We inspected Bethany House on 13 September 2017. The inspection was unannounced.

The service was previously inspected in June 2016 and was rated requires improvement. We found the provider had breached three regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the premises and equipment suitability, supervisions and training of staff and ineffective systems to monitor the quality and safety of the service. An action plan was submitted to us by the provider outlining how they would improve. We saw improvements had been made in all areas at this inspection and the provider was no longer in breach of any regulations.

Bethany House is a care home which supports people with mental health concerns and people who may also have a learning disability and/or autism spectrum disorder. The service can provide personal care for up to eight people. At the time of our visit eight people lived at Bethany House.

A registered manager was in post. 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.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Recruitment checks were carried out to assess the suitability of staff before they were employed. There was appropriate levels of staff on duty to ensure people’s needs were met.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. Where accidents or incidents had occurred records were kept and reviewed for patterns and trends by the manager. The provider told us following the inspection additional sections will be added to the accident documentation to ensure onwards reporting and actions identified to prevent a reoccurrence are recorded.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. This enabled staff to have the guidance they needed to help people to remain safe. The provider agreed to ensure staff had access to recognised risk assessment tools in areas such as falls and moving and handling where people’s needs increase in these areas.

We saw staff had received appropriate training and supervision on a regular basis and an annual appraisal. This supported staff to have the knowledge and skills to fulfil their role.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards, which meant they were working within the law to support people who may lack capacity to make their own decisions. Where people’s capacity was affected due to their mental health at times, care plans did not clearly outline what action staff should take to make decisions in people’s best interests. The manager agreed to update care plans to ensure this support was reflected.

Appropriate systems were in place for the management of medicines so people received their medicines safely. This included support for people to manage their medicines independently.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Staff showed they knew the people very well and could anticipate their needs. People told us they were happy and felt very well cared for.

We saw people were provided with a choice of healthy food and drinks, which helped to ensure their nutritional needs were met. People were supported to maintain good health and had access to healthcare professionals and services.

People were actively included, as were their relatives, in designing the care and support they wanted to receive. This included

We undertook this inspection of Bethany House on 22 June 2016. Our inspection visit was unannounced.

Our previous inspection of Bethany House took place in October 2014, when the service was found to be meeting the standards assessed at that time.

Bethany House is a residential care home. It is registered to provide care for up to eight people who are living with mental heal difficulties, including learning disabilities or autism spectrum disorder. At the time of this inspection eight people were living at the home.

Bethany House is located close to the centre of Harrogate, in a pleasant residential area close to local amenities, such as the Valley Gardens and shops. The property is an older terraced house that has been adapted for use as a care home.

The service did not have a registered manager at the time of our inspection, with the previous registered manager leaving their post in January 2016. 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. A new manager had just started work and was aware of the need to register with us.

The deputy manager had been acting as manager for Bethany House and another of the provider’s service while a new manager was recruited. People told us the deputy manager had done well, but that it had been a difficult time due to staffing issues and management changes. We found that some management and governance systems had suffered because of this. In addition, we found that staff had not received regular formal supervision in line with the provider’s policy and procedure and some staff training was in need of updating. We found that some adaptations to the premises were needed in order to meet people’s changing needs. We have required that the provider makes improvements in these areas.

Staff were recruited safely and there were enough staff on duty to provide the care people needed. There had recently been a turnover of staff and difficulty recruiting new staff. However, recruitment was taking place and the provider had put in place arrangements to try to retain existing staff.

People using the service told us they felt safe at the home. Staff knew how to report any concerns about people’s welfare and any concerns had been reported appropriately. Staff assisted people with their medicines safely.

People had individual risk assessments in place which ensured staff were aware of the risks relevant to each person’s care. Staff were able to describe how they encouraged and supported people to take positive risks and lead fulfilling lives.

The service was following the principles of the Mental Capacity Act 2005. At the time of the inspection no-one was being deprived of their liberty. Plans were in place to support people’s mental wellbeing and to provide care in the least restrictive way possible.

People told us that they were supported well and treated with dignity and respect by staff. Staff could describe how they maintained people’s confidentiality, privacy and dignity.

People were involved in planning and reviewing their care and support. The staff we spoke with knew people well and were able to describe people’s individual needs.

We saw people come and go as they wanted. People told us how staff supported them to access the local community and attend activities that interested them.

A complaints procedure was in place and a record of concerns and complaints showed that people had been listened and responded to. People had been encouraged to be involved and provide feedback through ‘resident’s’ meetings and surveys, although these had not taken place recently.

The staff we spoke with were committed to providing good, individual care and support to people. People using the service and staff who work

Our inspection team was made up of one inspector. During the inspection we asked five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

On the day of the inspection we met four people living at Bethany House. We spoke with three people about their experience of care and subsequently we spoke with the relative of one person. We talked with five staff and looked at records. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff and people we spoke with told us that they felt safe. Staff had received training in safeguarding and understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risk to people and helped the service to continually improve.

People were cared for in a service that was safe, clean and hygienic. A programme of refurbishment was underway to address identified areas that required improvement. This meant that some areas were not being used and a temporary kitchen-dining area had been set up so people could access simple meals and drinks.

Risk assessments were in place in individual support plans in relation to activities of daily living. Staff records contained all the information required which meant that the provider could demonstrate that staff employed to work in the home were suitable and had the skills and experience needed to support people. Staffing levels were appropriate to meet the needs of the service and these were reviewed and adjusted to address any changing needs. The manager had a proactive approach to recruitment of staff to fill vacancies and had access to bank staff as required.

Is the service effective?

People told us that they were happy with the care they received. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and they knew them well. One person was being supported to move on from the service in the future. Staff had received induction and mandatory training and had undertaken some additional training to improve their understanding of the needs of people who lived in the home. People's health and care needs were assessed with them and they were involved in writing their plans of care.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People who used the service were involved in management meetings and supported to share their views. Where shortfalls or concerns were raised, these were addressed. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes. One relative we spoke with described the staff, "They show an incredible degree of care and endeavour to do their best. They treat you with a great deal of courtesy."

Is the service responsive?

People were regularly involved in a range of activities inside and outside the service. The home supported people to take part in activities within the local community which included regular attendance at a specialist centre which provided activities and support, visiting local places of interest, shopping and walking. People knew how to make a complaint if they were unhappy and two people we spoke with told us that they felt that they could talk with any of the staff if they had a concern or were worried about anything.

Is the service well-led?

The service worked with other agencies and services to ensure that people received their care in a joined up way. Staff spoke positively about the health care staff who supported people living in the service. However, some concerns were expressed by the manager about the length of time taken by care managers in some local authorities to respond to requests for information and support. There was a concern that this could have an impact on the progress of people living in the service. The service had a quality assurance system which included planned audits. Records seen by us showed that complaints were investigated appropriately. People who lived in the service were asked for their views. The manager had introduced a new person centred support planning process. The manager had plans in place to ensure that the service was fully staffed and supported staff through regular supervision and flexible working. Any identified shortfalls were addressed promptly and as a result the service was constantly improving. Staff told us that they felt well supported by the manager.

People said they were happy living at the home, and that they were happy with their care, and understood their level of care and support. Comments made to us by people who used the service included, “I get the support if I want it” and “the staff are nice, you can always find somebody to have a chat with”.

People records contained assessments of the types of decisions they could make and where additional support might be needed. Where people could not make their own decisions, the service worked in the persons best interest using proper legal safeguards and involving other professionals as needed.

Some people’s care records needed updating and review, although in general records for each person showed that the home had carried out sufficient assessment of the needs of each person to enable appropriate care and support to be given.

People were supported to take their medication and there were sufficient systems in place to make sure that medication was managed properly and safely.

We found there were some issues due to a lack of maintenance at the home, and we have asked the provider to take action in relation to these.

Staff went through an appropriate recruitment process which included an interview and Disclosure and Barring Service (DBS) checks, although the home was unable to produce two references for some staff.

There was a written complaints procedure available and we could see where people had been supported in making a complaint.

We spoke with three people who were in at the time when we visited the home. They told us about the care they received and what it was like living at the home. People told us that they were well looked after and that they were happy with the care they received.

One person said, "Everything is all right here. It is comfortable living here, it is a relaxed setting and it is very nice." Other comments included; "I am happy here it is better since the new organisation took over. We have the freedom to do what we want" and "The staff are very supportive - yes I am happy living here."

We spoke with three people about meals at the home. They told us that they enjoyed the food at the home. People made comments about the food such as 'excellent' and 'very good'

We spoke with health and social care professionals who told us that the staff at Bethany House worked well with them, to ensure people are well cared for.

We spoke with the Local Authority Contracts Officer who informed us that they did not have any concerns about this service.