We carried out a review of the data available to us about Bethesda Eventide Homes - Ipswich on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Bethesda Eventide Homes - Ipswich, you can give feedback on this service.
Bethesda Eventide Homes is a residential care home in one adapted building across three floors and is registered to provide the regulated activity personal care without nursing for up to 27 people. At the time of our inspection there were 24 people using the service.
People’s experience of using this service and what we found
People told us their personal care needs were responded to in a timely manner. However, care and risk management plans did not always guide staff in relation to risks of acquiring pressure wounds and catheter care. In response to our findings the registered manager took action to ensure plans were put in place which would improve oversight and training for staff in record keeping.
Medicines were stored securely for the safety of the people supported. Medicines were audited to ensure people received their medicines as prescribed.
People told us they were satisfied with the care and treatment they received and were observed having positive interactions with staff. Relatives spoke positively about the caring culture of the service and felt that their loved ones were safe and well supported.
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 told us the service was managed well, communication was good and their opinions were sought
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was good (published 6 March 2019).
Why we inspected
We received concerns in relation to people’s access to personal care support and record keeping. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. The provider took action to mitigate the risks we identified.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bethesda on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
At our last inspection on 1 December 2017, we found five breaches of Regulation of the Health and Social Care Act 20018 (Regulated Activities) Regulations 2014. Improvements were needed with assessing and mitigating risks to people, safe management of people’s medicines, consent to care and treatment, how people’s dietary needs was managed, staff training and how the quality of the service was monitored by the provider. We rated the service overall requires improvement. The key questions safe, effective, caring, responsive and well-led were rated requires improvement.
At this inspection we found that improvements had been made and were ongoing. The provider was no longer in breach of any regulations. We were encouraged by the progress made by the management team to turn the service around and the overall rating has changed from requires improvement to good.
A registered manager was in post. 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.
Bethesda Eventide Homes-Ipswich is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service does not provide nursing care.
Bethesda Eventide Homes-Ipswich provided a safe service to people. This included systems in place intended to minimise the risks to people, including from abuse, falls and with their medicines. Staff understood their roles and responsibilities in keeping people safe. They were trained and supported to meet people’s needs. Staff were available when people needed assistance and had been recruited safely. Where people required assistance to take their medicines there were arrangements in place to provide this support safely.
People were cared for in a caring way by staff who understood their care needs. People and relatives were complimentary about the care provided and the approach of the management team and staff. Staff had developed good relationships with people. Staff consistently respected people’s privacy and dignity and promoted their independence.
People and their relatives where appropriate were involved in the planning of their care and people’s care records reflected their personal preferences. The care records were reviewed regularly and updated when people’s care needs changed.
People enjoyed a positive meal time experience and were supported to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and to access healthcare services. Input from other professionals was sought where concerns were identified about a person’s health or wellbeing needs. Information about people’s healthcare needs was shared appropriately with other professionals to ensure continuity of care.
The registered manager and the staff understood their obligations under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.
People were supported to pursue their hobbies and participate in activities that they chose. People knew how to complain and share their experiences. Their feedback was valued, acted on and used to improve the quality of the service.
There was visible leadership in the service. Improvements had been made and were ongoing to the systems for monitoring the quality and safety of the service provided and with implementing person-centred plans. Recording, auditing and documentation in these areas had improved.
There was a registered manager in place. 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.
This service was rated as Good at our last inspection of 7 August 2014. During this inspection of 1 December 2017 we found that the service had not sustained the previous Good rating. The overall rating was now Requires Improvement. The key questions Safe, Effective, Caring Responsive and Well-led were rated Requires Improvement. We found breaches of Regulation 12: Safe care and treatment, Regulation 18; Staffing, Regulation 11: Need for consent, Regulation 14: Meeting nutritional and hydration needs and Regulation 17: Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Improvements were needed in people’s care plans to identify how people were provided with person centred care which was tailored to meet their specific needs. There were inconsistencies in care records which needed attention to ensure that staff were provided with the most up to date guidance on how people’s needs were met. In addition, people’s care records which included guidance for staff about the risks in people’s daily living and how these were not robust and detailed. The ways that the service assessed risks to people and actions taken to reduce the risks required improvement to provide people with safe care at all times. There was limited evidence in records to show that people had participated in the planning of their care.
Improvements were needed in the systems in place for the safe handling of medicines. This included how staff recorded when people had been provided the medicines that were prescribed for administration externally, such as creams.
The majority of staff were trained in safeguarding, however, some staff had not received this training and some had not received it since 2013 or 2014, which meant that they were not provided with the most up to date information about how to keep people safe from abuse.
Staff were not provided with sufficient training to meet people’s needs effectively. Improvements were ongoing in how staff were provided with supervision.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.
People were supported to see, when needed, health and social care professionals. The service worked with other professionals involved in people’s care to improve people’s lives. However, the records maintained were kept in a confusing way.
Where there were concerns about people’s dietary intake referrals to other professionals were made. People were provided with high calorie supplements to assist people to maintain a healthy weight. However, the ways that people made their choices about meals needed improvement to provide a more person centred service.
Where incidents had occurred the service did not have robust systems in place to learn from these and use the learning to drive improvement in the service. The quality assurance systems in place which assisted the provider and the manager to identify shortfalls and address them were not robust.
There were some staff vacancies which were being covered by existing staff and agency staff. The service was actively recruiting to these vacant posts. Recruitment of staff was done safely and checks were undertaken on staff to ensure they were fit to care for the people using the service.
The environment was clean and hygienic and there were infection control systems in place.
Staff spoke about people in a caring and compassionate way. People had positive relationships with the staff who supported them.
People were provided with the opportunity to participate in activities that interested them.
People’s views were listened to and acted upon relating to their end of life care. There were systems in place to support people to have a pain free and dignified death.
There was a complaints procedure in place, which needed updating, and a system to manage complaints.
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
This visit was unannounced, which meant the provider and staff did not know we were coming. At the last inspection in 21 May 2013 there were no areas of concern in the standards we looked at.
Bethesda Eventide Homes – Ipswich is a residential home for up to 27 people who may be elderly, have a physical disability or be living with dementia. It does not provide nursing care. At the time of our inspection there were 26 people who used the service.
A registered manager was in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law as does the provider. We received positive feedback from people who used the service, relatives, staff and healthcare professionals.
People who used the service told us they felt safe, were treated with kindness, compassion and respect by the staff and were happy with the care they received.
Staff knew how to recognise and respond to abuse correctly. People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Any risks associated with people’s care needs were assessed and plans were in place to minimise the risk as far as possible to keep people safe.
CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. DoLS are a code of practice to supplement the Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed and authorised by appropriately trained professionals.
We found the service was meeting the requirements of the DoLS. The registered manager had a full and up to date knowledge of the MCA 2005 and DoLS legislation, and when these applied. Documentation in people’s care plans showed that when decisions had been made about a person’s care, where they lacked capacity, these had been made in the person’s best interests. This meant that people who could not make decisions for themselves were protected.
Appropriate systems were in place to ensure that there were sufficient numbers of suitably skilled staff to meet people’s needs. In line with the provider’s policy and procedures newly employed staff received an induction and training. Records showed that staff received ongoing training, regular supervision, an annual appraisal and opportunities for professional development.
We looked at people's care records. The records seen showed that care and treatment was planned and delivered to ensure people's safety and welfare. Information in the records provided clear guidance to staff on how to meet people’s individual needs and promote their independence.
People were supported to maintain their health and well-being. They attended appointments with other healthcare professionals such as opticians, physiotherapists, dentists and chiropodists.
People were supported to be able to eat and drink sufficient amounts to meet their needs. People told us they liked the food and were provided with a variety of meals. We found that people were encouraged to be as independent as possible but where additional support was needed this was provided in a caring, respectful manner.
Throughout the inspection we observed staff interacting with people in a caring, respectful and professional manner. Where people were not always able to express their needs verbally we saw that staff were skilled at responding to people’s non-verbal requests promptly and had a good understanding of people’s individual care and support needs.
People we spoke with told us that they felt confident and able to raise issues. Records seen showed people’s comments, concerns, compliments and complaints were responded to in line with the provider’s complaints procedure. People were listened to and any issues raised acted upon.
Robust systems were in place that assessed and monitored the quality of the service provided. The views of the people who used the service, their relatives, staff employed at the service and visiting healthcare professionals had been sought and acted on where required.
We observed that the staff were attentive to people's needs. Staff interacted with the people who used the service in a friendly, respectful and professional manner. We saw that staff sought their agreement before providing any support or assistance. The people we saw were relaxed and interacted with each other.
We looked at three staff files and found evidence that showed that the service took all necessary precautions to ensure that they only employed staff that were of good character, had the skill and qualifications necessary to effectively care for older people.
We looked at the way that complaints were recorded and dealt with and saw that they were handled in line with the provider's policy.
We saw that people who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.