Bethany House Care Home

Bethany House is a nursing home providing personal and nursing care for up to 31 older people. At the time of the inspection there were 30 people living at the home, some of whom were living with dementia. The home is one large building with people living on two floors.

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

At our last inspection people’s safety was not managed. Quality assurance systems were not robust and had failed to identify the areas of concern found. At this inspection we found we found improvement had been made.

People told us they were happy. They said, “It’s home from home here, nice and friendly.”

Medicines systems were organised, and people were receiving their medicines when they should. Minor improvements were required to records for the administration of controlled drugs and people’s food supplements. The provider was following national guidance for the receipt, storage, administration and disposal of medicines.

Staff were skilled and knowledgeable in the care and support people required. The provider had a recruitment system in place, however some long-term staff required their DBS renewing. The staff team was consistent with some staff working at the service for many years. Staff worked with family members and a range of professionals to ensure people received the care and support they required.

People told us they felt safe whilst being supported by staff. Relatives were confident family members were well cared for. There was a proactive approach to assessing and managing risk which allowed people to remain as independent as possible.

The provider promoted person-centred care which was delivered through the assessment and planning of people's individual and specific needs. Care plans were detailed and informative. They identified the specific care that people required.

People were involved in decisions about the care they received. People had maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and staff had access to, and support from a management team who had improved quality monitoring of the service. People, their relatives and staff had their views on the service sought and told us if they were worried about anything they would be comfortable to talk with staff or 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 28 February 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At this inspection we found the provider continued to breach the regulations related to safe care and treatment and good governance. This is the second time we have rated the service as required improvement.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; is the service safe, effective, caring, responsive and well-led, to at least good.

We found evidence that some improvements had been made to the service to protect people from harm. However, there remained areas of concern which required improvement to ensure people’s continued health, safety and well-being.

Bethany House 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.

The service provides nursing and personal care for older people and people living with dementia or a physical disability. The home is a detached 31 bed purpose built care home. It is set out over two floors. At the time of our inspection there were 30 people using the service.

We observed that people could enter or leave the building through unlocked doors without staff being aware. This posed a risk of harm to all people living at the service.

We found doors to sluice rooms, the cleaners cupboard and laundry were left open and accessible to anyone living at the service. This meant people were not protected from the potential hazards and risks associated with equipment and chemicals stored in these rooms.

Where people required the use of bed rails to prevent them from falling out of bed, we found safe practices were not always being followed to protect people from harm.

The provider had an infection control policy in place to help protect people from the risk of infection. However, we found this was not always being practiced which meant that people were not being protected from the potential spread of infections.

We found new systems were being introduced to continually improve the service through quality monitoring. However, we found the current governance systems had failed to identify the concerns found during this inspection.

Medicines management had improved following our last inspection.

People said they were well cared for and told us the staff were kind, considerate and caring. Care records provided staff with a summary of people’s needs and preferences. People told us they had been involved in developing their care plans.

Staff had a good understanding of both safeguarding and the provider’s whistle blowing procedure. They told us they wouldn’t hesitate to use the procedure to keep people safe.

Staffing levels had improved and were sufficient to meet people’s needs. People told us staff were reliable and responded to their needs well.

There were robust recruitment procedures to ensure new staff were suitable to work at the service.

Incidents and accidents were logged, with details recorded of the action taken to keep people safe. These were monitored to identify any patterns and trends.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems in the service supported this practice.

Care plan audits were being undertaken regularly to ensure any change of need or issues could be addressed quickly.

Staff were well supported and received the training they needed, including a suitable induction for new staff. Records confirmed supervisions, appraisals and training was up to date.

People were supported to meet their nutritional needs as required. Where necessary, staff supported people to attend healthcare appointments.

The service displayed details of advocacy services and the provider’s complaint procedure.

People had access to activities to help avoid social isolation. This included events in the local community and the service.

People had the opportunity to discuss their end of life care wishes. Where people had specific requests, these were included in their care plans.

The provider consulted and engaged with people and staff to gather their views about the service.

The provider was submitting statutory notifications for significant events as required.

The provider was working in collaboration with external partners.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the report.

Bethany House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of inspection the service was full with 31 people living there.

A registered manager was in post at the time of the inspection visit. They were registered with the Care Quality Commission in December 2011. 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.

The last inspection of the service was carried out in December 2015 and found that the service was meeting all the requirements of Health and Social Care Act 2008 and associated Regulations and rated them as good.

At this inspection we found that the standards at the service had deteriorated and required improvement.

We found concerns with the administration of medicines and the provider was following unsafe practice which was not within best practice guidelines.

Plans were not in place to minimise all risks to people who used the service. For example where a person self-administered their medicines or if a person was an insulin dependent diabetic.

People were at risk of harm from scalding due to high temperatures from the tap in their bedroom sink and due to windows opening wider than health and safety guidelines recommend.

Not all staff received a fire or full evacuation drill which meant at the time of an emergency people could be at risk.

Audits were not taking place for health and safety. The audits that were taking place were not effective in identifying the issues we found.

Due to these concerns we sent the provider an urgent action letter requesting them to take immediate action to address the concerns and keep people safe.

The majority of people enjoyed the food provided and were offered choice.

The premises were very plain without any contrasting colours and did not have any dementia friendly adaptations. We have made a recommendation about this.

Staff had received all the training they needed to carry out their roles effectively. However, nurses had not received up to date percutaneous endoscopic gastrostomy (PEG) training. PEG feeding is a means of providing nutrition and hydration to people through a feeding tube inserted into the stomach. We were aware of one person with a PEG at the time of the inspection. Staff were fully supported from supervisions and a yearly appraisal.

People who lived at the service were safeguarded from abuse and potential abuse. People told us that they felt safe at the service and that they trusted staff. Safeguarding training was completed by staff and they had access to information about how to prevent abuse and how to respond to an allegation of abuse. Staff knew what was meant by abuse and said they would not hesitate to report any kind of abuse which they were told about, suspected or witnessed.

A number of recruitment checks were carried out before staff were employed to ensure they were suitable.

Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) training and demonstrated a basic understanding of the requirements of the Act. The registered manager understood their responsibilities in relation to the DoLS. Evidence of consent was sought.

Comments from people highlighted there were not enough staff on duty. Staff we spoke with said they felt staffing levels were difficult when they had sickness.

People said staff were kind and caring, however, many said they did not like to disturb them [staff]. People felt they were not receiving baths as often as they would like. We have made a recommendation about this.

Care plans provided information on people’s wishes and preferences. However, there was no record of people’s life histories. We have made a recommendation about this.

We saw evidence of activities that had taken place. People provided mixed responses about activities with many complaining they were bored.

The service had a complaints policy that was applied if and when issues arose. People and their relatives knew how to raise any issues they had. All complaints received had been investigated.

This is the first time the service has been rated Requires Improvement.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was not making sure the premises were safe, risk assessments were in place or medicines were administered safely and the provider was not assessing, monitoring and improving the quality and safety of the service. You can see what action we told the registered provider to take at the back of the full version of the report.

We previously inspected Bethany House Care Home on 20 January 2014, at which time the service was compliant with all regulatory standards.

Bethany House Care Home is a residential home in Newton Aycliffe providing accommodation and nursing care for up to 31 people who require nursing and personal care. There were 31 people using the service at the time of our inspection.

The service had a registered manager in place. 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.

We found that there were adequate numbers of staff on duty in order to meet the needs of people using the service.

Safeguarding principles, types of abuse to look out for and relevant contact information should people who used the service, relatives or staff have concerns were clearly displayed throughout the service. Members of staff displayed a good knowledge of safeguarding issues and a clear understanding of warning signs to be mindful of and their prospective actions should they have such concerns

We saw risks to people were managed through risk assessments and associated care plans. These risks were reviewed each month and we saw when relevant information was provided by healthcare professionals this was incorporated into care planning and risk assessment.

We found the service had systems in place for ordering, receiving, storing and disposing of medicines, including controlled drugs. Administration of medicines was generally safe and adhered to the National Institute for Health and Clinical Excellence (NICE) guidelines.

There were effective pre-employment checks of staff in place, including Disclosure and Barring Service checks, references and identity checks, whilst records of interviews were detailed and specific to the role.

The service was clean throughout, with a range of infection control measures in place, including two domestic assistants on duty at the time of inspection.

Training was relevant to people’s needs, with staff having completed communication training recently to help support their engagement with people who could not verbalise their wishes. Other recently completed training included: dementia awareness, infection control, manual handling, first aid, person-centred care, safeguarding, death, dying and bereavement, equality, diversity and inclusion and medicines administration. When we questioned staff about the practicalities of a range of these areas, they were able to give detailed and informed answers.

Staff had a good knowledge of people’s likes, dislikes and life histories and built a rapport with the people they cared for. This was facilitated by a key worker system, whereby staff had responsibility for individuals, leading to trusting relationships and a greater continuity of care.

Staff were well supported through formal supervision and appraisal processes as well as ad hoc support when required.

People had choices at each meal as well as being offered alternatives if they did not want the planned meal options. People told us they enjoyed the food and we observed calm and attentive interactions between staff and people they supported during lunchtime. We saw the service had successfully implemented a tool to manage the risk of malnutrition. The service’s approach to supporting people who required specialised diets was praised by a dietitian.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA. The registered manager displayed a sound understanding of capacity and we found related assessments and decisions had been properly taken and the provider had followed the requirements in the DoLS.

The atmosphere at the home was welcoming and vibrant, with people engaged in activities that were meaningful to them, such as visiting the nearby day centre or watching films, and engaging in warm interactions with staff. Relatives and external stakeholders agreed that staff were caring and compassionate.

Extensive person-centred care plans were in place and daily notes were accurate and contemporaneous. Regular reviews ensured relatives and healthcare professionals were involved in ensuring people’s medical, personal, social and nutritional needs were met.

People’s religious beliefs were respected and encouraged. A local church regularly held services in the home, whilst also providing befriending support. The service had built and maintained strong community links, with the church, a day centre and educational establishments, from which students regularly attended on work experience placements.

We spent time with the people who used the service as they had their breakfasts and lunches and observed how staff supported and encouraged them. We saw staff encouraged people to make their own choices and decisions. We saw staff understood each person's different needs, for example, when they required additional support.

We saw that staff supported people to make choices about how they spent their day and the range of activities offered. On the day of our visit some of the people who used the service went out to various day centres.

We saw that staff treated people with dignity and respect and supported them to retain as much independence as possible. One person told us, 'It was difficult coming here. But now I am here the staff have been so good and help me when I need it'. We saw that people had freedom of movement around their home and could spend time in their bedrooms whenever they wanted. We saw that each person had their own bedroom which was personalised. We saw the provider had made suitable adaptations to meet the people's physical needs.

'I am looked after very well in here.'

'It's alright, I have no complaints.'

'The staff are very good, they will always help you.'

'We have regular residents' meetings every month so we can talk about things.'

We found that before people received any care or treatment they were asked for their consent and the provider had acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We found that people who used the service were protected and safe. We found that there was an effective infection control system in place and that the home had a clean and suitable environment.

We found that there were good systems in place for the involvement of other health or social care professionals.

We found that people who used the service had their care and welfare needs met.

We found that staff had been well supported to deliver care and treatment safely. We were able to speak with four staff on duty at the home. All of the staff told us they were well supported by their manager.

We found that people's views were important and listened to. We found that there was an effective complaints system in place.