Bethany House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to safe care and treatment and the provision of person-centred care.

This service scored 33 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people’s care and treatment was effective because they did not check people’s health, care, wellbeing and communication needs were being met and did not effectively discuss people’s changing needs with them.

People’s support plans did not always accurately reflect people’s up to date needs. We identified 2 people whose quality of life had deteriorated. Their needs had not been effectively reassessed and therefore robust plans were not in place to address this decline.

Some recent assessments had been completed by the provider’s in-house psychologist, but recommendations, including communication plans, had not fully been implemented. A referral for 1 person to the in-house psychologist, so a full assessment of needs could be completed, had not been made. This was made following our assessment feedback.

The provider did not always plan and deliver people’s care and treatment in line with current evidence-based good practice and standards.

Some standard assessment tools had not been consistently completed, for example, tools to monitor the risk to people’s skin integrity and the risk of malnutrition. This meant the service was unable to monitor ongoing risk and changes to people’s needs.

One person was prescribed medicine to support the management of episodes of distress and anxiety. This medicine was not always used as a last resort, which was not in line with the NHS England STOMP (Stopping the Over Medication of People with a Learning Disability or Autism) initiative.

Staff, management and the provider did not work effectively together. Staff told us there was a divide within the staff team. Staff were not always given appropriate and up to date information to enable them to effectively support people. Information given to the provider from the registered manager of the location was not always fully accurate which impacted the provider’s oversight of the service.

Information to be shared with other services was not always up to date, such as hospital passports and personal emergency evacuation plans.

Monitoring and recommendations completed by other services and professionals were not always implemented or recorded by the location. For example, information about people’s weight and outcomes from mobility and falls assessments were not always detailed in people’s support plans.

We found one person had missed a medical appointment due to insufficient actions taken by the location to ensure this was attended.

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.

We found 2 people’s quality of life had deteriorated. Where people had previously enjoyed time in communal areas of the house and going out to cafes, clubs and events, these occasions had significantly reduced. Whilst some measures had been taken to encourage an improvement in quality of life, these measures were limited and had not been effective.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent. 2 people’s quality of life had deteriorated, and support had failed to effectively improve this. Care plans did not robustly incorporate people’s skills, strengths and goals. People were not working towards any meaningful goals or towards increasing their independence. Following our assessment feedback, the interim manager did take positive steps to review people’s quality of life and implement improvements and ongoing monitoring.

The provider did not always have robust processes and documentation in place around consent and mental capacity.

Staff sought people’s consent before carrying out day to day tasks and understood this requirement. However, there was not always clear guidance for staff around supporting people who may experience fluctuating capacity, and documentation around consent and the assessment of people’s capacity was not always in place. This had already been identified by the provider who had completed a workshop with managers around the Mental Capacity Act 2005 (MCA) and was in the process of carrying out a full review of this area including implementation of new MCA compliant documentation.