About the service: Bethany House is a residential care home providing personal care for a maximum of up to 18 people aged 65 and over. At the time of the inspection there were 16 people living at the home; some of who were living with dementia.

People’s experience of using this service:

At the last inspection we found the service did not always meet people’s needs because care plans were not up to date. We also found the way the home monitored the quality of the service was not effective at identifying and sorting out any shortfalls. We made two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found these breaches and shortfalls had been put right and many other improvements had been made to the quality of the service and running of the home.

There was a new manager in post, who along with the provider’s operations manager, had brought about clear leadership and an improved system to ensure people received good quality care. People who lived in the home, their relatives and professionals were impressed with the new manager and spoke of her being very approachable with an open management style.

Everyone we spoke with told us this was a good home and said people were well cared for. People’s needs were now being well met through up to date care plans, care being offered by a well-trained and supported staff team and by sufficient numbers of staff on duty to respond to their needs.

Staff knew how to keep people safe and this included having a good knowledge of safeguarding people from abuse. Risks to people were now well managed, with a particular focus on reducing people’s risk of falls and managing behaviours that maybe challenging to the service.

Care was person-centred, based around each individual’s personal care and health needs and to also meet their social needs and interests. Care planning had improved with particular attention paid to including instructions from healthcare professionals.

People rights were respected and protected because the service had a good understanding of the Mental Capacity Act. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with dignity and compassion. They told us the staff team knew them well, took a genuine interest and were kind and caring. People looked well-groomed and well cared for.

There was a good choice of meals and people said the food was very good and they liked that it was ‘home cooked’. Support was provided which ensured people received food and drink when they needed this.

Good working relationships had been developed with health and social care professionals that meant people were supported to stay well and any health issues were quickly addressed.

People’s medicines were being better managed with a focus on staff training and competency.

The service was well-maintained, comfortable, clean and odour free. Since the last inspection a number of improvements had taken place. These included internet access and the improved use of technology which had benefited people in the home and the staff team.

Rating at last inspection: Requires improvement (09/03/2018).

Why we inspected: We inspected the service as part of our inspection schedule methodology for ‘Requires Improvement’ rated services and to check the provider had made the improvements they told us they would, following our last inspection.

Follow up: We will monitor as part of the inspection programme for a Good service. If any concerning information is received we may inspect sooner.

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

This inspection took place unannounced on 23 January 2018. At our last inspection in July 2015 the service was rated good. At this inspection we found the service Requires Improvement. This is the first time the service has been rated as Requires Improvement.

Bethany House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home provides personal care and accommodation for up to 18 older adults including people living with dementia and some with mental health needs. The home is an older building which has been adapted. A stair lift is used to access the majority of the bedrooms on the first floor. Communal rooms are situated on the ground floor of the home. At the time of our inspection the home had no vacancies.

The service has a registered manager. This 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.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were about people having an up to date care plan that met their individual needs; and about the systems to check the quality of the service.

Everyone we spoke with told us this was a good home and said people were well cared for. They told us there were enough staff to provide the support people required and the staff treated people in a kind and caring way.

The staff knew people well and care was planned and provided to meet people’s needs. However we found some records had not been fully updated or reviewed after changes to a person’s condition had occurred, such as after a fall. We also found this to be the case with records for supporting people at the end of their life and with behaviours that were challenging to the service.

The provider and the service had some quality assurance checks in place to ensure the safety of the building, equipment and quality of the care offered. However we found that these needed to be strengthened to ensure that all aspects of the service were covered and that actions were set out and monitored to meet any shortfalls. The home did not currently have a formal development plan for future improvements or developments for the service.

Records showed people received their medicines as prescribed and in their preferred manner. We made a recommendation about how the home disposed of unused medicines.

Staff worked with external professionals to promote people's physical and mental well-being. People being cared for at the end of their life were treated with dignity and respect.

People’s rights were respected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Where people were not able to agree to aspects of their own care people who knew them well had been included in making decisions in their best interests. Some of the records in people’s care plans were not clear on the support they needed to make decisions. We made a recommendation about how people’s capacity was assessed and recorded.

We found staff were being recruited safely and there were enough staff to take care of people and to keep the home clean. Staff were receiving appropriate training and they told us the training was good and relevant to their various roles. They told us they felt supported by the registered manager and were receiving formal supervision where they could discuss their on-going development needs. There was good teamwork between the staff.

People were treated with respect a

This unannounced inspection took place on 13 July 2015. We last inspected Bethany House on 12 September 2013 and found the service was not meeting all the regulations that we assessed. This was because the home required some upgrading to the building and a quality assurance system was needed to monitor the running of the service.

We told the registered provider to take action to address these issues. The registered provider wrote to us and gave us an action plan saying how and by what date they would make the improvement.

At this inspection July 2015 we found that the registered provider had made the improvements they said they would and were no longer in breach of the regulations.

Bethany House is an older property, adapted and extended for its current purpose and is situated in the conservation area of Whitehaven. It is near to all the amenities of the town. Accommodation is in single rooms with ensuite toilet facilities. The home provides care for mainly older people with dementia or other mental health needs.

The service had a registered manager in post. The current registered manager had been in post since May 2014.

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.

At the time of the inspection there were 18 people living in the home. Those we spoke with told us that they felt safe living there, that staff were “kind”, and there were enough staff available when they needed them.

Throughout our visit we observed caring, supportive relationships between people living at Bethany House, the manager and the care staff.

People were treated in a way that demonstrated that a positive, caring and inclusive culture existed in the home.

We saw that staff were knowledgeable about people’s backgrounds and the care they required. This led to people being treated in a dignified and respectful manner.

The home was being well maintained and the facilities had been improved for people. We found that all areas were clean and free from lingering odours.

We found that there was sufficient staff on duty to provide support to people to meet individual’s personal care needs. The home had effective systems when new staff were recruited and all staff had appropriate security checks before starting work.

Staff had received training relevant to their roles and were supported and supervised by the registered manager and the care manager. The staff knew how to identify abuse and protect people from it.

People enjoyed the food provided and were supported to take a good diet that was based on an assessment of their nutritional needs.

People were able to see their friends and families as they wanted and go out into the community with support. There were no restrictions on when people could visit the home. All the visitors we spoke with told us that the manager was “approachable” and that staff were “friendly” and “available” when they wanted to speak with them.

Medicines were being administered and recorded appropriately and were being kept safely.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves.

The service worked well with health care professionals and external agencies such as social services and mental health services to provide appropriate care to meet people’s different physical and emotional needs.

Support plans were based on thorough assessments and were written using a person centred approach.

People were promoted to maintain their independence and some people were actively involved in the local community.

There was regular monitoring of quality of the service. The registered manager had good systems in place to monitor the quality and safety of the service and facilities provided at the home.

The home had created a friendly, open and welcoming atmosphere. One person said, “It’s a home from home here.” We saw that people living in the home treated it like their home and were enjoying doing household chores such as hoovering, setting the table, clearing away and helping out in the garden.

People living there told us, “It’s very good here they (staff) help you when you need it. They asked me ‘do you fancy a bath this morning?’ I can choose about these things.” Another person said, “The staff are very attentive, nothings too much trouble for them.”

Visitors we spoke with said, ‘When we came for a look round we felt it was very much a home and not an institution.’ Another relative said, “I would recommend them to anybody.”

The staff team were experienced and well trained, and had skills and knowledge to help them support and care for older people.

The home had carried out some improvements to the building since we last visited. A number of areas of the home had been upgraded for example some bedrooms re-decorated and a new extractor fan for the kitchen. However there were still areas of the home that required upgrading. We found some carpets were worn and marked, skirting boards and paint work chipped and some furniture required cleaning or needed to be replaced.

We found that the way the home's standards were monitored was basic and needed work to make it fit for purpose to ensure that the home was well maintained and a safe place to live.

A noticeable feature of the home was the relationship and interactions between staff and the people living there. There was obviously a genuine affection and respect shown by staff in the way they attended to and responded to people. We found that the majority of people were well stimulated and had frequent staff attention for both care and social needs. People were engaged in their surroundings and alert, frequently having conversations with each other and with staff.

People living there told us, “The staff do well with us, they are all friendly.” Another said, “They (the care staff) know me very well and know what I like.” “We get to please ourselves, you can go to bed anytime, have a bath as often as you like, morning afternoon, evening it’s up to you.”

We found the home to be appropriately staffed for the needs of the people living in the home. The staff team were experienced and well trained, and had specialist skills and knowledge for caring for people with dementia.

The home had created a friendly, open and welcoming atmosphere. Visitors we spoke with said, “The home has an open door policy for us, the staff and the manager are approachable and nothings too much trouble for them. It’s like an extended family.” Another said, “I would recommend them to anybody.”

People told us they were happy with the care and services provided.

"It is very nice here...I am quite happy and have no worries".

Where people could not express their opinion we relied on relatives who were visiting on the day.

"My relative has settled very well and as a family we have no concerns. They are very good and [my relative] is always well cared for and seems to be much more relaxed. They are able to give the right kind of support so that the confusion is easier to manage".

"As long as she is happy we are happy...never had any problems".