Bethany Lodge

Updated 20 February 2021

The inspection

This was a targeted inspection to check on a specific concern we had about staffing, medicines and oversight of the service.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Bethany Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We reviewed information shared with us by other agencies and members of the public.

We used all of this information to plan our inspection.

During the inspection

We spoke with one person who used the service about their experience of the care provided. We spoke with two members of staff including the operations manager and a nurse. We observed people receiving support from staff.

We reviewed a range of records. This included multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We reviewed a range of records shared with us by the provider. We spoke with two relatives and two members of staff.

Updated 20 February 2021

This inspection took place on 20 and 21 June 2017 and was unannounced. The previous inspection was carried out in March 2016 and concerns related to the policies and procedures relating to the administration of medicines, some records relating to monitoring and checks, person centred detail recorded within people’s care plans and systems and processes to audit the service. We asked the provider to send us an action plan about the changes they would make to improve the service. At this inspection we found that actions had been taken to implement these improvements, although some other areas required some minor improvements.

Bethany Lodge Care Home provides accommodation with personal and nursing care for up to 24 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 23 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. There were two lounges, a dining room, and separate toilets and showers or bathrooms. All bedrooms were single with specialist beds and hoisting tracks. There was also an arts and crafts room in the grounds and a hydrotherapy pool at the sister service nearby.

The service had a registered manager who was not available on the days of the inspection, however; the registered manager from the sister service was able to assist in all areas 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.

Overall medicines were well managed. People received their medicines safely and when they needed them. Staff followed correct and appropriate procedures in the storage and dispensing of medicines. Some people were prescribed medicines to take ‘as and when required’, there was guidance in place for staff to follow for most people but some people were missing the guidance.

A number of audits and checks were carried out each month by the registered manager or senior staff, but the medicines audit had not been effective in identifying the shortfalls in medicines guidance highlighted during our inspection.

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. Staff followed the guidance of healthcare professionals where appropriate and we saw evidence of staff working alongside healthcare professionals to achieve good outcomes for people.

Recruitment files contained the required information about staff. This helped to ensure that the staff employed to support people were fit and appropriate to be working with people. There were enough staff on duty and they had received relevant training and supervision to help them carry out their roles effectively. Staff were supported to complete an induction when they began work at the service. They were supported, 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.

Staff knew how to keep people safe from abuse and neglect and any incidents were appropriately referred to the local safeguarding authority. Incidents and accidents were monitored to make sure the care provided was safe. Fire safety had been addressed through training, drills and alarm testing. Maintenance had been carried out promptly when repairs were needed. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

Staff encouraged people to be involved and feel included. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff. People's privacy and dignity was respected.

People had a choice of meals, snacks and drinks, and could choose where they would like to eat. Staff encouraged people to eat their meals and gave assistance to those that required it.

Staff understood the principles of the Mental Capacity Act and knew how to support people who were not able to make their own decisions. People's rights were protected.

Staff treated people with kindness, compassion and respect. Staff took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives.

Activities were offered to people; with a range of one to one and group activities to meet individual needs and preferences.

Complaints had been properly documented, and recorded whether complainants were satisfied with the responses given. People said they knew how to complain if necessary and that the registered manager was approachable.

Staff told us they were clear about their roles and felt well supported by management. Staff said there was good communication. Feedback was sought from people, relatives and professionals.

We have made the following recommendations:

We have made a recommendation about the records management of some medicines.

We have made a recommendation about the medicines audit.