Bethany Homestead

Updated 2 December 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by one inspector and one Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Bethany Homestead is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Bethany Homestead is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This service is also a domiciliary care agency. It provides personal care to people living in their own houses and flats within the grounds of the care home when required.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with six people who used the service and seven relatives of people using the service, about their experience of the care provided. We spoke with seven members of staff including the registered manager, a care administrator, a trustee and four care workers.

We reviewed a range of records. This included seven people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 2 December 2022

About the service

Bethany Homestead is a residential care home providing personal care for up to 38 people. The service provides support to older people and young adults, people with dementia, physical disability and people with sensory impairments. At the time of our inspection there were 35 people using the service.

Bethany Homestead provide accommodation across two floors with a lift to the second floor. People with higher dependency needs are accommodated on the ground floor. Rooms have en- suite facilities and there is a communal lounge and dining room.

Bethany Homestead also provides a domiciliary service for the regulated activity of personal care to people living in their own homes within the grounds of Bethany Homestead. At the time of our inspection no one who used the domiciliary service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability. We considered this guidance as there were people using the service who have a learning disability.

The provider had not ensured effective oversight of the service to ensure enforcement action was complied with in the required time frame and risks to people were mitigated.

The providers and registered managers systems and processes had not always ensured effective oversight of the safety and quality of the service. Readmission processes required improvement to ensure any changes in people’s health and care needs could be met.

Improvements required in clarity of information for staff in people’s risk assessments and care plans to mitigate risk. Accidents and incidents were recorded and monitored for trends and patterns and measures put in place to mitigate future risk.

Medicines were administered stored and disposed of safely. People received their medicines when they needed them. There were some improvements required to the consistency of how staff recorded when they had given as and when required medicines (PRN).

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 mostly supported this practice. There was further work underway to ensure all people had decision specific mental capacity assessments.

The home was clean and well maintained. People were protected from the risk of infection and from risk in the environment such as fire and scalding. Staff had access to personal protective equipment.

Systems and processes were in place to protect people from the risk of abuse. Staff were trained and had a good understanding of how to keep people safe and how and to report concerns. Safe recruitment practices were in place and there were enough staff to meet people’s needs.

The provider and registered manager promoted a positive culture that supported choice and independence as much as possible. People’s social, cultural and religious needs were met.

The provider and management team worked in partnership with other professionals to ensure good outcomes for people.

People, relatives and staff were invited to give feedback on care which was reviewed by the provider and registered manager and monitored for themes.

Staff received regular supervision and appraisal and felt well supported by the management team.

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 requires improvement (published 23 July 2021). At this inspection we found the provider remained in breach of regulations and the service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulations 12 (safe care and treatment) and 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bethany Homestead on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to the managerial oversight of the safety and quality of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.