Archived: Bethany Francis House

Updated 5 April 2019

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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part by on-going concerns shared with the CQC, since the last inspection on 10 and 17 September 2018, by the local authority and whistle-blowers.

Inspection team: An inspection manager and inspector carried out this inspection.

Service and service type:

Bethany Francis is a ‘care home.’ People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, both were looked at during this inspection. The care home accommodates up to 34 older adults, including people living with dementia, in one adapted building over two floors.

The service has been without a registered manager since 25 July 2018. A registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection: This inspection was unannounced. This meant that the service did not know we were coming.

What we did:

Prior to this inspection we reviewed the information we held about the service, including notifications. A notification is information about events that by law the registered persons should tell us about. We looked at feedback from the local authorities monitoring visits of the service of people's care. This was to find out their views on the quality of the service. We used information the provider sent us in an action plan following our inspection in September 2018 telling us about the improvements they were making to address breaches of regulation and meet conditions imposed on their registration.

During the inspection, we looked at various information including:

• Care records for four people.

• Looked at four staff files including all aspects of recruitment, supervisions, and training records.

• Looked at health and safety, servicing records and risk assessments.

• Looked at records of accidents, incidents and complaints.

• Looked at audits and surveys.

• Looked at people’s medicines management.

• We spoke with two people using the service, two staff, the maintenance person, the deputy manager, home manager (of six weeks) and the operations manager (of one week).

• We took photographic evidence of environmental and maintenance concerns.

Updated 5 April 2019

About the service: Bethany Francis House is a residential care home that was providing accommodation and personal care to 16 people aged 65 and over on the first day of the inspection and to 15 people on the second day.

People’s experience of using this service:

People’s experience at Bethany Francis House was poor. There continued to be widespread systemic failings at the service despite the continued support from the local authority safeguarding and quality monitoring teams to mitigate risk to people using the service. Continued failure in the provider’s understanding in their legal responsibility to ensure adequate staffing levels and training, and an environment that is fit for purpose, clean and hygienic has continued to impact on the quality and safety of care delivered to people at Bethany Francis House. Lessons had not been learned to minimise reoccurrence of risk and drive improvement effectively.

Inconsistent management and leadership has led to a failure to address recurring risk to people’s safety and welfare, and to drive and sustain improvement. The provider did not have any systems or processes in place that were effective to identify and manage where things had lapsed or were going wrong.

There were not enough staff to meet the needs of people, respond to them in a timely way, maintain their dignity and keep them safe. Due to insufficient staffing numbers people had to wait to go to the toilet and were left for long periods of time, unsupported and unsupervised.

People were not provided with regular access to activities that were meaningful and appropriate to their needs, to promote their wellbeing and protect them from social isolation. Care was mainly based around completing tasks and did not take into account people’s preferences, choices, abilities and strengths. It was not planned or individualised and did not promote independence, where possible. Care records provided insufficient guidance for staff in how to provide care and support to people that was appropriate to their needs and minimised risk to their health and wellbeing.

Staff worked very long hours, and on occasion double shifts, to ensure shifts were covered and ensure people received care from staff they knew and trusted. However, staff were tired and unsupported by the provider; this had caused some to become sick, and others to leave.

Staff were not suitably trained. People were not cared for and supported at all times by staff who had the right knowledge, skills and competency to carry out their roles properly and safely. Staff did not always respond to safeguarding concerns in a safe way and they had limited or no understanding of how dementia affected people in their day to day living.

The home required significant redecoration and repair and many areas of the home were unhygienic and unsafe. There continued to be significant risk around fire safety and water safety. The environment had not been adapted to meet people’s diverse needs and did not promote a dementia friendly environment. There were no suitable bathing or showering facilities for people to have a bath or shower safely and comfortably. Corridors were dimly lit.

Rating at last inspection: The service was rated Inadequate at the last inspection and placed into Special Measures. The report was published on 6 November 2018. For more details please see the full report on www.cqc.org.uk.

Following the last inspection, we sent an urgent action letter to the provider telling them about our findings and the seriousness of our concerns. We asked them to complete an urgent action plan telling us what they would do and by when to improve the key questions safe, effective, caring, responsive and well-led to at least ‘Good.’ We took immediate enforcement action to stop further admissions to the service and force improvement.

Why we inspected: We inspected in February 2019 because the home was in special measures which means we must return within six months to check the service again. We were aware before this inspection of continued concerns raised by whistle blowers, relatives and local authority.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: The overall rating of this service is Inadequate and the service therefore remains in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

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