Archived: Bethesda

Bethesda is a residential care home providing personal and nursing care to 19 people aged 65 and over at the time of the inspection. Bethesda is part of the Christadelphian community but also offers support to people outside of that faith.

Bethesda can accommodate up to 23 people in one adapted building. The service offers both long stay and short stay respite care. Some people were living with dementia. Bethesda does not provide nursing care. Where needed this is provided by the community nursing team.

People’s experience of using this service and what we found

People told us they felt safe living at Bethesda. People were protected from the risk of harm. Risks

were managed safely, and safe processes were in place.

There was a relaxed atmosphere between people and staff. Staff were kind, caring and attentive. People told us, “They’re so friendly; so obliging” and “They’re very kind and all lovely. I couldn’t be anywhere better.”

Staff had enough time to meet people's needs and spend time with them in conversation. Staff had the skills and knowledge to meet people's needs effectively. Staff told us they were well supported in their role.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were involved in making decisions about their care and supported to maintain their independence. Care plans contained detailed up-to-date information about each person's needs and preferences. People received personalised care from staff who knew them well.

People enjoyed taking part in social activities, going out in the local community, and spending time with family and friends. People chose to live at Bethesda because of its Christadelphian ethos. The service also accommodated people who were not Christadelphians. People were supported, to attend their local church. Daily prayer meetings and bible readings took place within the service.

The service was well managed. When speaking about the registered manager, staff said, “(Registered manager’s name) has huge knowledge about everything” and “A good leader of the team.” Quality assurance processes ensured people received high quality care.

Rating at last inspection

The last rating for this service was good (published 26 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on the 8 and 13 March 2017; the first day of the inspection was unannounced. One adult social care inspector carried out this inspection. Bethesda was previously inspected in January 2015; we found people’s individual evacuation plans (PEEP) did not contain sufficient information and improvements were required in relation to the homes recruitment processes. At this inspection, we found improvements had been made.

The home 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 said they felt safe and well cared for at Bethesda, their comments included “I do feel safe,” "I’m very happy here” and “I would recommend this home to anyone and we do.” Relatives told us they did not have any concerns about people's safety. People were protected from abuse and harm. Staff received training in safeguarding vulnerable adults and demonstrated a good understanding of how to keep people safe. There was a comprehensive staff-training programme in place. This included safeguarding, first aid, pressure area care, infection control, and moving handling. Staff had also received training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were encouraged to make choices and were involved in the care and support they received. Staff had a good understanding of the MCA and DoLS and how to support people within their best interests.

People told us they were happy living at Bethesda, staff treated them with respect and maintained their dignity. Throughout our inspection, there was a relaxed and friendly atmosphere within the home. Staff spoke affectionately about people with kindness and compassion. People and relatives told us they were involved in identifying their needs and developing the care provided. People's care plans were informative, detailed, and designed to help ensure people received personalised care. Care plans were reviewed regularly and updated as people's needs and wishes changed. Risks to people's health and safety had been assessed and regularly reviewed. Each person had a number of detailed risk assessments, which covered a range of issues in relation to their needs, which included personal emergency evacuation plans (PEEP).

People received their prescribed medicines when they needed them and in a safe way. There was a safe system in place to monitor the receipt and stock of medicines held by the home. Medicines were disposed of safely when they were no longer required. Staff had received training in the safe administration of medicines.

People spoke positively about activities at the home and told us they had the opportunity to join in if they wanted. People chose to live at Bethesda because of its Christadelphian ethos. Although the home was able to accommodate people who were not Christadelphians, they understood that the home offered people this experience. People were supported, to attend the local Christadelphian church or if they wished, they could take part in Daily prayer meetings and Bible readings within the home.

People told us they enjoyed the meals provided by the home. Comments included, “the food is excellent”, “well cooked,” and “very nice.” One person said, “There is always plenty of choice and if I don’t fancy what’s for lunch all you have to do is let them know and they will fix me something else.”

People, relatives, and staff spoke highly of the management team and told us the home was well managed. Staff described a culture of openness and transparency where people, relatives and staff, were able to provide feedback, raise concerns, and were confident they would be taken seriously.

The provider used a variety of quality management systems to monitor the services provided at Bethesda, which included a range of audits and spot checks.

The inspection was carried out by an adult social care inspector and took place over two days. During the inspection we looked at the evidence to answer five key questions:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well- led?

Bethesda is a care home without nursing providing care and support for up to 24 older people. During the inspection we spoke with 12 people who lived at the home, and one person who was staying for a short period of respite care. We also spoke with five relatives, a district nurse, two members of the organisation's welfare committee, four members of staff and three members of the management team. We reviewed records relating to the care of people who lived in the home, which included five care plans, and also observed the care and support being provided.

We were told that the organisation's Welfare Committee consisted of members of local Christadelphian Churches who provided voluntary support and companionship to people who lived in the home.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service caring?

During our inspection we saw staff supporting people well. The comments we received about the service included 'The staff are lovely', 'The food is excellent', and 'We are very well looked after'. One relative we spoke to said 'I am very happy with the care being provided, I have no complaints'. We spoke to a District Nurse who was visiting the service and they told us 'Staff are very kind and caring'.

We observed staff as they provided care and support. No-one we spoke with had any complaints about the staff or the care they delivered. Comments included, 'The staff do their best, but they are often very busy' and 'They don't always have time to sit and chat". We observed staff checking that one person was comfortable in their bedroom. The staff member was gentle and respectful and clearly had a good rapport with the person they supported.

All of the staff we spoke to were passionate about their role in the home and wanted to provide a good service to the people they supported.

Is the service responsive?

It was evident from records and discussion with staff that the needs of some people who lived in the home had increased due to their age and conditions related to the ageing process. Although the staff were working hard to meet the needs of all the people who lived in the home, records and staffing levels had not been updated and reviewed sufficiently to reflect these changes.

We saw that the provider had taken action to address recent concerns raised as part of a safeguarding concern. The Registered Manager had attended multi-agency meetings and started to liaise with family members to ensure that their views and wishes were considered in the planning and delivery of care.

A District Nurse we spoke to who was visiting the home told us that the staff always contacted them when required and also asked the right questions about people's health needs.

The home did not have a formal system in place to respond to complaints or concerns raised about the service.

Is the service safe?

We saw that the service had started to address concerns that had been raised by relatives in relation to people's capacity to consent to their care and treatment. The Registered Manager said that they were in the process of completing Deprivation of Liberty authorisation applications for people who lacked the capacity to make decisions about their care. The Care Quality Commission monitors the Deprivation of Liberty Safeguards, which applies to care homes. The Deprivation of Liberty Safeguards aim to ensure that people are protected from the risks of inappropriate restraint in any form. However, we found that people's rights and best interests had not always been considered in the planning and delivery of care.

We found that people's needs had been assessed but care and treatment was not planned in sufficient detail or delivered consistently in line with identified care needs. This put people at risk of unsafe or inappropriate care.

Systems were not in place to regularly review staffing levels alongside people's assessed needs. Feedback from staff included 'Staffing arrangements can be very stressful', 'People need staff who are calm, but it is often very rushed', 'We don't really get time to sit with people', 'The more independent people miss out' and 'Staffing levels have never changed even though people's needs have'. A relative we spoke to said 'The staff always appear to be busy and rushed'.

Is the service effective?

The effectiveness of the service was challenged by the wide variation of the needs of the people who lived there. For example one person was living with advanced dementia and required two staff to support them with their daily personal care needs. Three people required close monitoring due to the risks associated with dementia and increased frailty. In addition a large number of people in the home remained independent with many aspects of daily care and were able to go out into the community unsupported. Prior to and during the inspection staff and relatives raised concerns that the home had not responded effectively to the changing and diverse needs of people who used the service.

Relatives we spoke to said that although staff were kind and caring they were concerned that care was not always being provided consistently particularly as people's health and care arrangements became more complex.

Is the service well-led?

The Registered Manager had only been working in the home for two months at the time of our inspection. Records confirmed that the Registered Manager had started to take action to address recent safeguarding concerns and had also prioritised action required as part of a recent internal audit undertaken by the organisation. Staff and people who used the service said 'The new manager is open and helpful' and 'Things have improved and she spends time with people and supports staff'.

During the inspection we found a number of gaps in records relating to the service and people's care arrangements that had not been picked up by the home's quality monitoring systems.

There were 19 people living at Bethesda at the time of our inspection. We spoke with eight people who lived at the home and also spoke with three care workers a senior care worker, a head of care and the manager.

We found that people's consent had been obtained for care and treatment provided to them by the service.

People who lived at the home told us they were well looked after and were happy. One person said "we are all very happy living here. We get the best of care, lovely food and the staff are lovely."

There were enough qualified, skilled and experienced staff to meet people's needs.

People told us that they felt safe and knew what to do if they had concerns. One person said "We have regular residents' meetings when we can raise any concerns we may have. If there are any urgent concerns we can talk to any of the staff."

People told us that they would not hesitate to report any issues to any member of staff. One person said, 'I would complain if there was ever anything to complain about'.

People that lived at Bethseda told us they were very happy with the care they received. One person said 'we love it here, we go out when we want to and we have a choice of food, they are good cooks'; another person told us that 'you couldn't improve how we are looked after. We are well fed and well looked after, small things are not overlooked'.

We asked four staff about infection control procedures. They all told us they received infection control training and this was updated annually. One care worker told us that staff were 'trained to wash hands properly'.

Staff we spoke with told us that they felt well supported and senior staff were very accessible. One care worker told us 'I have lots of training, my mandatory training is up to date, I have regular supervision and appraisals, we all get on well together here'.

We asked care staff how they knew day to day how they were doing a good job. One care worker told us that 'staff tell me how I am doing, people tell me they like having me here; I am sure they would tell me if I was doing something wrong. I feel very privileged to work in a place like this'.