Archived: Bethany Francis House

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

The inspection took place on 10 and 17 September 2018 and was unannounced. It was prompted in part following information received from the local authority, their safeguarding team and whistle blowers and, to check that the required improvements from our earlier inspection on 21 February and 12 March 2018 had been made. At that time, we found the registered provider was in breach of multiple regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to submit an action plan to tell us how they intended to make the required improvements. They told us improvements would be made by 30 June 2018.

At this inspection on 10 and 17 September 2018 we found the provider had not taken enough action and they were still in breach of Regulations. We found the provider lacked oversight of the service and there was a lack of robust systems and controls in place to protect people and keep them safe.

There was not a registered manager in post. The registered manager left Bethany Francis House in July 2018. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

A new manager had been recruited and had been in post for four weeks prior to this inspection.

The provider did not have robust and effective governance systems in place and was failing to consistently assess, check and improve the quality and safety of the service and care delivered. There were no proper monitoring and review systems to inform, drive and sustain an ongoing plan for improvement and embed in practice.

There were not enough staff to provide people with adequate supervision, enough to eat and drink, continence support, help to reduce anxieties or support people with complex needs. They did not always respond in a timely manner to all of people’s needs. Opportunities to take part in meaningful activity was limited and activities provided were not personalised or tailored to meet people’s level of ability, choice or preference.

Management and staff showed they did not have enough knowledge and skills about how to support people safely and protect them from harm. There were significant risks associated with fire safety, aspiration and choking, medicine management, incidents triggered by people’s mental state and/or dementia related needs. Applications to restrict people lawfully when they had been assessed as lacking capacity had not always been made to the local authority supervisory body.

The quality of training staff received was not effective enough to show staff were able and competent to the needs of people using the service. The provider did not have systems in place to ensure they were up to date with best practice and there was a lack of effective learning from complaints and safeguarding incidents to reduce risks to people from reoccurring.

There was a lack of systems in place to receive, manage and record complaints. The provider did not have any records to show whether they had managed, resolved and learned from complaints received since the last inspection.

The provider had not notified the CQC of all incidents that it was legally obliged to let us know of.

Thorough risk assessments were not carried out routinely to identify and mitigate risks in relation to people's healthcare and support needs. People’s care records did not provide enough or up-to-date information for staff around safe care, supporting people’s wellbeing and protecting people from harm.

Following this inspection, we sent an urgent action letter to the provider telling them about our findings and the seriousness of our concerns. We requested an urgent action plan from them telling us what they were going to do at once to address them. An action plan was returned the next day. We also shared our concerns with the local authority and their safeguarding team. We took immediate enforcement action to restrict admissions to the service and force improvement.

The overall rating for the service is 'Inadequate' and the service is therefore 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. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there will still be a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate in any of the five key questions it will no longer be in special measures. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Bethany Francis House accommodates up to 34 people in one building and provides accommodation over two floors which is served by a lift. At the time of this inspection 23 people were accommodated.

This unannounced inspection took place on 21 February and 12 March 2018 as concerns had been raised around the care people received, staff training and management of the service

At our previous inspection in December 2016 the home was overall rated good. The service is now rated as requires improvement.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

We found that individual risks to people had not always been identified and appropriately documented and those that were in place did not contain sufficient guidance to staff. There were also risks within the environment that had not been well managed.

Arrangements had not been made to ensure that there were sufficiently trained staff on duty to enable people to receive their medicines as prescribed.

Some parts of the home were not clean and infection control practices were not being followed.

People’s dignity and respect was not always upheld and staff did not always spend time with people because their approach was more task led then person centred.

Systems to monitor the service were not effective and many of the shortfalls found during this inspection had not been identified by either the registered manager or registered provider.

Care plans provided limited information about people’s history, likes dislikes and care needs. Care plans had not always been updated when people’s needs had changed. Not all staff had the required training to adequately support people.

People could not be assured they would receive their medicines as prescribed and in a timely way.

Accidents and incidents had been appropriately recorded and records showed that appropriate action had been taken when an incident had occurred.

People received support in relation to their health conditions in a timely manner. Advice was sought and followed from other health professionals. People’s preferences were documented for their wishes at the end of their life.

Visitors were welcome at any time and the service had an effective complaints procedure. People were able to follow hobbies, interests and activities.

There were regular meetings for staff, people who use the service and their relatives. Staff were recruited in a safe manner, they received supervision and support to undertake their role and they felt well supported by the registered manager

As a result of our findings we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Our last inspection took place on 15 February 2016 and as a result of our findings we asked the provider to make improvements to the staffing levels within the service. We received an action plan detailing how and when the required improvements would be made by and this action has been completed.

This unannounced inspection took place on 1 and 13 December 2016. There were 23 people receiving care at that time.

The provider had made improvements in the service’s staffing levels since our last inspection and there were sufficient staff to meet people’s assessed needs. Staff were only employed after the provider had carried out comprehensive and satisfactory pre-employment checks. Staff were well trained, and well supported.

Systems were in place to ensure people’s safety was effectively managed. Staff were aware of the procedures for reporting concerns and of how to protect people from harm. The service was clean and smelled fresh and staff had an understanding around the prevention and control of infection.

People received their prescribed medicines appropriately and medicines were stored safely. People’s health, care, and nutritional needs were effectively met. People were provided with a balanced diet and staff were aware of people’s dietary needs.

People’s rights to make decisions about their care were respected. Where people did not have the mental capacity to make decisions, they had been supported in the decision making process.

People received care and support from staff who were kind, caring, thoughtful and respectful to the people who lived at the service. People and their relatives had opportunities to comment on the service provided and people were involved in every day decisions about their care. People were treated with dignity and respect.

Care records provided staff with sufficient guidance to provide consistent care to each person. Changes to people’s care was kept under review to ensure the changes were effective and met their current needs. There was a programme of events for people to join in with and people were encouraged to maintain their hobbies and interests.

The service had a registered manager in place who was approachable and supportive towards staff. 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.

People and relatives were encouraged to provide feedback on the service in various ways both formally and informally. People’s views were listened to and acted on. Concerns were investigated and plans actioned to bring about improvement in the service.

The provider’s quality assurance systems had not always been effective, leaving people at risk of harm. Improvements had been made to the quality monitoring systems. However, these needed time to embed and show that improvements were sustained.

This inspection was unannounced and took place on 15 February 2016.

The home had a registered manager in post. 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 and associated Regulations about how the service is run.

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Staff had received training in this subject but those spoken with during this inspection were not able to demonstrate that they were fully aware of the principles of the MCA or DoLS and their obligations under this legislation.

Staffing levels were not adequate to meet peoples care and support needs.

Care plans contained all of the relevant information that staff required so that they knew how to meet people’s current needs.

Risks had been managed to keep people as safe as possible. Risk assessments had been completed when necessary. This meant that staff had the information they required to ensure that people received safe care.

The provider had a recruitment process in place and staff were only employed within the home after all essential safety checks had been satisfactorily completed.

People’s privacy was respected at all times. Staff were seen to knock on the person’s bedroom door and wait for a response before entering. People were not always given a choice of when they were assisted when getting up in the mornings.

People were provided with a varied, balanced diet and staff were aware of people’s dietary needs. Staff referred people appropriately to healthcare professionals. People received their prescribed medicines in a timely manner and medicines were stored in a safe way.

The provider had a complaints process in place and people were confident that all complaints would be addressed.

The provider had an effective quality assurance system in place to audit all areas of the home to identify areas for improvement. They were able to demonstrate how improvements were identified and acted upon.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found

Is the service caring?

People we spoke with were very complimentary about the care and support that was provided by the staff. We saw that people were supported by staff who treated them with respect and ensured their dignity was maintained. People were encouraged to be as independent as possible.

Is the service responsive?

We saw that people's needs had been assessed before they moved into the home. We found that care records were updated when people's care and support needs changed and the care records were reviewed on a monthly basis.

Is the service safe?

People told us they felt safe. Staff we spoke with were clear about the procedure to follow if they witnessed or had concerns about any safeguarding issues. The policy and procedure in the home relating to safeguarding vulnerable people was available to staff and had been reviewed in July 2013.

The Environmental Health Officer (EHO) had carried out a visit in December 2013. They had made recommendations that the home needed to address. During this visit we found that the action plan stated that the provider had addressed the issues raised. An audit of the kitchen had been conducted three days prior to our inspection and identified no issues with the cleanliness, but did state that a deep clean was carried out regularly. On the day of our inspection we found a number of issues, including that there was no clear work space, the kitchen and oven were unclean and food was left uncovered in the fridge and the oven. This put people's health and safety at risk.

Recruitment practice was safe and thorough and all the required checks had been carried out before staff commenced their employment.

Is the service effective?

Staff we spoke with understood people's care and support needs. Information on advocacy was available in the office if people required support in making decisions. Peoples care records were up to date, these gave staff clear guidance about how people liked to be supported with their care and support needs.

Is the service well led?

Staff we spoke with told us they enjoyed their job and felt supported to do their Quality assurance Records we looked at did not whilst some of them had identified some areas for improvement there was no detail available to how these will be addressed within a timescale. We found that auditing was not effective.

If you wish to see the evidence supporting our summary please read the full report.

Prior to this inspection we received some information of concern in relation to staffing levels and poor care.

During this inspection we found that improvements had been to ensure that people care plans gave staff detailed information on how people's needs are to be met.

Staffing levels were appropriate to meet people's needs.

We found that not all people's care records were up to date, making it difficult to understand what the person's support needs were and could put them at risk of not receiving appropriate care. Although we observed and talked with staff who were knowledgeable about the people they supported, we found that not all people's care records were up to date about their needs. This could put them at risk of not receiving the care they required.

We found that appropriate equipment was in use and had been regularly serviced to ensure its safety for people.

Staff understood how to protect people from abuse and what to do if they suspected any abuse had occurred.

Staff told us they felt well supported in their work and received the appropriate training to carry out their roles.

People who lived at the home told us that they were happy living there and that the staff met their needs in a way which respected their privacy and dignity. One person told us, "I love it here." Another person told us, "The staff are very good, I love them all."

Improvements had been made to people's care records. People now had clear care plans which provided good guidance for staff about how to meet people's individual needs. The number of staff on duty had been increased and so staff had more time to spend with individual people.

Staff training and supervision had improved so that staff felt well supported and able to carry out their roles effectively.