Bethrey House

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

Systems and processes in place to check the quality of the service people received were not consistently identifying areas for improvement. For example, care records had entries which were not appropriately described by staff, some records of interviews for staff vacancies were not on file and some care plans lacked detail. The registered manager understood their responsibilities for managing the home and ensured they followed duty of candour. The provider worked in partnership with other agencies and involved people, relatives and staff in the service.

People were safeguarded from abuse by staff who understood how to recognise the signs and report any concerns. Risks to people’s safety were assessed and plans put in place to reduce them. People were supported by enough staff to meet their needs. People were supported by staff who understood how to protect them from risks related to the spread of infection. Any incidents were investigated, and learning shared to reduce the risk of reoccurrence.

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 supported this practice.

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

Rating at last inspection

The last rating for this service was requires improvement (4 February 2021)

Why we inspected

We received concerns in relation to the management of the service and people’s safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection. However, we have found evidence that the provider needs to make some improvements. Please see the well-led sections of this full report.

Recommendations

We have made a recommendation about window restrictors.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Bethrey House is a residential care home providing personal care to 12 people at the time of the inspection, some of whom were living with dementia. The service can support up to 19 people.

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

People's risk assessments did not always contain clear guidance for staff to support them to meet their needs. Despite this, people were supported by trained staff who knew them well.

Whilst people received their medicines as prescribed, improvements were required in relation to people's medicines records to ensure staff had clear guidance around their 'as required' medicines and creams.

People were supported by sufficient staff in a flexible way in line with their preferences. However, staff recruitment records did not always contain comprehensive information about their employment history.

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 supported this practice.

People were supported to maintain a balanced diet in line with their preferences. People were encouraged to give feedback about their care and be involved in their care planning. There were regular activities at the service which people told us they enjoyed.

People and their relatives felt able to speak with the management team should they have any concerns. People had access to healthcare professionals as they required these.

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

Rating at last inspection

The last rating for this service was requires improvement (published 21 March 2019). 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 and concerns around how the service was managing infection prevention and control and governance. 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 coronavirus and other infection outbreaks effectively. We undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only. As there were no concerns identified in relation to the key question of caring.

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.

Bethrey 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. Bethrey House accommodates up to 19 older people. At the time of the inspection there were 16 people living at the service, many of whom were living with dementia.

A registered manager was in post. 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.

People were not supported in an environment that had been developed in line with best practice guidelines around dementia friendly environments. People’s rights were not always fully upheld by the effective use of the Mental Capacity Act 2005 (MCA). People did not have access to an appropriate range of leisure opportunities and activities. Governance and quality assurance systems were not consistently effective.

Staff understood how to protect people from abuse and harm such as accidents and injuries. Sufficient numbers of care staff were in post who had been recruited safely.

People received their medicines as prescribed. People were protected by effective infection control processes. People enjoyed the food and drink. People had regular support from a range of healthcare professionals and their day to day health was maintained.

People were supported by a staff team who were kind and caring. People were supported to make choices. Their privacy and dignity were respected and their independence promoted.

The care people received met their needs and preferences. People were involved in the development of their care plans and people’s changing needs were reviewed regularly.

People were happy with the management of the service. They felt they had a voice and could raise concerns when required. People were supported by care staff who felt motivated and well supported in their roles.

Bethrey House is registered to provide accommodation for up to 19 people who require personal care and support. On the day of the inspection there were 14 people living at the home. 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 told us they felt safe. People received care from staff that protected them from the risk of potential abuse. Staff were confident in reporting any concerns or suspected abuse. Risks to people were recorded and understood by staff. There were enough staff to meet people’s needs and provide them with effective care and support. People received their medicines as prescribed. Medicines were stored securely and there were clear audit trails for people’s medicines.

Staff received regular training and had the skills, knowledge and experience to meet people’s care and support needs. People’s consent was sought before care was provided and appropriate assessments had been carried out around people’s capacity to make certain decisions. People enjoyed the food provided and told us they received the food and drink they required. Staff were aware of people’s preferences and people with specific dietary requirements received appropriate food. People had access to appropriate healthcare according to their needs and staff responded without delay to changes in people’s health.

Staff knew people well and treated people with kindness. Staff had a good knowledge of people’s needs and preferences. People were involved in making decisions about their care and support.

Staff acted in a way that protected people privacy and dignity. People’s relatives were welcome to visit the home at a time of their choosing.

People’s care was tailored to their individual needs and choices. Staff had a good understanding of people’s preferences and life histories and provided them with support that was responsive to their needs. People felt able to express their views to the staff or the registered manager. There were systems in place to manage complaints.

People, relatives, professional visitors and staff felt the home was well managed. Staff felt they were listened to when they contributed ideas and that they were valued. The registered manager and senior staff carried out quality checks to ensure people received good quality care.

We carried out an inspection to help us answer five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who use the service, the staff supporting them and from looking at records. We spoke with three people, one visitor, three members of staff and the manager. We looked at three people's care records. There were 15 people staying at the service at the time of our inspection.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with told us they felt safe living at the service. One person told us, 'I do feel safe'. A visitor told us that they had never had any concerns.

Systems were in place to make sure that managers and staff learned from events such as accidents, incidents and complaints. This helped to reduce the risks to people.

No recent applications for Deprivation of Liberty Safeguards (DoLS) had been submitted by the service. DoLS is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury. Staff showed good knowledge about how they should protect people's rights.

Records showed that management addressed staff performance and training through the use of supervision meetings and appraisals and managed staff performance, when required. There were some gaps in training for staff, but the manager was taking steps to address these.

Is the service effective?

People's health and care needs were regularly assessed and records reflected people's individual needs.

People told us, and records reflected that staff ensured people received appointments with outside professionals to support their health and wellbeing. These included appointments for eye and foot care for people with diabetes.

People's health was supported by being offered appropriate nutritional support. This included healthy foods and food supplements, where required.

One person told us that staff had recognised they needed emergency medical support even though they had not recognised that they were ill themselves. They told us that staff had reacted effectively and efficiently to ensure they received appropriate care.

People had the opportunity to take part in activities. We saw that the service arranged outside events for people, such as a canal trip and a trip to the theatre, which meant that people were kept stimulated by appropriate activities.

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Is the service caring?

We observed staff interacting with people and saw that these interactions were positive, patient and caring. People were complementary about the staff. One person told us that staff were, 'Kind' and that they were 'afforded every care'.

We saw that staff adapted their approach to suit the person. This included communicating in the most effective ways and delivering care in a way which bought comfort to people. A visitor told us that a person was tactile and enjoyed contact with people. We saw staff sitting with this person and holding their hand.

Is the service responsive?

People told us, and records confirmed that staff and the management team listened to their opinions about the service. We saw that the service sought people's views in different ways. We saw that appropriate actions were taken to address any issues raised.

Although no recent complaints were recorded, people told us they would feel confident to speak with the manager if they did have a concern. People we spoke with told us they had never had cause to raise a complaint.

We saw that the manager undertook a number of audits to ensure the standard of the service and people's safety and wellbeing. We saw that effective medication audits were carried out by staff and over seen by the manager.

Is the service well-led?

The previous registered manager had left the service. The new care manager was present during our inspection and showed us that there were taking steps to apply for registered manager status.

We saw that the care manager had implemented a number of improvements and had reacted to improvements required by the CQC and other agencies.

We saw evidence of the service cooperating with others, such as the district nurse service and G.P.s, to promote people's wellbeing. This meant that staff took into consideration external professional advice in order to promote people's health and wellbeing.

We found that the management of medicines had improved since the last inspection and the service was now able to demonstrate that they were looking after and administering medicines safely. We found that the administration records were able to demonstrate that people were having their medicines administered as prescribed, by competent care staff.

We found that a needs assessment was carried out to establish people's care and treatment needs but people could not be confident that their needs would be met. One visiting relative said, 'I was involved in x initial needs assessment.'

People had a choice of meals but we found that recommendations made by a dietician had not been acted on. We found that people who required an ethnic meal did not have access to this. However, one person who used the service said, 'The food here is lovely.'

The management of medicines remained unsafe and this meant that people did not always receive their prescribed treatment.

The provider had taken measures to arrange training for staff to ensure they had the appropriate skills and competence to carry out their role.

We found that the provider had taken action to implement a quality assurance monitoring system. However, we found that this system was not entirely robust to ensure people received that appropriate care and treatment.

On the day of the inspection there were 16 people in residence. We spoke with three people who used the service, a visiting relative, a care staff and the registered manager.

We found that the management of people's medicines was unsafe and placed them at risk of not receiving their prescribed treatment.

We found that not all staff had received relevant training to ensure they had the appropriate skills to support people with their care and treatment needs. However, the people we spoke with were satisfied with the service they had received. One person who used the service said, "The staff are very kind."

The home's quality assurance monitoring systems had improved but they were not entirely robust to ensure people were protected against the risks of inappropriate or unsafe care and treatment.

We found that people's consent for care was obtained before this was provided.

We found that care plans did not provide staff with sufficient information to ensure people's care and treatment needs were met. However, the care staff we spoke with demonstrated a good understanding about how to care for the individual. One person who used the service said, 'I'm treated with care here.'

Discussions with two care staff confirmed they had a good understanding of their responsibility of protecting people from potential abuse. One person who used the service said, 'I feel very safe here.'

The management of people's medicines were unsafe and placed them at risk of not receiving their prescribed treatment.

We found that staff did not have access to relevant training and this placed people at risk of receiving inadequate care and support.

The home's quality assurance monitoring systems were not robust to ensure people were protected against the risks of inappropriate or unsafe care and treatment.