The inspection took place on 14 and 15 December 2015 and was unannounced. This meant the provider or staff did not know about our inspection visit.We previously inspected Bethany House Care Home on 20 January 2014, at which time the service was compliant with all regulatory standards.
Bethany House Care Home is a residential home in Newton Aycliffe providing accommodation and nursing care for up to 31 people who require nursing and personal care. There were 31 people using the service at the time of our inspection.
The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 found that there were adequate numbers of staff on duty in order to meet the needs of people using the service.
Safeguarding principles, types of abuse to look out for and relevant contact information should people who used the service, relatives or staff have concerns were clearly displayed throughout the service. Members of staff displayed a good knowledge of safeguarding issues and a clear understanding of warning signs to be mindful of and their prospective actions should they have such concerns
We saw risks to people were managed through risk assessments and associated care plans. These risks were reviewed each month and we saw when relevant information was provided by healthcare professionals this was incorporated into care planning and risk assessment.
We found the service had systems in place for ordering, receiving, storing and disposing of medicines, including controlled drugs. Administration of medicines was generally safe and adhered to the National Institute for Health and Clinical Excellence (NICE) guidelines.
There were effective pre-employment checks of staff in place, including Disclosure and Barring Service checks, references and identity checks, whilst records of interviews were detailed and specific to the role.
The service was clean throughout, with a range of infection control measures in place, including two domestic assistants on duty at the time of inspection.
Training was relevant to people’s needs, with staff having completed communication training recently to help support their engagement with people who could not verbalise their wishes. Other recently completed training included: dementia awareness, infection control, manual handling, first aid, person-centred care, safeguarding, death, dying and bereavement, equality, diversity and inclusion and medicines administration. When we questioned staff about the practicalities of a range of these areas, they were able to give detailed and informed answers.
Staff had a good knowledge of people’s likes, dislikes and life histories and built a rapport with the people they cared for. This was facilitated by a key worker system, whereby staff had responsibility for individuals, leading to trusting relationships and a greater continuity of care.
Staff were well supported through formal supervision and appraisal processes as well as ad hoc support when required.
People had choices at each meal as well as being offered alternatives if they did not want the planned meal options. People told us they enjoyed the food and we observed calm and attentive interactions between staff and people they supported during lunchtime. We saw the service had successfully implemented a tool to manage the risk of malnutrition. The service’s approach to supporting people who required specialised diets was praised by a dietitian.
The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.
People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).
We checked whether the service was working within the principles of the MCA. The registered manager displayed a sound understanding of capacity and we found related assessments and decisions had been properly taken and the provider had followed the requirements in the DoLS.
The atmosphere at the home was welcoming and vibrant, with people engaged in activities that were meaningful to them, such as visiting the nearby day centre or watching films, and engaging in warm interactions with staff. Relatives and external stakeholders agreed that staff were caring and compassionate.
Extensive person-centred care plans were in place and daily notes were accurate and contemporaneous. Regular reviews ensured relatives and healthcare professionals were involved in ensuring people’s medical, personal, social and nutritional needs were met.
People’s religious beliefs were respected and encouraged. A local church regularly held services in the home, whilst also providing befriending support. The service had built and maintained strong community links, with the church, a day centre and educational establishments, from which students regularly attended on work experience placements.