This inspection took place on 17 December 2015 and 6 January 2016. The inspection was unannounced.
The last inspection of Bethany House took place on 20 August 2013. At that time we found that the provider was fully compliant with all the regulations assessed.
Bethany House is a residential care home for older people. It is owned by Preston Bethany Care, a Christian charity. It is a purpose built, single storey home. The home is situated within its own grounds, close to local shops and other community facilities. There are 26 single rooms. Thirteen have en suite facilities. At the time of our inspection of this location there were 26 people who lived at the service.
The registered manager was available and received feedback throughout the inspection. 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.
We asked people who lived at the service if they felt safe. People told us that they felt safe and well cared for. We did not receive any concerning feedback from people who lived at the service or relatives.
We looked at how the service protected people against bullying, harassment, avoidable harm and abuse. We found that the service had not always followed local authority safeguarding protocols when a person had fallen and sustained injuries.
We found that staff were confident to raise their concerns and held good understanding of safeguarding principles. However we found that people who lived at the service and visitors did not have free access to information about safeguarding. We have made a recommendation about this.
We looked at how the service identified and managed risk for people on an individual basis. We pathway tracked the care of six people who lived at the service. Pathway tracking enabled us to determine if people received the care and support they needed and if any risks to people’s health and wellbeing were being appropriately managed.
We found that people’s needs and preferences had been assessed prior to admission and records showed what initial risk had been identified. However we found examples where known risk had not been cross referenced into a plan of care to show how the identified need would be managed.
We asked staff about their knowledge of risk to individuals and found that staff held a good level of understanding about people’s needs and associated risk.
We found that other risk assessments had been undertaken for people on an individual basis. For example risk assessments for nutrition and the risk of damage to a person’s skin. However monitoring of the known risk was not undertaken for people who were at risk of malnutrition or skin damage. We made a recommendation about this.
We looked at how the service managed people’s medicines. We found shortfalls in safe administration of medicines, care planning for the use of medicines and record keeping.
We found that the service had effective systems in place for assessing, monitoring and maintaining environment safety.
We found that staff had been safely recruited and deployed.
We found that the provider had a policy and procedure to guide staff around best practice for infection prevention and these included infectious outbreaks referral methods.
However we found that infection prevention systems needed review to ensure that the service was working in line with best practice. We made a recommendation about this.
We received positive feedback from people who lived at the service, relatives and visiting professionals about how effective the service was in meeting people’s individual needs.
We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA), and whether any conditions on authorisations to deprive a person of their liberty were being met.
We found that the registered manager and care workers lacked knowledge and understanding about referral processes around Deprivation of Liberty Safeguards (DoLS).
We found that the service did not have effective systems in place to assess a person’s mental capacity prior to requesting consent or acting in a person’s best interest.
We found that the majority of staff had been employed at the service for many years. Staff told us that they were happy within their employment. We looked at staff personnel files and found that induction training had been provided.
We looked at the training matrix and found that gaps were evident in core training areas such as health and safety, infection control, Mental Capacity Act 2005 and dementia awareness.
Staff told us that they were happy with the standard of training provided.
We looked at staff personnel files and found that supervisions were undertaken. Staff told us that they felt supported and listened to.
We found that people who lived at the service were happy with the standard of food provided.
We observed a lunch time meal service. We found that people enjoyed the meal service and were offered choice and control. One person requested an alternative to the daily menu and this was provided.
We spoke to the chef and kitchen staff. We found that they were actively involved in helping people maintain a healthy balanced diet and they had access to important information such as people’s individual diet types and preferences.
Staff had a good knowledge of people’s individual needs including those on specialist diets to prevent them from choking or aspirating.
We found that the service was not always effective at continually monitoring people’s nutritional intake. The registered manager took action during our inspection to improve monitoring systems for people that required this level of support to enable effective nutritional screening.
We found that people were referred to external health care professionals in a timely manner.
We found that staff had positive working relationships with external health care professionals and felt confident to ask for advice.
We found that the environment was clean and fit for purpose.
People who lived at the service told us that the care they received was kind and considerate of their needs and preferences.
We received feedback from a visiting health care professional who confirmed that the service was good at supporting people at the end of their life. The professional told us that people experienced kind care.
We undertook a short observational framework for inspection (SOFI). The SOFI tool is used by CQC inspectors to capture the experiences of people who use services who may not be able to express this for themselves.
We observed staff interact with people in a kind and considerate manner. Staff were responsive to people’s requests and attentive to people who were not able to verbally communicate their needs.
We found that staff had formed positive caring relationships with people who lived at the service and their relatives.
We observed very good standards of dignity and privacy throughout the inspection. Staff were genuinely caring towards people who lived at the service and visitors.
We found that end of life care for a person living at the service had been organised with great empathy and consideration for the person’s personal preferences and wishes.
People were supported to maintain their religious activities. Across two days of inspection we observed people visit from local churches and we saw that this brought people great comfort.
We observed staff organising activities and they encouraged people to participate throughout both days of the inspection. People were engaged and provided with stimulation. We observed those who did not wish to take part in activities given the opportunity to decline and their decision was respected.
We found that the service was proactive in providing person centred care. Staff understood people’s individual needs, wishes and preferences.
We observed staff provide support for people as outlined in their care plan.
We looked at the provider’s complaint procedure. We found that this was accessible to people who lived at the service and visitors. We looked at complaints management and found that complaints were reviewed in line with the policy and procedure.
People who lived at the service and their relatives told us that they felt confident in the management of the service and happy to raise their concerns.
We observed a positive culture throughout the service.
We observed staff offer people choice and control on various occasions throughout the inspection, people were encouraged to maintain their independence and included in decisions about their care and support.
We looked at how the service assured quality and development. We found that audits had been undertaken as planned.
We found that audits were undertaken. However some issues identified at this inspection had not been found. The registered manager was receptive to feedback and on the second day of inspection demonstrated pro-active planning around the improvements needed.
We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to safeguarding, medicines and need for consent. You can see what action we have told the provider to take at the back of the full version of the report.