Archived: Bethany Homestead

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

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 Inadequate. At this assessment the rating has remained 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 the assessment and planning of care, delivery of evidence-based treatment, staff collaboration, monitoring of outcomes, and people’s rights under the Mental Capacity Act.

This service scored 42 (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 always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. People’s needs were not always assessed or reviewed in a consistent or comprehensive way. For example, where people’s needs had changed due to pressure damage or deterioration in health, their risk assessments had not been reviewed, and care plans had not been updated to inform staff how to mitigate the risks. There was no system in place to manage people’s changing needs, for example, where one person had a reaction to the sun caused by their prescribed medicine, there was no associated risk assessment or care planning in place to avoid recurrence.

The registered manager had implemented a daily system of checks to prompt staff to review people’s condition and wellbeing; however, these were not carried out daily or in full. Although staff had begun to log hydration and repositioning checks during handovers, there was no management oversight of these. This meant action required were not always identified or taken when people showed signs of not receiving their care as planned. While improvements had started, these systems were not yet embedded enough or reliably identify and respond to people’s changing needs. This meant people remained at risk of receiving unsafe or inappropriate care and support.

The provider did not always plan and deliver people’s care and treatment with them. For example, information about what was important and mattered to people. We also found and treatment was not always planned or delivered in line with best practice. Although people’s care was assessed using evidence-based tools; these were not updated as people’s needs changed. Staff did not have up to date information on how to manage people’s care and mitigate known risks. There were inconsistencies in how staff managed people’s hydration and nutrition needs were managed. For example, one person’s fluid intake was significantly below their target, there was no clear system to alert anyone to this, or action taken to escalate this to health professionals. People were supported to receive the prescribed consistency of food and drink to help prevent choking. Consistent evidence-based practice was not yet in place across all areas and further action was needed.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services. Staff did not always work effectively together to deliver consistent care. We observed situations where staff were not aware of risks that had already been identified. Staff did not share important information such as faulty sensor mats, a faulty pressure relieving mattress or fire door alarms. We brought this to the attention of the registered manager who arranged for these issues to be addressed. Communication between cleaning and care teams also appeared inconsistent, leading to equipment being moved or disconnected without staff being informed. This placed people at risk of falls as sensor mats were moved.

A deputy manager had been employed and staff told us they were approachable and were responsive to concerns when highlighted.The registered manager had made some progress in improving documentation and was working with external partners such as the community medicines team and the district nursing team to improve practice.

People were not always supported in a way that helped them manage their long-term conditions or health risks proactively. Staff did not always follow people’s plan of care which led to people not having their needs met. People were at increased risk of acquiring a pressure ulcer as staff did not carry out the planned regular repositioning. For example, where people’s care plans showed people required 2 to 3 hourly repositioning, staff recorded these were being carried out over 5 hourly. People were at increased risk of dehydration as staff documentation of fluid intake was inconsistent and there was no consistent oversight of how much people drank daily. Staff had recorded changes in people’s health, for example, the presence of pain or a change in bowel habits but there was no evidence this had been followed up with medical advice or updates to the person's care plan.

There was a good working relationship with the GP who visited the service weekly. A relative told us, “The regular GP visits are all good.” Staff worked with the GP to improve people’s health when it had been identified people had incurred a higher number than expected infections from staff not being vigilant in providing personal care.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. There was limited evidence that people’s care and treatment were regularly monitored or reviewed to ensure they achieved good outcomes. In addition, there was no reliable managerial oversight of people’s health and wellbeing. Although staff monitored people’s clinical observations such as blood pressure, staff did not reliably monitor people’s pain or bowels and where people had experienced changes there was no corresponding clinical review or investigation. In some cases, there were delays in recognising or acting on changes in health, such as abdominal pain or diarrhoea and no record of GP advice being sought. The registered manager had implemented a system of daily checklists to include reviews of daily care logs, but these had not been carried out daily or in full; and there was no managerial oversight to embed them into practice.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. People’s consent to care and treatment was not always clearly documented or supported by appropriate mental capacity assessments. For example, there were instances where individuals with dementia were receiving care interventions such as repositioning or personal care. However, there was no clear documentation of their consent or legal safeguards, including best interest decisions or family involvement. In response, the registered manager had begun to carry out mental capacity assessments and planned to complete best interest decisions involving suitable representation for these for all individuals who lacked capacity. Some improvements had been made, but the service had not yet embedded a reliable system to ensure people’s rights under the Mental Capacity Act were consistently upheld.