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

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 provider was in breach of the legal regulation relating to nutrition and hydration.

This service scored 29 (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 were effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them. People and their relatives told us they had not been involved in assessing and reviewing people’s needs.

Staff did not have all the information they needed to carry out clinical assessments. For example, people’s height had not been recorded; this was needed to calculate people’s risk of malnutrition using the Malnutrition Universal Screening Tool (MUST). People’s risk assessments and care plans did not include important information about the slings used for moving and handling; staff did not always have the information they needed to ensure safe transfers using the hoist which meant people were at risk of harm from unsafe moving and handling.

Staff did not ensure people’s care records were always detailed to support reviews of people’s needs. For example, there was not enough information about incidents to review people’s risk of falls and how to mitigate this. There had been no system to review the content of people’s risk assessments and care notes to identify where there were shortfalls.

The provider did not plan and deliver people’s care and treatment with them, including what was important and mattered to them. People could not always be assured they would receive food that met their dietary needs. Not all staff who prepared and served food had received training in preparing food for people with swallowing difficulties. There was no reliable system for all staff to know the consistency of people’s food and drink requirements. This put people at risk of aspiration and choking. We brought this to the attention of the manager who updated the information available to staff. However, the access to this information needed to be embedded. People who were in their rooms did not always have access to drinks. There was not a reliable system in place for staff to know who had a fluid target to maintain their hydration. Staff did not reliably record what people drank. There was no oversight of what people drank daily to ensure people remain hydrated.The provider had implemented an electronic system to record all care; the manager told us, “Staff have been learning the importance of inputting the data and this remains monitored and ongoing."The manager had changed the pharmacy which had improved the consistency and safety of medicines.

The provider did not work well across teams and services to support people.

Staff did not have sufficient information available to them in the form of care plans or handovers to understand how to mitigate all risks and reliably provide care that met people’s current needs. This meant staff did not always understand how to meet people’s current needs. The provider failed to have systems in place to ensure staff had the information they needed, and people received consistent care.

The provider did not always support people to manage their health. The provider did not have reliable systems to ensure people’s care was in line with health care advice such as consistency of their food. However, staff recognised when people’s health deteriorated and referred to healthcare professionals in a timely way and followed healthcare advice. One relative told us, “When [Name] is unwell, [staff] contact me and keep me informed.” The manager had arranged for people to change their GP in order that they could benefit from weekly face to face GP rounds. The GP told us staff referred people for review appropriately and had all the information available for the reviews.Where people experienced falls staff referred them to the falls team.

The provider did not 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. For example, there was no reliable monitoring of what people ate, drank or events that led to incidents.

Although there were clinical monitoring tools to assess people’s risks, the actions required to mitigate the assessed risks were not fully recorded or embedded. Staff did not have all the information they required to know how to mitigate the known risks. This meant people were at risk of dehydration, falls and weight loss.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment. People living with dementia did not have mental capacity assessments to consent to the use of bed rails, medicines and receiving personal care. There was a risk people received care without their consent or legal safeguards in place. We brought this to the attention of the manager who arranged for people to have mental capacity assessments. However, these had not been completed and the system to carry this out routinely had not been embedded.

Some staff told us and records showed staff were encouraged to wake up some people early in the morning to get washed and dressed for the day without this being their preference. This meant people’s sleeping patterns were interrupted and people were being woken without prior consent.