Archived: Bethany House Care Home

Bethany House Care Home provides accommodation with personal and nursing care for up to 15 adults who need care and support with physical disabilities and complex needs, such as congenital disorders, degenerative illnesses and acquired brain injuries. At the time of the inspection there were 15 people living at the service, most were younger adults although the service also supported people who were older.

People were living with a range of care and nursing needs, many people needed support with all of their personal care, and some with eating, drinking and mobility needs. Other people were more independent and needed less support from staff. People's bedrooms were all en-suite and provided over two floors, with a passenger lift in-between. There was a large sitting and dining room on the ground floor and a quiet lounge on the first floor. On the ground floor there was also a hydrotherapy pool. Outside there was an enclosed garden and grounds which people could access.

The service had a registered manager who was available on the days 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.

Staff followed correct and appropriate procedures in the storage and dispensing of medicines. People were supported in a safe environment and risks identified for people were managed in a way that enabled people to live as independent a life as possible. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

A robust system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit and appropriate to be working with people. There were sufficient numbers of staff on duty to make sure people were safe and received the care and support that they needed. Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people's needs. Staff continued to receive training, competence checks and support to meet the needs of people. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people's care and lives.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns. Staff knew about whistle blowing and were confident they could raise any concerns with the provider or outside agencies if needed.

Equipment and the premises received regular checks and servicing in order to ensure it was safe. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

The care and support needs of each person were different, and each person's care plan was individual to them. Care plans, risk assessments and guidance were in place to help staff to support people in an individual way. People's legal rights were protected as staff provided care in line with the Mental Capacity Act (2005). Correct procedures were followed when depriving people of their liberty. Staff followed the guidance of healthcare professionals where appropriate and we saw evidence of staff working alongside healthcare professionals to achieve outcomes for people.

Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities of their choice. Staff knew people and their support needs very well. Feedback we received from people, their relatives and health professionals was positive. We were told about good standards of care; which improved the quality of people's lives and gave their families peace of mind. We observed warm, caring attitudes from staff and commitment to provide the best service for people.

Staff were caring, kind and respected people's privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff.

People and relatives were complimentary about the food and were offered choices around their meals and hydration needs. Staff understood people's likes and dislikes and dietary requirements and promoted people to eat a healthy and nutritious diet.

Staff told us that the service was well led and that they felt very well supported by the registered manager and provider to make sure they could support and care for people safely and effectively. Systems were in place to ensure care at the home was of a good quality. People's feedback was sought and action was taken to implement improvements. The registered manager had good management oversight and was able to assist us in all aspects of our inspection.

There was a registered manager working at Bethany House. 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 and associated Regulations about how the service is run.

We last inspected this service on 15 October 2014. At that inspection we found some improvements were needed in respect of the understanding and implementation of the Mental Capacity Act 2005 by the provider, registered manager and staff and obtaining of consent. Accurate records of peoples care and support were not being maintained and some important health information had been overlooked. We asked the provider to send us a report of how they would address these issues and within what timescale, which they had done. At this inspection we found the provider had addressed most of the outstanding requirements but further shortfalls had been highlighted in regard to some operational and service user records.

People could be placed at risk because the provider could not assure their self through the records they maintained that all staff had received the recommended number of fire drills or that visual checks of fire equipment and some equipment used to support peoples care were taking place.

Staff said that they felt supported and the registered manager monitored their practice when she worked on shift with them but formal recorded staff supervision was irregular, with none recorded since August 2015; this meant there was no mechanism in place for recording staff performance and development throughout the year to inform their annual work appraisal or to monitor actions that have been highlighted for improvement.

Management of medicines required improvements. Staff showed that they had a good understanding of people’s individual styles and range of communication, but this information was not recorded to inform newer staff. Similarly, some people expressed their emotions from time to time through behaviour, staff understood this and how to de-escalate situations in the least restrictive way, their practice however, was not recorded in care and support plan guidance for all staff to ensure they responded in a consistent manner.

A service development plan was in place and relatives were asked to share their views about the service; there was however, no system in place to analyse their comments, and use these to inform the service development plan, nor a mechanism to provide feedback so people surveyed knew their views were listened to. Audits to assess and monitor service quality were largely undeveloped so the provider and registered manager could not assure their selves that all aspects of service delivery were operating to a good standard and any shortfalls were highlighted and dealt with.

People were given individual support with their interests and hobbies but we have recommended this be reviewed to ensure the range quality and frequency of activities is discussed with people and their relatives.

Relatives and staff referred to this as a ‘happy home’ and we saw that people were content, relaxed and comfortable in the presence of staff. Staff interacted well and showed they understood people’s individual needs.

Relatives told us they were kept informed and had been consulted about their family members care and treatment plans. They said they were invited to and attended care reviews annually where possible, they felt able to contribute to these meetings and felt listened to.

Staff monitored people’s health and wellbeing and ensured health professionals were contacted in a timely manner if health needs changed they supported people to attend routine and

specialist health appointments when this was needed. Staff understood people’s nutritional needs and provided them with a varied diet that was suitable for them; the cook was aware of people’s personal food preferences and ensured these were incorporated into the menus provided. Weights were recorded and monitored to highlight any emerging problems. Staff sought advice and guidance from health professionals around supporting people who may have need of assistance with eating or having their nutritional needs met appropriately.

Risks were appropriately assessed and measures implemented to reduce the likelihood of harm occurring. There was a low level of accidents and incidents and these were monitored by the provider and registered manager.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Since the last inspection staff had received appropriate training to understand their responsibilities and applications for DoLS authorisations had been made for everyone in the service who met the criteria. The provider and registered manager now understood when an application should be made and the service was now meeting the requirements of the Deprivation of Liberty Safeguards.

Staff had been trained to recognise abuse and knew how to protect people from harm. There were enough staff to meet people’s needs. Staff recruitment procedures ensured that all the necessary checks were made to protect people from unsuitable staff. Staff were provided with a wide range of essential and specialist training to help them understand and meet people’s needs. They received support through staff meetings.

People lived in a clean, well maintained environment. The premises were well maintained. People were supported to personalise their bedrooms to their own taste. Equipment checks and servicing were regularly carried out to ensure the premises and equipment used was safe. Fire detection and alarm systems were maintained; Guidance was available to staff in the event of emergency events so they knew who to contact and what action to take to protect people.

We recommend that a record be made of the temperature of all hot food served to ensure this meets the requirements of food standards monitored by Environmental Health.

We would recommend that a review of the range, quality and frequency of activities on offer be undertaken in consultation with people and their relatives.

We found a number of 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.

Most of the people who use this service were not able to comment directly on their care due to communication difficulties. However, we observed the way staff interacted with them and noted that they were aware of how people could make their feelings and wishes known through facial expressions and vocalisations. Staff could interpret signs that a person may be in pain for example in order to provide pain relief and seek medical attention if required.

We looked at the systems in place to ensure effective infection control and spoke with staff including domestic staff. We found that staff had a good understanding of infection control procedures and were given appropriate training as part of their induction.

We found that the people were aware of the complaints procedure. They were confident that they could raise concerns and they would be dealt with appropriately. Staff showed a good awareness of how to support people if they wanted to make a complaint.

Records showed that people were supported to make decisions about their day to day lives and things that were important to them. People could choose when to get up and go to bed, what to do and what to eat each day and staff respected their choices.

Staff understood people's needs and their individual methods of communication. People's health care needs were met and they were supported to keep in contact with health care professionals. A person said they liked the staff and that staff were kind and polite. They said 'they are so friendly and kind' and 'they are marvellous'.

The service was clean and well maintained and people told us that they liked their rooms. Bedrooms reflected people's personalities and shared areas were spacious with plenty of room for people who used wheelchairs to move around in.

There were enough staff on duty to support people safely. The organisation had processes and procedures in place to regularly check on the quality of the service people received and to keep them safe.