Archived: Bethany House

Bethany House is a residential care home providing personal care and accommodation for up to 30 people, some of whom may live with Dementia. The service was supporting 10 older people at the time of the inspection.

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

People were not supported in a safe way. People were not protected from potential harm. Infection prevention and control (IPC) was unsafe. Risks to people were not assessed or mitigated. Hospital discharges, medicines management, moving and handling equipment and kitchen management were not safe.

The providers systems failed to identify that care and support was not provided in a safe way. Audits did not identify shortfalls in IPC processes and practices relating to, the use of personal protective equipment (PPE), assessment and monitoring of risk, hospital discharges, medication services, maintenance of moving and handling equipment, and kitchen management.

The provider did take immediate action when information of concern was shared with them, to protect people from harm.

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 18 October 2019).

Why we inspected

We received whistleblowing concerns and a complaint, about safe care and treatment. This included a bullying and closed culture, ineffective and non-compliant PPE, ineffective IPC, lack of training, unsafe medication practices, poor moving and handling, ineffective food and kitchen management and ineffective management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We looked at IPC 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 have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report. The provider took immediate action to mitigate the risks of people receiving unsafe care.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bethany House 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 safe care and treatment and governance.

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 work alongside the provider and 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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Bethany House is a residential care home providing personal care and accommodation for up to 30 people. The service was supporting eight people at the time of the inspection.

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

People were not supported in a safe way or protected from potential harm. Infection prevention and control (IPC) practices, medicines management and staff recruitment were not safe. Risks to people were not assessed or mitigated.

The providers systems failed to identify that care and support was not provided in a safe way. Check list audits did not identify shortfalls in IPC, medication services, staff recruitment or assessment and mitigation of risk.

The provider took immediate action to protect people from harm, when information of concern was shared with them.

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

The last rating for this service was Inadequate (published 31 March 2021) and there were breaches of regulation. At this inspection enough improvement had not been made or sustained, and 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.

We looked at IPC 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.

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 at this inspection in relation to, safe care and treatment, staffing and recruitment, staff training and skills, dignity and respect, and good governance.

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.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Bethany House is a residential care home providing personal care and accommodation for up to 30 people. The service was supporting eight people at the time of the inspection.

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

The provider and manager did not consistently or effectively follow the provider's recruitment policies and procedures, introduced following the previous inspection, to protect people from avoidable harm.

The provider and manager did not consistently or effectively follow the provider’s governance matrix, introduced following the previous inspection, to provide oversight of the service including recruitment practices. The provider’s failure to maintain oversight of the service left people at potential risk of avoidable harm.

This was a targeted inspection to consider recruitment processes, management and governance of the service. Based on our inspection, the provider’s recruitment processes were unsafe and the governance of the service was ineffective.

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 inadequate (published 12 October 2021) and there were multiple breaches of 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 enough improvement had not been made or sustained and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to check the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met around a specific concern we had about the safety of recruitment and selection of staff, and governance and oversight of the service. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

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.

You can read the report from our last focused inspection, by selecting the 'all reports' link for Bethany House on our website at www.cqc.org.uk.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Bethany House is a residential care home providing personal care for 16 people aged 65 and over at the time of the inspection. The service can support up to 30 people.

Bethany House accommodates up to 30 people across four converted houses that have been adapted into one large house.

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

The provider’s governance systems to check the quality of the service provided for people were not consistently effective and required further improvement.

Although 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 required some improvement to ensure the provider continued to support this practice.

Continued Improvements were required to the home environment to ensure it could support people living with dementia.

People were safe using the service. Staff knew how to protect people from harm and reduce the risk of accidents and incidents. The service was sufficiently staffed to ensure people's needs were met. There were enough suitably recruited staff on duty to meet people’s needs and to keep people safe. People were supported by consistent staff who they got to know well. Staff supported people with their medicines and this was done safely. Staff understood how to prevent and control the spread of infection.

People were assessed before being accepted to the service to ensure the provider could meet their needs. Assessments addressed people's physical and health needs, their cultural and language needs, and what was important to them. Staff received training which helped them to deliver personalised care. The provider worked well with external health and social care professionals and people were supported to access these services when they needed them to ensure their health was maintained.

Staff were knowledgeable and kind. People and relatives told us how friendly and caring the staff were. Staff enjoyed their work and got on well with the people they supported. Staff encouraged people’s independence, protected their privacy and treated them with dignity.

Some of the people using the service at the time of the inspection could not always tell us about their experiences. However, whilst on site, we saw positive interactions between people and staff and people looked comfortable with the way they were being supported. Relatives we spoke with gave us good feedback on the service and the way the staff supported their family members to remain safe. Staff provided responsive care to people in line with their preferences and choices. If people communicated non-verbally staff knew how to engage with them.

People were supported by staff who knew their preferences. Complaints made since the last inspection had been investigated and families knew who to contact if they had any concerns. Relatives and staff were happy with the way the service was being led and there was a clear culture amongst the staff team in providing person-centred care.

The provider monitored the service to ensure it continued to provide good quality care. The culture of the service was open and honest and the provider and staff were approachable. All the people, relatives, and staff we spoke with said the service provided good quality care.

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 05 September 2018) and there were multiple breaches of regulation. The provider had submitted monthly reports since the last inspection to show what improvements have been made. At this inspection we found some 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.

During this most recent inspection, we found the provider had made the necessary improvements to meet the breaches of Regulations 11, 13(1), 15, 17 and Registration Regulation 18 identified at the last inspection.

Where people lacked the mental capacity to make informed decisions about their care, we found there had been an improvement with the completion of mental capacity assessments. However, improvement was still required around the provider’s and staff understanding of what could constitute a restriction on a person and when to submit an application to lawfully restrict a person, in their best interest.

Potential risks to people had been identified. Although skin management processes required improvement and staffs’ practice when moving and transferring people did not always follow guidance to minimise the risk of avoidable harm.

Full information about CQC's regulatory response to issues and concerns found during inspections are added to this report after any representations and appeals have been concluded.

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 our inspection 20 people were living at the home.

The registered manager is also the provider. 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.

Systems used for the effective management of information about people's changing needs and risks required further improvement to ensure people's safety was maintained. The provider was notifying the local authority and CQC about incidents and events as required by law. Staff knew how to escalate any concerns for people's safety and well-being but there was further training required to improve their knowledge on what constituted a restriction on people and moving and transferring people. The home environment was clean and improvements were underway to introduce a more dementia friendly environment, with systems in place to monitor the improvements and audit infection control practices.

People’s health care needs were assessed and reviewed but people were not always referred to professionals in a timely way when health needs changed. There were activities available that provided opportunities to optimise people’s social and stimulation needs although they were not always suitable for those living with dementia and required further improvement.

People received care and support from staff that had received training but their working practices and knowledge demonstrated that the training provided was not always effective and required further improvement. Staff received supervision and appraisals and they felt supported to carry out their roles.

People were supported by suitably, recruited staff that had received training to identify signs of abuse to keep people safe. There had been an improvement in identifying potential abuse and what action should be taken because the provider and staff followed safeguarding procedures. People were supported by sufficient numbers of staff to receive their care and support. People were adequately supported with their medicines.

There had been an improvement with the managing of people’s nutritional needs. People spoke positively about the quality of the food and the choice of food available. People who were on food supplements received them and we found those at risk of losing weight had appropriate referrals made to professionals and were seen to gain weight. Relatives told us the management team were good at keeping them informed about their family member’s care.

People and relatives told us that staff were kind, caring and friendly and treated people with respect, although there were occasions when people’s dignity was not maintained. The atmosphere around the home was welcoming. People were relaxed and were supported by staff to maintain relationships that were important to people. People and their relatives told us they were confident that if they had any concerns or complaints they would be listened to and matters addressed quickly. There were processes in place to ensure people would receive appropriate support at the end of their lives.

We saw staff treated people as individuals, offering them choices whenever they engaged with people. Where people had the mental capacity, they were encouraged to make their own decisions, staff sought people's consent for care and treatment and ensured people were supported to make as many decisions as possible.

Bethany House is registered to provide accommodation and residential care for up to 30 people, most of whom were living with dementia. At the time of our inspection 28 people were living at the home.

It is a legal requirement that the home has a registered manager in post. The registered manager is also the provider. 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.

At our last inspection in April 2016, improvements were required to the management of the service. At this recent inspection we found improvements had not been made and we identified further areas of concern.

Systems in place to monitor and improve the quality of the service were ineffective in ensuring people received a good and continually improving quality of service. The audits had not identified the issues we found and had not always been consistently applied to ensure where shortfalls had been identified, they were investigated thoroughly and appropriate action plans put into place to reduce risk of reoccurrences.

Where people lacked the mental capacity to make informed decisions about their care, it was not always clear how relatives, friends and relevant professionals were involved in best interest's decision making. Mental capacity assessments and best interest decisions were not always applied consistently to clearly show what decisions people were being supported or asked to make in relation to their care. Application to apply for a Dols for people who had mental capacity showed that the provider did not have effective systems to ensure staff understood the legislationso people’s rights were protected. Some applications had been submitted to deprive people of their liberty, in their best interests; we found applications were not always submitted in a timely manner.

People were supported by suitably, recruited staff that had received training to identify signs of abuse to keep people safe. However, staff had not always followed safeguarding procedures when there had been verbal and physical altercations between people living at the home. Potential risks to people had been identified although staff practice did not always follow guidance put in place to minimise the risk of avoidable harm. People were supported by sufficient numbers of staff to receive their care and support. People were supported with their medicines, however, there was an improvement required with the administration of medicines.

Most people spoke positively about the choice of food available, although there was some inconsistency with staff not always ensuring people were given a choice of food available. People who were on food supplements received them, however, a number had consistently lost weight and referrals made to professionals were more reactionary as opposed to preventative. People were supported to access health care professionals, however this was not always consistent and some improvement was required. People’s health care needs were assessed and reviewed but people were not always referred to professionals in a timely way when health needs changed. Relatives told us the management team were good at keeping them informed about their family member’s care.

People and relatives told us that staff were kind, caring and friendly and treated people with respect, although there were occasions when people’s privacy was not maintained. The atmosphere around the home was welcoming. People were relaxed and were supported by staff to maintain relationships that were important to people. There were activities that provided opportunities to optimise people’s social and stimulation requirements although they were not always suitable for those living with dementia. People and most of their relatives told us they were confident that if they had any concerns or complaints they would be listened to and matters addressed quickly.

People received care and support from staff that had received training but their working practices and knowledge demonstrated that the training provided was not always effective and required improvement. Staff received supervision and appraisals and they felt supported to carry out their roles.

We saw staff treated people as individuals, offering them choices whenever they engaged with people. Where people had the capacity to make their own decisions, staff sought people's consent for care and treatment and ensured people were supported to make as many decisions as possible.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review. If we have not taken immediate action to propose to cancel the provider's registration of the service, they will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe and a rating of inadequate remains for any key question or overall, we will take action in line with our enforcement procedures. This could be to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During this inspection we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

Bethany House is a home providing accommodation and residential care for up to 30 people. The home also provides short stay interim beds for people that require respite care. At the time of our inspection 26 people were living at the home.

There was a registered manager in post at the time 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.

At the last inspection it was found the provider had not always recognised when the care being offered had put restrictions on people’s ability to choose and move around freely. There had been an improvement. People had access to equipment to help them move freely around the home and measures had been put in place to ensure the provider was meeting the legal requirements to protect people’s human rights.

Systems were in place to monitor, audit and assess the quality and safety of the service but they had not always been effective at identifying the issues we found during this inspection and required improvement.

People felt safe living at Bethany House. Staff understood their responsibility to take action to protect people from the risk of harm because the provider had systems in place to minimise the risk of abuse.

There were sufficient numbers of staff available to support people. Suitable staff had been recruited and had received training to enable them to support people with their individual needs.

People felt supported to take their medicines.

People were able to choose what they ate and drank and enjoyed their meals and given the opportunity to join in different activities if they wished.

People were supported to receive care and treatment from a variety of healthcare professionals and received treatment if they were unwell.

Staff demonstrated a positive regard for the people they were supporting. People felt staff were caring and kind. Staff understood how to seek consent from people and how to involve people in their care and support.

People felt happy living at Bethany House. There was a complaints process in place and people felt they could raise concerns. Feedback on the service provided at Bethany House was sought from people living at the home, their relatives and professionals.

Throughout the day we saw staff speaking with people respectfully. One person told us,'They do a good job looking after me'. Another person told us, "Staff are very friendly''. All relatives spoken with told us that they were kept informed about their relative's health. All staff spoken with were knowledgeable about people's needs and told us all the information they needed was in people's care plans. This meant information was available to staff to ensure peoples preferences and care needs were met.

Staff knew their responsibilities in respect of protecting people and the actions they needed to take if they had any concerns. At the time of our inspection a safeguarding was under investigation.

We saw that people received their medication as prescribed. This meant people's health care needs were being met.

All staff told us that they received adequate supervision and training so they could care for people.

The provider had systems in place to seek people's views about the service provided and action was taken that ensured a better service for people.

We saw that accurate records were not always kept in relation to people's care and welfare. This meant the provider could not monitor and take action where required to improve the care provided.

Some of the people who lived at the home had dementia care needs. People with dementia are not always able to tell us about their experiences so we looked at records relating to their care and observed staff caring for them.

The two people we spoke with told us staff were kind and helped them. All Staff spoken with were able to tell us about people's care needs so that they received care in a way that they preferred. All five relatives told us they were consulted about their relative's care and kept informed about their relative's health so they felt involved in their care. One relative told us, "I am informed about all aspects of my relative care and consulted about any health issues they may have''.

On the day of our visit we saw that people were supported to eat their food when needed, we saw that the meal time was rushed and not organised. This meant on the day of our visit people did not have their meal in a calm and relaxed way and this did not enhance their experience of the meal time.

Staff received a range of training so that they had up to date knowledge and skills in order to support the people who lived in the home.

The provider had systems in place to monitor the service provided, but these were not always used and monitored effectively.