Betsy Clara Nursing Home

Betsy Clara Nursing Home is a residential care home providing accommodation and personal and nursing care to up to 50 people. The service is arranged across 2 levels with a lift to the upper level. The service provides support to a range of people including people with complex nursing needs and people living with dementia. At the time of our inspection there were 45 people using the service.

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

People told us they felt safe and were happy living in Betsy Clara Nursing Home. One person said, “I like being here.” Another said they liked it because they had a “nice comfy bed”. Relatives agreed that their loved ones were safe and happy. One relative told us, “She is safe. Nothing is any trouble. They always answer my questions.” Another relative said, “She is safe, and the staff are great. She talks to the staff and finds them friendly.”

People and their relatives spoke positively about the staff and the service. One person said, “The staff are very caring.” Another person said, “The carers are nice, they do the jobs I should be doing.” One relative told us, “The staff treat them like they are part of the family.” Another relative said, “They treat her like a friend, we like that.”

The service had good infection control practices in place and medicines were managed safely. People told us they got their medicines at the right time. There were processes in place for investigating any accidents or incidents so that lessons could be learned.

Relatives told us they thought the home was managed well and they found the registered manager approachable and understanding. Relatives and professionals said Betsy Clara Nursing Home was always very welcoming. The service had acted on feedback received and people, relatives and professionals described the communication as ‘excellent’.

The registered manager had effective quality assurance processes in place to monitor the service, and regular audits were undertaken, for example for medicines and infection control. Senior managers visited the service regularly. Staff told us the registered manager was approachable and supportive.

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 good (published 29 May 2018).

Why we inspected

The inspection was prompted in part due to concerns we received about safe care and treatment and standards of care. As a result, we undertook a focused inspection to review the key questions of safe and well led only. We found no evidence during this inspection that people were at risk of harm from these concerns.

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 remains good based on the findings of this inspection.

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.

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

Follow up

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

The service had a registered manager. 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 protected from abuse. Staff received regular safeguarding training, and were able to tell us about different types of abuse and what action they would take if they saw someone being abused. Risks to people had been identified and they had been involved in developing plans to minimise them. Positive risk taking was encouraged and guidance was provided to staff in order to help keep people safe. The provider had also ensured that the environment was safe for people. There were sufficient numbers of staff to keep people safe and meet their needs. The manager used a dependency tool to calculate the numbers of staff needed based upon the needs of the people living there. Staff were recruited safely. People received their medicines safely. The service had a close relationship with the local GP, who visited on a weekly basis to review each person’s medicines. People were protected by the prevention and control of infection. Accidents and incidents were reported by staff in line with the provider’s policy, and the registered manager took steps to ensure that lessons were learned when things went wrong.

People’s needs were assessed and their care was delivered in line with current legislation. Staff had the training and skills they needed to meet people's needs. Newly recruited staff received a comprehensive induction before they started to support people and regular ongoing face to face training sessions. People were supported to eat and drink enough to maintain a balanced diet. Staff referred to and followed guidance from health professionals such as dieticians and the local Speech and Language Therapy (SaLT) team. Suitable arrangements were in place to ensure that people received effective and coordinated care when they were referred to or moved between services, such as when they went to or returned from hospital. People’s needs were met by the adaptation, design and decoration of the service.

People were treated with kindness, respect and compassion. People had been supported to express their views and be actively involved in making decisions about their care and treatment as far as possible. People's privacy, dignity and independence were respected and promoted. Staff were able to give examples of how they treated people with dignity when supporting them.

People received personalised care that was responsive to their needs. Each person and their relatives were involved in the development of a personalised care plan which took into account their wishes and preferences. People were supported to follow their interests and take part in activities that were appropriate to them. The service employed a full-time activities coordinator who organised activities based on the interests of people. Complaints were listened and responded to. People told us they knew how to make a complaint and were confident to do so if they needed to. People were encouraged to maintain relationships with those who matter to them People were supported at the end of their life to have a comfortable, dignified and pain free death.

The registered manager had an oversight of and reviewed the daily culture in the service, including the attitudes, values and behaviour of staff. Management encouraged transparency and honesty within the service. The registered manager and registered provider were also aware of their responsibility to comply with the CQC registration requirements. Systems and procedures were effective in ensuring that shortfalls in service delivery were identified and rectified. The registered manager had ensured that regular audits were carried out to review the quality of the service. People, their families, staff and visiting professionals were encouraged to be engaged and involved with the service.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Betsy Clara Nursing Home on our website at www.cqc.org.uk.

Betsy Clara Nursing Home is a care home providing accommodation for up to 50 older people who are living with dementia and who require nursing and personal care. The accommodation is purpose built to care for people who use wheelchairs or have difficulty moving around. The home is located in a residential area in Maidstone, approximately one mile from the town centre. At the time of the inspection 39 people lived at the service.

There was a registered manager 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.

At our previous inspection on 13 and 16 September 2016, the service was in breach of regulation 12 (Regulated Activities) Regulations 2014. This breach was in relation to effective medicine management. We found that nurses had not always accurately documented when medicines were administered and people living with diabetes did not have guidance in place to manage their blood sugar levels. We also observed poor moving and handling techniques. At this inspection improvements had been made and the service was no longer in breach of the regulation.

Nurses were signing people’s medicine records accurately. There were no identifiable gaps in people’s medicine records. People living with diabetes had clear guides in their care plans.

Staff received appropriate training for moving handling. During our inspection we observed good moving and handling practices.

The provider had ensured that there were appropriate systems in place to identify and minimise risk for people living at the service. Risks to people's safety had been assessed and actions taken to protect people from the risk of harm.

There was sufficient staff to provide care to people. The provider had effective systems in place to ensure that there was appropriate cover when it was required. Staff had safety checks to ensure they were safe to work with adults.

People were protected from abuse by trained staff who could identify the forms of abuse and who they can report to. The provider had effective safeguarding systems in place.

Betsy Clara Nursing Home is a care home providing accommodation for up to 50 older people who are living with dementia, who require nursing and personal care. The accommodation is purpose built to care for people who use wheelchairs or have difficulty moving around. The home is located in a residential area in Maidstone, approximately one mile from the town centre. At the time of the inspection 43 people lived at the service.

We last inspected the service on 19 and 26 May 2015. We made recommendations in relation to practice that included, Regulation 12, Safe care and treatment; Regulation 15, Premises and equipment; Regulation 16, Complaints; Regulation 17, Good Governance and Regulation 18, Staffing, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found that the provider had implemented changes and improvements had been made.

People said they felt safe and relatives told us that they knew their relatives were safe. However, we observed moving and handling practice that were not safe.

Medicines were stored, and disposed of safely. However, medicines were not always administered safely. There were policies and procedures in place for the safe administration of medicines, however these had not always been followed. People had access to GPs and other health care professionals. Prompt referrals were made for access to specialist health care professionals.

There were risk assessments in place for the environment, and for each person who received care. Assessments identified some needs but were not specific in meeting people’s individual needs, and showing how risks could be minimised.

The newly appointed manager had worked at the service since February 2016. She confirmed that completed application forms to be the registered manager of the service had been accepted by the Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Management understood when an application should be made. They were aware of the Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

The manager and staff had received training about the Mental Capacity Act 2005 and understood when and how to support peoples best interest if they lacked capacity to make certain decisions about their care.

People were protected against the risk of abuse. Staff had been trained in how to protect people, and they knew the action to take in the event of any suspicion of abuse towards people. Staff understood the whistle blowing policy. They were confident they could raise any concerns with the manager or outside agencies if this was needed.

People had varied needs, and some of the people living in the service had a limited ability to verbally communicate with us or engage directly in the inspection process. These people demonstrated that they were happy by showing warmth to the manager and staff who were supporting them. For example by nodding their head or giving a smile. Staff were attentive and interacted with people in a warm and friendly manner. Staff were available throughout the day, and responded quickly to people’s requests for help.

People and their relatives were involved in planning their own care, and staff supported them in making arrangements to meet their health needs. Nursing staff carried out on-going checks for people’s health needs, and contacted other health professionals for support and advice.

There were enough staff with the skills required to meet people’s needs. Staff shortages were being covered by agency staff and staff recruitment was underway. The manager said that there was now a full nursing team, and that staff had been recruited to cover the staff vacancies. Staff were recruited using procedures designed to protect people from the employment of unsuitable staff. Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.

People were provided with diet that met their needs and wishes. Menus offered variety and choice. People said they liked the home cooked food. Staff respected people and we saw several instances of a kindly touch or a joke and conversation as drinks or the lunch was served.

People were given individual support to take part in their preferred hobbies and interests, and a range of activities were being provided by the activities co-ordinator and staff. Relatives were able to visit their family members at any reasonable time.

People were aware of the complaints procedure and they knew who to talk to if they were worried or concerned about anything. Relatives said that they knew who to complain to if they had any concerns and provided positive feedback on the service as a whole.

There were systems in place to obtain people’s views about the service. These included formal and informal meetings; events; and daily contact with the provider and staff.

The providers and registered manager regularly assessed and monitored the quality of care to ensure standards were met and maintained. The providers and registered manager understood the requirements of their registration with the CQC. People’s confidential information was securely kept.

The provider had put into place signage on bedroom doors and pictorial signage on bathroom and toilet doors to aid and support independence of people living with dementia.

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 this report.

We saw that people were generally relaxed with staff and seemed content. Some were smiling or talking, or playing with different items. People's comments included 'I am happy here'; 'I like the activities but I don't know what is happening this afternoon'; and 'The staff are kind and friendly.'

We saw that care planning documentation was up to date and was appropriately completed to show people's different needs and assessed risks.

We found that medication management was satisfactorily maintained.

We talked with staff about their training and support, and viewed training and supervision records. Staff worked well together and most said that they felt well supported by the management.

We saw that staff were aware of people's different moods, and were able to assess if they were upset or anxious. Relatives told us that they could ask the staff or the manager about any concerns at any time, and were confident that their concerns would be addressed.