Bethany Lodge

Bethany Lodge is a residential care home that provides nursing and personal care to up to 24 people with physical and learning disabilities. At the time of our inspection, there were to 22 people living at Bethany Lodge.

As this was a targeted inspection, we did not look at all aspects of Right Support, Right Care, Right Culture. However, we would expect the service to be able to demonstrate how they were meeting the underpinning principles of the guidance. This was because they would be able to show the model of care and setting maximises people's choice, control and independence, the care is person-centred and promotes people's dignity, privacy and human rights and the ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. At this inspection we observed that people’s were supported in a person-centred way that encouraged people’s independence. The leadership and culture of the service promoted people having maximum choice and control in their lives.

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

People were supported by enough staff who were suitable for their roles. People’s medicines were administered by trained and competent staff in the way they preferred. Staff understood the need for infection control measures, had received training and used PPE appropriately. The service had been divided into two sections to minimise the risk of infection.

The provider had a vision for high quality care which was shared by staff. Staffing levels had been increased to give staff more time to spend with people. Audits of the quality of the service provided were completed regularly and used to drive improvement. Relatives and staff told us the management team were approachable and open to new ideas.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (published 08 August 2017)

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about staffing, medicines and the oversight of the service. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bethany Lodge Care Home provides accommodation with personal and nursing care for up to 24 adults who need care and support with physical disabilities and complex needs, such as congenital disorders, degenerative illnesses and acquired brain injuries. At the time of the inspection there were 23 people living at the service, most were younger adults although the service also supported people who were older.

People were living with a range of care and nursing needs, many people needed support with all of their personal care, and some with eating, drinking and mobility needs. Other people were more independent and needed less support from staff. There were two lounges, a dining room, and separate toilets and showers or bathrooms. All bedrooms were single with specialist beds and hoisting tracks. There was also an arts and crafts room in the grounds and a hydrotherapy pool at the sister service nearby.

The service had a registered manager who was not available on the days of the inspection, however; the registered manager from the sister service was able to assist in all areas of 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.

Overall medicines were well managed. People received their medicines safely and when they needed them. Staff followed correct and appropriate procedures in the storage and dispensing of medicines. Some people were prescribed medicines to take ‘as and when required’, there was guidance in place for staff to follow for most people but some people were missing the guidance.

A number of audits and checks were carried out each month by the registered manager or senior staff, but the medicines audit had not been effective in identifying the shortfalls in medicines guidance highlighted during our inspection.

People were supported in a safe environment and risks identified for people were managed in a way that enabled people to live as independent a life as possible. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required. Staff followed the guidance of healthcare professionals where appropriate and we saw evidence of staff working alongside healthcare professionals to achieve good outcomes for people.

Recruitment files contained the required information about staff. This helped to ensure that the staff employed to support people were fit and appropriate to be working with people. There were enough staff on duty and they had received relevant training and supervision to help them carry out their roles effectively. Staff were supported to complete an induction when they began work at the service. They were supported, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people's needs. Staff continued to receive training, competence checks and support to meet the needs of people.

Staff knew how to keep people safe from abuse and neglect and any incidents were appropriately referred to the local safeguarding authority. Incidents and accidents were monitored to make sure the care provided was safe. Fire safety had been addressed through training, drills and alarm testing. Maintenance had been carried out promptly when repairs were needed. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

Staff encouraged people to be involved and feel included. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff. People's privacy and dignity was respected.

People had a choice of meals, snacks and drinks, and could choose where they would like to eat. Staff encouraged people to eat their meals and gave assistance to those that required it.

Staff understood the principles of the Mental Capacity Act and knew how to support people who were not able to make their own decisions. People's rights were protected.

Staff treated people with kindness, compassion and respect. Staff took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives.

Activities were offered to people; with a range of one to one and group activities to meet individual needs and preferences.

Complaints had been properly documented, and recorded whether complainants were satisfied with the responses given. People said they knew how to complain if necessary and that the registered manager was approachable.

Staff told us they were clear about their roles and felt well supported by management. Staff said there was good communication. Feedback was sought from people, relatives and professionals.

We have made the following recommendations:

We have made a recommendation about the records management of some medicines.

We have made a recommendation about the medicines audit.

Bethany Lodge is a purpose built service on ground level providing accommodation, nursing and personal care for up to 24 adults with complex physical disabilities, including acquired brain injury, and congenital and degenerative conditions. There are two lounges, a dining room, and separate visiting or entertainment area and separate toilets and showers or bathrooms. All bedrooms are single with specialist beds and hoisting tracks; the more recent extension has slightly larger rooms. There is a spacious arts and crafts room in the grounds. All areas are wheelchair accessible. A hydrotherapy pool is available for people’s use at a partner service nearby.

At the time of inspection there were 24 people living in the service. The age range of people varied from younger adults to people who were older. Care and support was provided by a matron (who is a registered nurse) and a team of nurses and care assistants supported by the daily presence of the provider. The provider was also the current registered manager though the matron had applied to become the registered manager. 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. Both the provider and the matron supported our inspection visit.

Staff knew people well and understood their needs, choices and preferences. Personalised detail was absent from some care plans which meant that peoples’ preferences about their care may not be known and carried out.

Medicines were stored safely, and administered by trained nurses, however for people who wished to self- administer medicines there was no protocol in place to ensure that they were assessed as safe to do so.

People were offered a choice of food at mealtimes. People’s intake of food and drink was monitored but records did not accurately reflect how much fluid people were drinking or if the amounts taken were sufficient to maintain people’s health.

People were thoroughly assessed prior to admission and a plan of care created to ensure all their needs were met. Life histories were obtained so staff could apply this knowledge to the care of people. The interaction between staff and people was compassionate and understanding. People and their relatives had confidence in staff to respond to their needs, and listen to any concerns they had. Family members were made welcome so they could be involved in people’s care.

All staff had received training in the Mental Capacity Act 2005 (MCA) and staff understood the principles of the Act and how to apply them. Where people lacked the mental capacity to make decisions the home was guided by the principles of the MCA to ensure any decisions were made in the person’s best interests.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been made for people who lived in the home to ensure that people were not deprived of their liberty unnecessarily. Staff had received training in adult safeguarding and knew how to follow the home’s safeguarding policy in order to help people keep safe.

Checks were carried out on all staff to ensure that they were fit for employment. Systems were in place to ensure that new staff were recruited and trained to deliver the safest possible care. Staff said they were supported within the team, knew how to perform their roles safely and were given regular training and supervision by the management team. There were opportunities for staff to develop and refresh their skills. There were sufficient numbers of staff available to meet people’s needs without being rushed.

An arts and crafts tutor provided the popular activity of art therapy, which also helped form links between people and the local community. Other activities and entertainments were provided, including trips out to places like pubs and bowling. Peoples’ views on what they would like to do was actively sought and their ideas taken up by the management team. Complaints about the service were acted on and responded to appropriately.

The service was clean and staff knew what action to take to minimise the spread of infection. People’s rooms were personalised and furnished with their own things. The rooms reflected people’s personalities and individual tastes. Checks were regularly carried out to ensure the premises and equipment used were safe. Fire detection and alarm systems were maintained and staff knew what to do in the event of emergency to protect people.

Any medical problems arising in people were referred promptly to the relevant healthcare professional. The service was currently developing ways to improve their partnership with the local medical practice to ensure continuity of care out of hours.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were supported in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff and nurses on duty to meet the needs of the people living at the home. A member of the management team was available for any evening and weekend emergency support.

Is the service effective?

People were involved in their assessment and care planning. All care and support was planned with people's consent. Where people were thought to lack capacity to consent to decisions, an assessment had taken place and people who knew the person well were consulted too.

Is the service caring?

People's care was reviewed regularly, and adjustments were made to make sure they remained comfortable, safe and as independent as possible. Everyone we spoke with said the staff were kind. People said the team were 'Great'; the food was 'Pretty good, really tasty'. People told us that they could raise concerns with the manager or staff and saw the managers most days.

Is the service responsive?

People's day to day support was kept under close review, and any changes needed were communicated to the team. People told us the manager and team were easy to speak with and were quick to sort out problems. We saw that the team sought help from other professionals or services without delay, meaning people remained well supported.

Is the service well led?

Records showed us that the management team were up to date on safety matters. There was an effective action plan in case of emergencies. Complaints and comments were responded to quickly and used to improve service provision.

People told us they were treated with dignity and respect and that their privacy was maintained.

People were involved in developing their own care plans. They had consistent staff providing care and support and their own keyworker, which meant that staff knew people's individual needs and preferences.

People told us they were happy and safe at the service and they could talk to the manager, staff or their own keyworkers about any problems they had.

One person told us there was "Sufficient staff, always someone here to meet people's needs...and the staff are equipped for their caring roles 100%".

People, their relatives or representatives were invited to express their views and opinions on their visits to the service, through "Resident's meetings" and through questionnaires.

People's records were kept individually and information about them was accurate and fit for purpose.

People told us they had a choice of daily activity within the service and transport provided opportunities to go out shopping, to the cinema and visit garden centres. However, one person told us 'the weekends here are really boring' because there were limited opportunities to go out as the transport could only accommodate two wheelchairs at a time. They commented that 'the week is better as there is an activities manager who takes us out'. People said the service felt welcoming and that special events were celebrated, evidenced by Halloween preparations.

People who used the service said their representatives were happy with the care they received. If they were not they knew who to speak to and that their concerns would be dealt with promptly and effectively.

One person told us they managed their own medicines and the service was supportive with encouraging independence.