Archived: Bethany Homestead

Updated 16 November 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This unannounced inspection was carried out by an inspector and took place on the 14 and 17 September 2015. Before the inspection, the provider completed a Provider Information Return [PIR]. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The provider returned the PIR and we took this into account when we made judgements in this report.

We also reviewed information we held about the provider including, for example, statutory notifications that they had sent us. A statutory notification is information about important events which the provider is required to send us by law. We contacted the health and social care commissioners who help place and monitor the care of people living in the home that have information about the quality of the service.

We undertook general observations in the communal areas of the home, including interactions between staff and people. We viewed one person’s private accommodation by agreement with them.

During this inspection we spoke with 16 people who used the service. We looked at the care records of the five people. We spoke with the registered manager, five care staff and three support staff and a volunteer who represented the ‘Friends of Bethany Homestead’. We looked at four records in relation to staff recruitment and training, as well as records related to quality monitoring of the service by the provider and registered manager.

Updated 16 November 2015

This unannounced inspection took place on the 14 and 17 September 2015. Bethany Homestead provides accommodation for up to 38 people who require residential care for a range of personal care needs. There is also a complex of bungalows within the grounds where some people receive personal care and support to enable them to retain their independence and continue living in their own home.  There were 37 people in residence and 6 people receiving care in their own homes during this inspection.

There was 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 2008 and associated regulations about how the service is run.

The registered manager had the knowledge and experience to motivate staff to do a good job however, they were not always supported by the provider on a daily basis. The provider relied on committees to make decisions which had the potential to delay actions that had an effect on the management and maintenance of the home.  Systems and processes for the health and safety and maintenance of the home required improvement and embedding as more support from the provider in establishing these was required.

People were supported to maintain their links with the community and with significant others, such as friends and relatives. The provider had an entertainment committee to fund activities, however the provider did not provide sufficient support for people to take up activities, they instead relied on the good will of the Friends of Bethany Homestead and volunteers to provide enrichment to people’s daily living.

People were safeguarded from harm as the provider had systems in place to prevent, recognise and report any suspected signs of abuse. People received their care and support from sufficient numbers of staff that had been appropriately recruited and had the training to provide safe care. However the deployment of staff needs to be strengthened to ensure that there are sufficient staff on duty at all times to enable people to pursue their interests. 

People’s care and support needs were continually monitored and reviewed to ensure that care was provided in the way that they needed. Staff referred people to relevant health professionals where indicated. People’s care plans reflected their individual needs; they had been involved in planning and reviewing their care when they wanted to.

Staff were kind and compassionate, they knew people well and ensured that people received their care in line with their likes and dislikes. People’s needs were discreetly met by staff so that they maintained their privacy and dignity.

Staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005) and in relation to Deprivation of Liberty Safeguards (DoLS).

There were appropriate arrangements in place for the management of medicines. Staff followed policies and procedures that had been updated when required. The quality control audits for people’s care were comprehensive and followed up with timely actions led by the manager.

Appropriate and timely action was taken to address people’s complaints or dissatisfaction with the service provided.

We identified that the provider was in breach of one of the Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 (Part 3) and you can see at the end of this report the action we have asked them to take.