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Inspection carried out on 11 September 2018

During a routine inspection

This inspection was unannounced and took place on the 11 and 12 September 2018.

Bethel House is a ‘care home’ and is registered to accommodate up to 31 people. 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 the inspection, 22 people were accommodated at the home.

There was a registered manager in place. 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 and associated Regulations about how the service is run.

People felt safe at Bethel House and they were very much at the heart of the service. Staff enjoyed working at the home and understood the needs of people using the service and supported people in a personalised way. Staff knew people well and we saw that care was provided respectfully and sensitively, taking into account people’s different needs.

The staff were responsive to people’s needs and wishes. People were able to choose what activities they took part in and suggest other activities they would like to complete. The service developed and promoted community involvement within the home.

Relevant recruitment checks were conducted before staff started working at the home to make sure they were of good character and had the necessary skills. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

The risks to people were minimized through risk assessments. There were plans in place for foreseeable emergencies and fire safety checks were carried out.

People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and went out of their way to provide people with what they wanted.

Staff received regular support and one to one sessions or supervision to discuss areas of development. They completed a wide range of training and felt it supported them in their job role. New staff completed an induction programme before being permitted to work unsupervised.

Staff had an understanding of the Mental Capacity Act (MCA) and were clear that people had the right to make their own choices. Staff sought consent from people before providing care and support. The ability of people to make decisions was assessed in line with legal requirements to ensure their rights were protected and their liberty was not restricted unlawfully. People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; policies and systems in the service supported this practice.

People were cared for with kindness, compassion and sensitivity. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

The registered manager maintained a high level of communication with people through a range of newsletters and meetings. ‘Residents meetings’ and surveys allowed people and their families to provide feedback, which was used to improve the service. People felt listened to and a complaints procedure was in place.

Regular audits of the service were carried out to assess and monitor the quality of the service. There were appropriate management arrangements in place.

Inspection carried out on 7 June 2016

During a routine inspection

The inspection took place on the 7, 8 and 9 June 2016 and was unannounced.

Bethel House is registered to provide accommodation and personal care for up to 31 people. The service does not provide nursing care. At the time of our inspection 29 people were living at the home. The home provides a service for older people and people living with dementia. Accommodation at the home is provided over two floors, which can be accessed using stairs or passenger lifts. There are large garden and patio area’s which provide a safe and secure private leisure area for people living at the home.

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 told us they were safe and well cared for at the home. Staff knew how to identify abuse and protect people from it.

People knew how they could raise a concern about their safety or the quality of the service they received.

The service had carried out risk assessments to ensure that they protected people from harm.

There were enough staff deployed to provide the support people needed. People received care from staff that they knew and who knew how they wanted to be supported.

Medicines were ordered, stored, administered and disposed of safely.

Staff had developed caring relationships with people who used the service. People were included in decisions about their care.

People who required support to eat or drink received this in a patient and kind way.

The registered manager was knowledgeable about The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The Metal Capacity Act Code of Practice was followed when people were not able to make important decisions themselves. The manager understood their responsibility to ensure people’s rights were protected.

People and relatives were asked for their views on the service and their comments were acted on. There was no restriction on when people could visit the home. People were able to see their friends and families when they wanted.

We have made a recommendation about how the provider can reduce the risk of social isolation. You will find this in the responsive section of this report.

Inspection carried out on 5 August 2014

During a routine inspection

In this report Susan Elizabeth Pope and Gemma Natalie Ridout-Bowden were not in post and not managing the regulatory activity at this location at the time of our inspection. Their names appear because they were still registered as managers of this service on our register at the time.

We brought forward a scheduled inspection of Bethel House (the home). This was because following a number of notifications the home sent us we had concerns about how the home promoted people�s skin care and managed pressure sores. We found the home managed this well. A visiting member of the local community nursing team told us the home always contacted the team for advice if they had concerns about the integrity of people�s skin.

At the time of our visit 27 people were accommodated at the home. We spoke with eight of them in order to hear about their experiences of living at the home.

Due to their physical and/or mental frailty we were unable to speak with some people who lived at the home and consequently we used other methods to help us understand their experiences such as observation of daily life in the home and looking at records and other documents.

We spoke with three visiting relatives and two visiting healthcare professionals. This was to hear what they thought about standard of support people who lived at the home received.

We also spoke with three members of staff as well as the home�s acting manager. This was in order to hear what they had to say about how the home functioned.

We gathered evidence against the outcomes we inspected to help answer our five key 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.

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

Is the service caring?

The service was caring as the support and treatment people received was planned and delivered in a way that was intended to ensure their safety and welfare and uphold their rights.

Is the service responsive?

The service was responsive as the home arranged for them to see healthcare professionals when they were unwell. We saw records that showed confirmed the home contacted GPs and the community nursing service if they were concerned about people�s health needs.

People�s needs were regularly and routinely reviewed. Where necessary the support people required was altered to meet their changed needs.

Is the service safe?

The service was safe as risks to people�s welfare such as malnourishment and pressure sores were identified and plans were put in place to manage them.

The provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening and people living at the home told us they felt safe.

People were protected from the risk of infection because appropriate guidance had been followed.

Is the service effective?

The service was effective as people were asked for their consent before they received any care or treatment and their wishes were respected and where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

The provider had arrangements in place that ensured staff were competent to use specialist equipment and such equipment was checked, serviced and if necessary repaired or replaced

Is the service well led?

The service was well led because the provider had an effective system in place to regularly check and monitor the quality of their service and also to identify, assess and manage risks to the health, safety and welfare of people using it.

Inspection carried out on 17 June 2013

During a routine inspection

We were assisted by the manager throughout the inspection. We sat in communal areas for most of the inspection so that we could observe the care provided to people and the interaction between staff and residents. We spoke with people who lived at the home; however the majority were not able to tell us what it was like living at Bethel House owing to their degree of dementia. We also spoke with two members of staff and one visiting relative.

We found that people�s care and support needs had been assessed with care plans had then been developed to inform staff on how to support people.

People were provided with drinks throughout the day and those people assessed as being at risk of not having enough to drink were monitored through fluid monitoring charts. People were assisted appropriately at lunchtime to ensure that they had enough to eat.

We found that staff were being recruited in line with all the regulations and there were robust recruitment systems in place.

The home had systems in place to monitor the quality of service provided to people who lived at Bethel House.

You can see our judgements on the front page of this report.

Inspection carried out on 16 October 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because the inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector who was joined by an Expert by Experience (people who have experience of using services and who can provide that perspective). We talked with seven people who lived in the home and three relatives who were visiting at the time of our inspection. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People told us that staff treated them with respect and dignity. One person told us: "The staff are always very forthcoming and respectful." Another person commented: "This is a happy place."

People told us they could have visitors at any time of the day, this being confirmed by their relatives. They also told us that relatives could join in activities in the home, for example a live music event that was taking place that day. One relative commented, "I really love this home. My husband is well looked after and I can join in too." Another relative said: "I can pop in at any time. I am happy my wife is here."

We asked people and their relatives if they had seen their care plans or been involved in writing them. One visitor knew what a care plan was but could not remember being involved. The other people we spoke with did not know what a care plan was.

We spoke with people who lived in the home about the food they were given. One person commented: "I find the food good. I can't complain." Another person, who had specific dietary needs, told us: "The food is very good, usually a choice between meat and fish. I have allergy problems with various things...they do try to get the right food."

We asked people whether drinks and snacks were given to them during the day. People confirmed that they were provided with these: "We can have anything...we just ask and someone brings it."

None of the people we met reported that they had needed to raise any concerns as they were satisfied with the care they received. All the people we spoke with during our inspection told us that they would be happy to raise concerns with staff or management if they needed to. One person commented: "If I saw something I didn't like, I would ask to see the manager, whether it was about me or someone else. Nothing like that has happened in here."

People told us there were enough staff available to meet their needs. One person commented: "There are plenty of staff around. I like to get up early and go to bed early which I can do happily in here." Another person said: "I think there are enough staff around. I have never had to press the bell."

People also spoke positively about the staff who supported them and the registered manager. They told us they felt staff understood their needs. One person told us: "I am quite happy here...they do a good job", while two relatives commented: "They are very good in here."

Although the feedback we received from people who lived in the home, and their visitors, was positive, we identified some shortfalls in relation to meeting people's nutritional needs and records. Risks in relation to people's nutrition were not always fully identified and incomplete records meant that people's food intake was not effectively monitored. We raised our concerns with the registered manager of the home who agreed to take action to address the shortfalls.

Inspection carried out on 25 November 2011

During an inspection in response to concerns

We spoke with three people who use the service and they all were happy to be living in the home. One person told us that the �place is not home but they try their best to make into a home.� She told us members of staff �are kind and listen to you. We are like family to them.� People we spoke with told us they liked the food served by the home. One person told us: �They give us a choice and if I don�t like the choice, I can always order what I want.� People told us they were happy with the arrangments for cleaning the home and they found the home clean and tidy.

Reports under our old system of regulation (including those from before CQC was created)