Archived: Bethany Homestead

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question Inadequate. At this assessment the rating has remained Inadequate.This meant people were not treated with compassion and there were breaches of dignity; staff caring attitudes had significant shortfalls. The service was in breach of legal regulation in relation to people’s dignity, respect, and the failure to consistently provide kind, compassionate care.

This service scored 45 (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 treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

People and relatives had mixed views about the way they were treated by staff. Some people told us, “[Staff] are so young, but they are so kind” and “The staff are kind and always very helpful, we are all looked after very well.” A relative told us they could hear staff assisting their relative in the hoist, they said, “I can hear the carers saying, ‘don’t worry, it’s alright’ and reassuring them.” However, some people believed they were not treated with compassion. A person told us, “The staff are too busy to talk to you, and they only talk to you when they want something, like to make you take your tablets.” A relative told us, “[Name] doesn’t like [Staff] and they do not like [Name]. If [Name] asks [Staff] to do something for them [Staff] doesn’t do it, they always say that their back is hurting.” Another relative told us, “[Name] doesn’t get washed often now, about once a week if they are lucky; when I go in, I notice that [Name] smells.” We observed many examples of kind, warm interactions between staff and residents. These positive relationships indicate that the culture was not uncaring, but the consistency of compassionate, respectful care varied depending on which staff were on duty.

The provider did not always treat people as individuals or ensure that care and support fully reflected their preferences and personal needs. Some care records lacked detail about people’s cultural backgrounds, interests, or how they preferred to receive support. For example, the use of equipment such as bedrails or sensor mats was not always clearly linked to people’s individual preferences or consent, particularly for those with cognitive impairments. Care plans tended to focus more on tasks than personal routines. However, staff were familiar with people’s likes and dislikes and tried to offer choices in day-to-day life. We observed people being asked what they wanted to wear or whether they wanted to join in with activities. People who could express their views told us they felt listened to. These moments of personal connection were evident but not consistently supported by care planning or team-wide practice.

The provider did not always promote people’s independence, so people did not always have choice and control over their care and wellbeing. Records showed limited evidence of actively encouraging independence, particularly for people with reduced communication abilities. Some people’s care routines appeared to follow staff convenience rather than the individual’s preferences. For instance, people were sometimes expected to wait long periods for personal care or had limited opportunities to influence when and how support was delivered. One person told us, “[Staff] like us to go to bed by 6 or 7pm but do I hell want to go to bed by 7pm.” Some staff were observed promoting independence, for example, encouraging people to walk short distances with support, or asking for input on clothing and meals. Where family members were involved, they told us they were consulted on key decisions. Management had started to work on reviewing care plans to reflect people’s preferences more clearly, but this work was not yet fully implemented or consistent across the team.

Staff did not always respond to people’s needs in the moment or act to minimise discomfort, concern or distress. We observed several call bells ringing for long periods without being answered, and staff appeared unaware that other staff needed assistance. In some cases, repositioning or requests for drinks and clothing were delayed or forgotten. A relative told us, “[Name] presses their bell and often it takes 20 or 25 minutes for someone to come, so they often wet themselves.” These lapses meant people were not always confident they would get help when they needed it. However, when support was given, staff interactions were often kind and reassuring. People told us they appreciated the care they received once staff were available. There were also examples of staff responding quickly when someone appeared distressed or uncomfortable. A relative said, “I know that they always look in and check [Name] at night and they have managed to get [Name] to wear her toggle [call bell].” These examples were encouraging, but inconsistent responsiveness continued to affect people’s experience and comfort.

The provider did not always care about or promote the wellbeing of their staff or support them consistently to deliver person-centred care. Staff told us they were often under pressure and felt unsupported by senior colleagues, particularly when the service was? short-staffed. Senior carers were described as focused on medication and office work, with little involvement in hands-on care or team support. This impacted staff morale and the delivery of timely care. On the other hand, some staff spoke positively about the deputy manager’s approachability and recent efforts to improve communication and oversight. Team meetings had been introduced to discuss performance, and performance management plans were in place for underperforming staff. While these steps were promising, further work was needed to create a supportive, enabling environment where all staff could consistently deliver high-quality, compassionate care.