Bethany Homestead

Bethany Homestead is a residential care home providing personal care for up to 38 people. The service provides support to older people and young adults, people with dementia, physical disability and people with sensory impairments. At the time of our inspection there were 35 people using the service.

Bethany Homestead provide accommodation across two floors with a lift to the second floor. People with higher dependency needs are accommodated on the ground floor. Rooms have en- suite facilities and there is a communal lounge and dining room.

Bethany Homestead also provides a domiciliary service for the regulated activity of personal care to people living in their own homes within the grounds of Bethany Homestead. At the time of our inspection no one who used the domiciliary service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability. We considered this guidance as there were people using the service who have a learning disability.

The provider had not ensured effective oversight of the service to ensure enforcement action was complied with in the required time frame and risks to people were mitigated.

The providers and registered managers systems and processes had not always ensured effective oversight of the safety and quality of the service. Readmission processes required improvement to ensure any changes in people’s health and care needs could be met.

Improvements required in clarity of information for staff in people’s risk assessments and care plans to mitigate risk. Accidents and incidents were recorded and monitored for trends and patterns and measures put in place to mitigate future risk.

Medicines were administered stored and disposed of safely. People received their medicines when they needed them. There were some improvements required to the consistency of how staff recorded when they had given as and when required medicines (PRN).

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service mostly supported this practice. There was further work underway to ensure all people had decision specific mental capacity assessments.

The home was clean and well maintained. People were protected from the risk of infection and from risk in the environment such as fire and scalding. Staff had access to personal protective equipment.

Systems and processes were in place to protect people from the risk of abuse. Staff were trained and had a good understanding of how to keep people safe and how and to report concerns. Safe recruitment practices were in place and there were enough staff to meet people’s needs.

The provider and registered manager promoted a positive culture that supported choice and independence as much as possible. People’s social, cultural and religious needs were met.

The provider and management team worked in partnership with other professionals to ensure good outcomes for people.

People, relatives and staff were invited to give feedback on care which was reviewed by the provider and registered manager and monitored for themes.

Staff received regular supervision and appraisal and felt well supported by the management team.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 July 2021). At this inspection we found the provider remained in breach of regulations and the service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulations 12 (safe care and treatment) and 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bethany Homestead on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to the managerial oversight of the safety and quality of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Bethany Homestead is a residential care home supporting younger adults, older people, people living with physical disability or sensory impairment and people living with dementia. At the time of our inspection 33 people were living at the service which can support up to 38 people.

Bethany Homestead provide accommodation across two floors with a lift to the second floor. People with higher dependency needs are accommodated on the ground floor.

Bethany Homestead also provides a domiciliary service for the regulated activity of personal care to people living in their own homes within the grounds of Bethany Homestead. At the time of our inspection no one who used the domiciliary service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided

People’s experience of using this service and what we found

Risk assessments in place did not always contain strategies for staff to follow to reduce the risk.

We identified multiple missed signatures on the Medicine Administration Records (MAR). Staff are required to sign the MAR chart to evidence that they have administered each medicine.

Records required improvements. For example, fluid intake was not consistently recorded by staff and daily fluid intake was not always calculated or met. Cleaning tasks had missing data recorded, mostly at weekends.

People's needs were assessed before they moved into the home to ensure these could be met. However, we identified that people’s current support and healthcare needs were not always recorded in their care plans.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; However, the policies and systems in the service did not always support this practice.

Quality assurance systems required further development and improvement.

People told us they felt safe. Staff received training on safeguarding and understood how to recognise and report abuse.

The provider completed pre employment checks to support safer recruitment. However, some staff files relating to staff who were employed years ago, did not have all the checks recorded.

Staff received the training required to carry out their roles effectively. Staff felt supported.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 03 April 2020) with three breaches of regulation. This resulted in conditions being applied to the providers registration. The provider completed monthly action plans after the last inspection to show what they would do and by when to improve.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections. At this inspection enough improvement had not been made. The provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bethany Homestead on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicine management, safe care and oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bethany Homestead is a residential care home supporting younger adults, older people, people living with physical disability, people living with sensory impairment and people living with dementia. At the time of our inspection 35 people were living at the service which can support up to 38 people.

Bethany Homestead provide accommodation across 2 floors with a lift to the second floor. People with higher dependency needs are accommodated on the ground floor. All rooms have private en-suite facilities.

Bethany Homestead also provides a domiciliary service for the regulated activity of personal care to people living in their own homes within the grounds of Bethany Homestead. At the time of our inspection no one who used the domiciliary service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People were not always safe. Staff were not always following safe moving and handling techniques and the competency of staff was not monitored effectively. People had incurred injuries when being supported with changing position. Accident and Incident forms were completed, but the registered manager had failed to identify themes of poor practice.

The provider continued to place people at risk from cross infection when being supported with moving and handling.

Medicines were managed, stored and disposed of safely.

People told us they felt safe and there was enough staff to meet their care needs.

The provider was working in partnership with healthcare professionals. However, people with swallowing difficulties were not consistently referred for professional support.

Staff were friendly with people and treated them in a kind and respectful way, promoting their privacy and independence. People felt able to approach staff and express their views and wishes.

People were offered choice and their preferences were reflected throughout their care plans. People were offered the opportunity to take part in a variety of activities both within the home and in the community.

People's end of life wishes had been discussed where appropriate and there was information in their care plans.

A complaints procedure was in place. Formal complaints were not always fully managed in line with the complaints policy.

The registered manager had quality monitoring systems in place to monitor the standards of care. However, we found these tools were not robust enough to highlight some issues we found on our inspection.

At the time of inspection the registered manager was in the process of making improvements in staff training and supervision, this would need to be continued and embedded in practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At our last comprehensive inspection published 11 September 2018 this service was rated as Requires Improvement . A focussed inspection was carried out in November 2018 and the service was rated Requires Improvement in Safe and Well-led (latest report published 14 December 2018) with a breach in regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection there was not enough improvement sustained and the provider was still in breach of regulations. The service remains rated Requires Improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment of people using the service, how quality and safety of the service is monitored and improved and staff training.

We have also asked the provider for an explanation of why they had failed to notify us of safeguarding incidents and a Deprivation of Liberty Safeguards (DoLS) authorisation. We will review their response and if required undertake any appropriate enforcement action.

Follow up

We have requested monthly action plans from the provider to monitor the progress of improvements. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This responsive focussed inspection took place on 5 November 2018 and was unannounced. This inspection focussed on the safe and well led domains to establish whether people were receiving safe care. No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them.

This was the third inspection carried out at Bethany Homestead since December 2016.

Bethany Homestead is registered to provide the regulated activities of accommodation for persons who require nursing or personal care and also personal care to people living in accommodation within the grounds of Bethany Homestead. This focussed inspection only looked at the regulated activity of accommodation for persons who require nursing or personal care.

At our last comprehensive inspection in May 2018 we rated the service as Requires Improvement in safe, caring and well led domains. The provider was in breach of one regulation relating to sufficient numbers of staff deployed to meet the needs of people using the service. The provider was required to submit action plans demonstrating how they were to achieve compliance with the regulations. At this inspection we were satisfied improvements had been made and sufficient numbers of staff were deployed to safely meet people’s needs.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People were at risk of not receiving safe care because not all staff followed safe moving and handling procedures when supporting people to change position.

The provider did not follow best practice infection control prevention procedures. This placed people at risk of cross infection.

Policies and procedures were in place to safeguard people from harm and abuse and staff were aware of them. However, not all staff understood the care practices they were undertaking put people at risk of harm.

The systems in place to asses, monitor and improve the quality and safety of the services provided were not always effective.

Risk management plans were in place to safeguard people's personal safety and manage known environmental risks.

People were supported to take their medicines as prescribed. Medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

The provider and registered manager had made some changes within the service which had a positive impact on the moral of staff working at the service.

Events such as safeguarding matters, accidents and incidents had been reported to the Care Quality Commission (CQC) and other relevant agencies as required.

We found one breach 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 the report.

Bethany Homestead is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Bethany Homestead also provides the regulated activity of personal care to people living in their own homes within the grounds of Bethany Homestead.

Bethany Homestead is registered to accommodate up to 38 people. At the time of our inspection 38 people were living at the home. The service supports older people and people living with dementia. Bethany Homestead was also supporting three people with personal care needs who were living in their own homes within the grounds of the home.

Both regulated activities were looked at during this inspection; however, the focus throughout the report is on the care home.

At the last inspection in December 2016 this service was rated good. At this inspection the service is rated as requires improvement. This is the first time the service has been rated requires improvement.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

There was not always sufficient staff deployed in the home to meet the needs of people.

The systems in place to ensure there were always enough staff deployed to meet the needs of people who used the service had an impact on people’s dignity. The registered manager and provider lacked oversight of the day to day culture in the home and failed to address issues relating to the management of staff attitude, behaviours and code of conduct.

Staff followed the procedures for safeguarding people from the risks of harm or abuse. Risk management plans were in place to safeguard people's personal safety and manage known environmental risks.

People were supported to take their medicines as prescribed. Medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

People were supported to have sufficient amounts to eat and drink to maintain a balanced diet.

Staff had comprehensive induction training and on-going refresher training that was based on following current best practice.

Care plans contained information about peoples assessed needs and their preferences and people and their relatives were asked for feedback on improving the service.

All staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and had applied that knowledge appropriately.

Staff understood the importance of obtaining people’s consent when supporting them with their daily living needs.

The service had a complaints procedure in place. This ensured people and their families were able to provide feedback about their care and to help the service make improvements where required. The people we spoke with knew how to use it.

Events such as safeguarding matters, accidents and incidents had been reported to the Care Quality Commission (CQC) and other relevant agencies as required.

We found a breach 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 the report.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People were safeguarded from harm as the provider had systems in place to prevent, recognise and report concerns to the relevant authorities. The registered manager and senior knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and had applied that knowledge appropriately.

There were sufficient numbers of experienced staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person. Recruitment procedures protected people from receiving unsafe care from care staff unsuited to the role.

People’s care and support needs were continually monitored and reviewed to ensure that care was provided in the way that they needed. People had been involved in planning and reviewing their care when they wanted to.

People were supported to have sufficient to eat and drink to maintain a balanced diet. Staff monitored people’s health and well-being and ensured people had access to healthcare professionals when required.

Staff understood the importance of obtaining people’s consent when supporting them with their daily living needs. People experienced caring relationships with staff, who provided good interaction by taking the time to listen and understand what people needed.

People’s needs were met in line with their individual care plans and assessed needs. Staff took time to get to know people and ensured that people’s care was tailored to their individual needs.

People had the information they needed to make a complaint and the service had processes in place to respond to any complaints.

People were supported by a team of staff that had the managerial guidance and support they needed to carry out their roles. The quality of the service was monitored by the audits regularly carried out by the manager and by the provider.