Bethany House Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service had improved. Where incidents and accidents had occurred, action had been taken to reduce risk. Staff had undertaken training in safeguarding to enable them to identify concerns. Staff knew how to report concerns which were investigated and acted upon appropriately. People’s medicines were administered as prescribed. Medicines were stored and managed safely. There had been a recent focus on increasing staff skills and knowledge and staff had completed the training they needed to undertake their role. There was enough staff to keep people safe, although some people felt staffing levels could be increased so they could spend more time with people. Risk assessments and care planning had improved, however there were some areas of some care plans that still needed further work to ensure guidance for staff was up to date and accurate.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they were happy with the way incidents were managed. One person said, “I am happy with the way [managers] are handling it and keeping me informed. I feel very confident about saying anything to them or raising a complaint because they listen, and you feel respected.” Relatives said they felt their loved ones received safe care because they had “no concerns.” One relative said they were fully aware of issues in the past but said these have been addressed.

There were daily meetings where information on recent incidents and accidents was shared with staff. Staff discussed the actions planned and any lessons learned. Staff were encouraged to report incidents and told us they felt empowered to do so. The registered manager told us he invited a ‘Speak UP’ guardian from the head office who had sessions with staff on how to speak up and the benefits of raising concerns to promote openness and transparency within the staff team.

There were systems and processes in place to report and record incidents. When incidents had occurred, action had been taken to reduce the risk of further concerns arising. A bulletin was produced for staff focusing on lessons learnt and sharing actions taken so staff were aware of important information even if they had not been able to attend meetings where concerns were discussed. Incidents and accidents were reviewed to seek to identify any trends so that the underlying cause could be addressed.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they were happy with the support they received to remain safe. One person said, “I feel very safe here, I don’t have to worry about anything. I like all the carers.” Another person said, “I feel my personal property is respected.”

Staff confirmed they had received training on safeguarding people. They knew the signs to look for in the people they supported and told us they would report concerns if and when they arose. Staff told us they trusted the registered manager to take action to protect people. Staff knew how to whistleblow if they had concerns about unsafe practice which were not being addressed. The registered manager understood how to report any concerns to the local authority as required and notify CQC.

Staff were with residents to support them to remain safe. Staff checked regularly on those who preferred to be alone in their rooms. Staff spoke to people kindly and with respect. People were happy and appeared clean and well cared for. When staff provided personal care, they ensured doors and curtains were closed to protect people’s privacy.

People were protected from the risk of abuse. There were processes in place to reduce the risks to people. When concerns had arisen, these were recorded, reported and investigated as appropriate. Action had been taken to reduce risk. 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. People can only be deprived of their liberty when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Where people were deprived of their liberty appropriate legal authorisations were in place and reviewed as necessary.

People told us they felt their regular staff knew how to support them with risks to their health and wellbeing. One person told us, “Staff know me well and what I need because I tell them, and they listen.” Another person said, “If I am ill, for example, the staff know straight away and call the ambulance and let my mum know. Or they call the GP, and they accompany me.” However, the registered manager was working with a sister service to build in more flexibility to staffing, this meant people were sometimes supported by staff who did not know them so well. One person said, “I don’t like it when they give me staff from next door because they don’t know me as well and I have to explain things over again, which can be tiring.” People were involved in care planning as far as possible. One person said, “I am included in the reviews as often or as little as I like.”

Staff told us they informed the nurses if they had concerns about people’s wellbeing or health conditions. Information about people’s risks were discussed daily during handovers to ensure staff knew about any recent changes or if the person was unwell. Staff had responded in a recent survey to express that they were confident in their skills and abilities but felt that care plans still needed to be improved. The registered manager was aware of this and was working with staff to improve consistency in care planning.

Staff were visible throughout the day in communal areas and regularly checked on people when they chose to be in their rooms. Staff responded to people’s requests for help in a reasonable time frame. Call bells were responded to promptly. The number of staff on shift matched those the numbers planned on the rota to support people safely.

People had care plans and risk assessments in place to provide staff with the guidance they needed to support people. Some areas of some care plans still needed improvement as they contained outdated information which was conflicting. For example, one person’s care plan stated they are turned during the night, but another section of the plan stated the person did not like to be turned. Another person’s care plan indicated they needed support with daily incidents which was no longer the case. Staff knew how to support people. However, this increased the risk that new staff would not know people’s needs well. The registered manager was aware of this and was addressing concerns. This was an area for improvement. Other care plans had been reviewed and updated and included a good level of detail about how people wanted to be supported. For example, when people had feeding tubes there was clear guidance and on how to use and care for the tube and the surrounding skin.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Feedback from people about staffing levels were mixed. People told us they were not kept waiting. One person said, “When I use the call bell, I am not kept waiting, they come straight away, that’s not a problem.” But also “I would like more staff so they can spend more time with you.” Another person said, “I think there could be more staff.” Relatives also had mixed views. One relative said, “We are there at weekends and there was never a problem, [my relatives] room is always tidy, and no one is rushing around.” However, another said, “There can be times when residents need attention and need to wait a few moments – it’s not that the staff don’t care, but that there is not enough of them to undertake everything that needs to be undertaken.”

Staff had been focusing on increasing training completion and updating skills and knowledge. Staff were positive about the training they had undertaken. One staff said, “I can’t believe how much training I have had! We have online training but lots of face-to-face training. We get a schedule of training, and the registered manager is hot on your heels if you are late with any of it.” Feedback from staff was that there was enough staff on the rota to meet people’s needs. However, staff also told us they were very busy if someone was off sick. The registered manager was working with staff increase their skills and flexibility so staff could work in both this service and Bethany Lodge, which was in close proximity. The aim of this was to increase the number of staff who could potentially work in each service. This would reduce the likelihood of there being impact from staff sickness. The registered manager told us they felt this would improve staff wellbeing.

Staff were visible throughout the day in communal areas and regularly checked on people when they chose to be in their rooms. Staff responded to people’s requests for help in a reasonable time frame. Call bells were responded to promptly. The number of staff on shift matched those the numbers planned on the rota to support people safely.

There were enough staff to ensure people were safe. The registered manager used a dependency tool to assess how many staff were needed to provide support to people. The number of staff on the rota matched this assessed need. A supernumerary clinical lead had recently started in post. They were recruited to improve oversight, identify clinical issues and improve clinical practice. Staff had the training they needed to provide people with effective support. Staff were also now receiving regular supervision to provide them with support in their roles. This included clinical support and supervision where appropriate. New staff were supported by more experienced staff during their induction. There were checks on staff performance including competency checks to ensure staff understood how to support people safely. Appropriate checks were undertaken to ensure staff were recruited safety. For example, Disclosure and Barring service (DBS) checks were undertaken. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were happy with the support they received with their medicines. One person said, “I know what my medicines are for, and I get them on time. They pop them out of the pack and hand them to me to take myself.”

Nurses provided people support with their medicines. They understood people’s medical needs and what their medicines were used for. The nurses were undisturbed when administering medicines to people which helped ensure there were less errors made as a result of being disrupted.

People’s medicines were managed safely. People’s medicines administration records (MARs) included the information required and recorded medicines administered as prescribed. People’s medicines were stored safely. Medicines were stored safely in locked trolleys which were then locked in the medicines room. There were protocols in place for managing people’s as and when medicines, such as pain relief. Medicines were regularly audited and when we checked the totals of medicines in stock matched records.