspectors saw people being supported with manual handling in a safe way.

“Risk mitigation had not always been completed,” they said. “We found not all strategies recorded to reduce known risks to people had been completed as per people’s risk assessments. For example, we found strategies documented for diabetes had not consistently been completed and not all staff had received training on diabetes care. This put people at risk from harm linked to diabetes such as hyperglycaemia (high blood sugars), hypoglycaemia (low blood sugars) and Ketoacidosis (too many ketones in body).

"When people were unable to use a call bell... there were no risk assessments in place and records evidenced it could be up to three hours between staff checking the person. This put people at risk of not having their needs met.

“People told us they were cold as they did not have duvets on their beds on the first day of our visit. However, by the second day the temperature had improved, the environment was warm and people had access to duvets.

“Staff told us they felt the environment was suitable and clean. However, some staff felt the environment looked ‘tired and worn and required some work completed’.”

Inspectors said during the first day they observed not everyone had a call bell in reach and some call bells were not working. We saw improvements on the second day, all call bells were in reach and in working order.”

The provider had dementia signs to support people with dementia to navigate their environment. The home had a sensory room, garden and multiple communal rooms. The provider had regular safety checks to ensure safe water temperature and fire safety.

Medicine management required some improvement.

In the ‘Well Led’ part of the scrutiny, inspectors said the provider had failed to ensure there were effective governance and quality assurance measures in place.

Not all audits were effective in identifying concerns or issues. For example, the medicine audit had not identified or recognised the issues with the recording of medicine administration. Audits had not identified when blood sugar monitoring had not been completed as required and the kitchen audit had not identified out of date food. Inspectors found improvement in the monitoring of records for food and fluids, oral care and mental capacity assessments.

Staff told inspectors that although they had been asked to feed back on the service to identify improvement, their views were not always actioned.

The oversight systems were still not always effective in identifying missing information.