27 July 2022
During an inspection looking at part of 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.