The inspection was unannounced and took place on 20 October 2016. A subsequent announced inspection took place on the 24th of October to ensure we could speak with people living at the service.

At our previous inspection in July 2015, there were breaches to legal requirement in relation to short falls in the leadership and quality assurance systems in place. They had failed to pick up inadequate training, appraisal and maintenance of the service. Policies were not always up to date. People’s records were not always accurate and they were not always lawfully deprived of their liberty. Staff awareness and training of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) was limited and out of date. During this inspection we found that improvements had been made.

Bethel Care Home provides accommodation and support with personal care for up to three people with a learning disability. On the first day of our visit the two people using the service were out. We observed interactions between a staff member and one person on the second visit.

The service had a registered manager. 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.

People told us they felt safe. Staff understood their responsibilities and how to recognise and report abuse.

There were appropriate risk assessments in place to manage any risks within and outside the service. Staff could explain the actions they would take to mitigate any identified risk.

Premises had been refurbished and looked clean. Appropriate health and safety checks, weekly fire drills took place to ensure the environment was safe.

Medicines were managed safely by staff who had received appropriate training. We checked medicine administration records and found no discrepancies.

There were appropriate recruitment checks in place to ensure only suitable staff were employed.

Although staff were supported by regular supervision and appraisal, we found that training could be further improved in areas such as autism awareness and understanding of the MCA. We recommend the provider seeks advice on appropriate training. In addition the signage in within the service was not in a pictorial format and could not be easily understood by one of the people.

People were supported to access health care services in order to maintain their health. We saw evidence of input from the GP and that referrals were made appropriately.

Care plans were individual and more specific to people’s needs. They were reviewed when people’s needs changed.

We observed that people were treated with dignity and respect. People’s diversity was respected and they were supported to eat a diet that met their cultural needs and preferences. People were enabled to attend their preferred places of worship and to maintain relationships with people who were close to them.

There was a complaints procedure displayed at the entrance in a pictorial format that was understood by people who used the service.

People told us they went out when they wanted. Activities were based on people’s interests and included regular outings.

Staff had attended mental capacity training but were not always fully aware of how it applied in their daily practice. The registered manager had taken appropriate steps to ensure a person’s best interest’s assessment took place in order to lawfully deprive them of their liberty for their own safety.

People thought the service was run well by an approachable management team. Staff and people were involved in how the service was run.

The inspection was unannounced and took place on 8 July 2015. There were breaches to legal requirements in relation to care and welfare and quality assurance at our previous inspection on 30 September 2014. During this inspection we found that improvements had been made, however there were new breaches to legal requirements.

Bethel Care Home provides accommodation and support with personal care for up to three people with a learning disability. On the day of our visit there were two people using the service.

The service had a registered manager. 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.

People told us they trusted staff and felt like a family. Medicines were stored, ordered and managed safely. Staff were aware of the procedure to follow in order to report any allegations of abuse. There were risk assessments in place in order to safeguard people from harm.

There were enough staff to meet people’s needs. Recruitment procedures were followed with the exception of ensuring staff had two verifiable references.

We observed that people were treated with dignity and respect. Staff addressed people by their preferred names. People’s diversity was encouraged and they were supported to eat a diet that met their cultural needs where applicable. People were enabled to attend their preferred places of worship and to maintain relationships with people who were close to them.

There was a complaints procedure displayed at the entrance in a pictorial format that was understood by people who used the service.

People’s records were not always accurate and did not always reflect people’s current needs. People were not always lawfully deprived of their liberty. Staff awareness and training of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards was limited and out of date.

We found shortfalls to the leadership and quality assurance systems in place as they had failed to pick up inadequate training, appraisal and maintenance of the service. Policies were not always up to date.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.