We carried out an unannounced inspection at Bethany House on 28 and 29 March 2017. The first day was unannounced.

Bethany House is a residential care home for older people. It is owned by Preston Bethany Care, a Christian charity. It is a purpose built, single storey home. The home is situated within its own grounds, close to local shops and other community facilities. There are 26 single rooms. 13 have en suite facilities. There were 25 people who lived there at the time of our inspection.

The service was managed by a registered manager. 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.

At our last comprehensive inspection on 17 December 2015 and 6 January 2016, we found the provider was not meeting three regulations. We therefore asked the provider to make improvements to safeguarding people from abuse and improper treatment, safe care and treatment and seeking people’s consent. Following the inspection, we asked the provider to complete an action plan indicating how and when they would meet the relevant legal requirements.

During this inspection, we found improvements had been made in order to meet the regulations. We saw that significant work had taken place since our last inspection to improve the management of people’s medicines and to improve the systems and processes for seeking people’s consent to receiving care.

Feedback from people and their relatives regarding the care quality was overwhelmingly positive. Views from the visiting professionals we spoke with were positive.

People who lived at Bethany House told us that they felt safe and there was sufficient staff available to help them when they needed this. Visitors and people who lived at the home spoke highly of the registered manager and the staff. They told us that they were happy with the care and treatment.

There were up to date policies and procedures in use by staff. We saw copies of satisfaction surveys that had been completed by people who lived at the home. These surveys demonstrated people thought their care and the staff who supported them were excellent.

We looked at how the service protected people against bullying, harassment, avoidable harm and abuse. We found there were policies and procedures on safeguarding people. Staff had received up to date training in safeguarding adults; they showed awareness of the signs of abuse and what actions to take if they witnessed someone being ill-treated.

Safeguarding incidents had been reported to the relevant safeguarding authority. Staff had documented the support people received after incidents. Staff had sought advice from other health and social care professionals where necessary. Risks associated with people’s care were identified and assessed. Plans to minimise or remove risks had been written and analysed for patterns and trends. There was a whistle-blowing procedure available and staff said they would use it if they needed to. People's medicines were managed appropriately and according to the records seen people received their medicines as prescribed by health care professionals.

The level of staffing on the day of the inspection was sufficient to ensure that the current number of people who lived at the home had their needs met in a timely manner. Systems were in place for the recruitment of staff and to make sure the relevant checks were carried out before employment.

Staff had received regular training in the safe management of medicines. On the day of the inspection we observed that medicines were administered safely and in a person centred manner. Records for medicines and audits had been completed. Minor improvements were required in respect of recording for medicines such as topical creams wher

People told us their care preferences and choices had been discussed with them and their agreement to their care plan had been sought. A relative told us they were always consulted about the care being provided to their family member and said they were kept informed about their welfare.

People who lived at the home told us they were happy with the care and support they received. One person said “It’s great here, I don’t think you could get better. I wouldn’t want to live anywhere else anyway”. Another person said, “I’m quite independent and I go out with my friends regularly. There is always help here if I need it”.

We found that up to date care assessments and care plans were in place and these were followed in practice.

People told us they enjoyed the food and that it was always of a good standard. They said an alternative was always available if they did not want the meal that was on the menu. Specialist advice and support was sought for people when dietary concerns or eating difficulties were identified.

There was a well established staff team who were suitably qualified, skilled and experienced to provide a safe and effective service. Effective recruitment and selection processes were in place. A relative said, “I have always found the staff extremely approachable and always very helpful”.

There was an effective system to regularly assess and monitor the quality of service that people receive and to ensure the provision of safe and appropriate care at all times.

We spoke with a range of people about the home. They included, the registered manager, some of the staff members on duty, people who lived at the home and some visiting relatives. We also had responses from external agencies including social services in order to gain a balanced overview of what people experienced using the residential services of Bethany House.

The home says it aims was to promote personal choice as well as meeting people’s physical, emotional, social and spiritual needs. People we spoke with told us they felt the home met those needs. Comments included, “My faith is important and that is one of the reasons I chose this home.” Also, “Mum had been here before so when it came to choosing a home I knew it would meet her needs.” Another person told us, “There are always things going on here. I like to watch the singers when they come in.”

People living at the home were positive about care and support provided by the staff team. One person told us, "I call in at different times and it is always the same, very relaxed with staff around.” Another person said “We are very well looked after.” A relative praised the support provided by the staff team. “I am very happy with the care my mum receives here.” Also, “The staff cant do enough they are marvellous.”

People told us that they had chosen to live at Bethany House because of its Christian roots and because the Christian ethos underpinned the home, with frequent services of worship and Holy Communion. They were happy to be living in this kind of environment.

People said they were well looked after by good staff. One person said, "Everyone is so kind". Another person said, "It's marvellous here". People felt they had the care they needed and access to all the medical and health care services.

We were also told that the food was good and that there was sufficient choice and variety. People living in the home also had choices in activities other than those associated with religious expression, such as musical events, pursuing hobbies, quizzes and outings. One person said, "There's plenty going on".

People living in the home felt that they were listened to, could air their views, and could tell the manager if they were not happy with anything.

Staff told us that they felt Bethany House was a good place to work and that there was a good staff team. We were told that people supported one another and that the manager in turn was supportive and available for help and advice.

This inspection took place on 17 December 2015 and 6 January 2016. The inspection was unannounced.

The last inspection of Bethany House took place on 20 August 2013. At that time we found that the provider was fully compliant with all the regulations assessed.

Bethany House is a residential care home for older people. It is owned by Preston Bethany Care, a Christian charity. It is a purpose built, single storey home. The home is situated within its own grounds, close to local shops and other community facilities. There are 26 single rooms. Thirteen have en suite facilities. At the time of our inspection of this location there were 26 people who lived at the service.

The registered manager was available and received feedback throughout the inspection. 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.

We asked people who lived at the service if they felt safe. People told us that they felt safe and well cared for. We did not receive any concerning feedback from people who lived at the service or relatives.

We looked at how the service protected people against bullying, harassment, avoidable harm and abuse. We found that the service had not always followed local authority safeguarding protocols when a person had fallen and sustained injuries.

We found that staff were confident to raise their concerns and held good understanding of safeguarding principles. However we found that people who lived at the service and visitors did not have free access to information about safeguarding. We have made a recommendation about this.

We looked at how the service identified and managed risk for people on an individual basis. We pathway tracked the care of six people who lived at the service. Pathway tracking enabled us to determine if people received the care and support they needed and if any risks to people’s health and wellbeing were being appropriately managed.

We found that people’s needs and preferences had been assessed prior to admission and records showed what initial risk had been identified. However we found examples where known risk had not been cross referenced into a plan of care to show how the identified need would be managed.

We asked staff about their knowledge of risk to individuals and found that staff held a good level of understanding about people’s needs and associated risk.

We found that other risk assessments had been undertaken for people on an individual basis. For example risk assessments for nutrition and the risk of damage to a person’s skin. However monitoring of the known risk was not undertaken for people who were at risk of malnutrition or skin damage. We made a recommendation about this.

We looked at how the service managed people’s medicines. We found shortfalls in safe administration of medicines, care planning for the use of medicines and record keeping.

We found that the service had effective systems in place for assessing, monitoring and maintaining environment safety.

We found that staff had been safely recruited and deployed.

We found that the provider had a policy and procedure to guide staff around best practice for infection prevention and these included infectious outbreaks referral methods.

However we found that infection prevention systems needed review to ensure that the service was working in line with best practice. We made a recommendation about this.

We received positive feedback from people who lived at the service, relatives and visiting professionals about how effective the service was in meeting people’s individual needs.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA), and whether any conditions on authorisations to deprive a person of their liberty were being met.

We found that the registered manager and care workers lacked knowledge and understanding about referral processes around Deprivation of Liberty Safeguards (DoLS).

We found that the service did not have effective systems in place to assess a person’s mental capacity prior to requesting consent or acting in a person’s best interest.

We found that the majority of staff had been employed at the service for many years. Staff told us that they were happy within their employment. We looked at staff personnel files and found that induction training had been provided.

We looked at the training matrix and found that gaps were evident in core training areas such as health and safety, infection control, Mental Capacity Act 2005 and dementia awareness.

Staff told us that they were happy with the standard of training provided.

We looked at staff personnel files and found that supervisions were undertaken. Staff told us that they felt supported and listened to.

We found that people who lived at the service were happy with the standard of food provided.

We observed a lunch time meal service. We found that people enjoyed the meal service and were offered choice and control. One person requested an alternative to the daily menu and this was provided.

We spoke to the chef and kitchen staff. We found that they were actively involved in helping people maintain a healthy balanced diet and they had access to important information such as people’s individual diet types and preferences.

Staff had a good knowledge of people’s individual needs including those on specialist diets to prevent them from choking or aspirating.

We found that the service was not always effective at continually monitoring people’s nutritional intake. The registered manager took action during our inspection to improve monitoring systems for people that required this level of support to enable effective nutritional screening.

We found that people were referred to external health care professionals in a timely manner.

We found that staff had positive working relationships with external health care professionals and felt confident to ask for advice.

We found that the environment was clean and fit for purpose.

People who lived at the service told us that the care they received was kind and considerate of their needs and preferences.

We received feedback from a visiting health care professional who confirmed that the service was good at supporting people at the end of their life. The professional told us that people experienced kind care.

We undertook a short observational framework for inspection (SOFI). The SOFI tool is used by CQC inspectors to capture the experiences of people who use services who may not be able to express this for themselves.

We observed staff interact with people in a kind and considerate manner. Staff were responsive to people’s requests and attentive to people who were not able to verbally communicate their needs.

We found that staff had formed positive caring relationships with people who lived at the service and their relatives.

We observed very good standards of dignity and privacy throughout the inspection. Staff were genuinely caring towards people who lived at the service and visitors.

We found that end of life care for a person living at the service had been organised with great empathy and consideration for the person’s personal preferences and wishes.

People were supported to maintain their religious activities. Across two days of inspection we observed people visit from local churches and we saw that this brought people great comfort.

We observed staff organising activities and they encouraged people to participate throughout both days of the inspection. People were engaged and provided with stimulation. We observed those who did not wish to take part in activities given the opportunity to decline and their decision was respected.

We found that the service was proactive in providing person centred care. Staff understood people’s individual needs, wishes and preferences.

We observed staff provide support for people as outlined in their care plan.

We looked at the provider’s complaint procedure. We found that this was accessible to people who lived at the service and visitors. We looked at complaints management and found that complaints were reviewed in line with the policy and procedure.

People who lived at the service and their relatives told us that they felt confident in the management of the service and happy to raise their concerns.

We observed a positive culture throughout the service.

We observed staff offer people choice and control on various occasions throughout the inspection, people were encouraged to maintain their independence and included in decisions about their care and support.

We looked at how the service assured quality and development. We found that audits had been undertaken as planned.

We found that audits were undertaken. However some issues identified at this inspection had not been found. The registered manager was receptive to feedback and on the second day of inspection demonstrated pro-active planning around the improvements needed.

We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to safeguarding, medicines and need for consent. You can see what action we have told the provider to take at the back of the full version of the report.