Bethesda provides accommodation and personal care for up to 23 older people who may be living with a dementia or physical disability. Bethesda is part of the Christadelphian community but also offers support to people outside of that faith. At the time of the inspection there were 17 people living at the home. The home offers both long stay and short stay respite care. Bethesda does not provide nursing care. Where needed this is provided by the community nursing team.

This inspection took place on the 8 and 13 March 2017; the first day of the inspection was unannounced. One adult social care inspector carried out this inspection. Bethesda was previously inspected in January 2015; we found people’s individual evacuation plans (PEEP) did not contain sufficient information and improvements were required in relation to the homes recruitment processes. At this inspection, we found improvements had been made.

The home 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 said they felt safe and well cared for at Bethesda, their comments included “I do feel safe,” "I’m very happy here” and “I would recommend this home to anyone and we do.” Relatives told us they did not have any concerns about people's safety. People were protected from abuse and harm. Staff received training in safeguarding vulnerable adults and demonstrated a good understanding of how to keep people safe. There was a comprehensive staff-training programme in place. This included safeguarding, first aid, pressure area care, infection control, and moving handling. Staff had also received training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were encouraged to make choices and were involved in the care and support they received. Staff had a good understanding of the MCA and DoLS and how to support people within their best interests.

People told us they were happy living at Bethesda, staff treated them with respect and maintained their dignity. Throughout our inspection, there was a relaxed and friendly atmosphere within the home. Staff spoke affectionately about people with kindness and compassion. People and relatives told us they were involved in identifying their needs and developing the care provided. People's care plans were informative, detailed, and designed to help ensure people received personalised care. Care plans were reviewed regularly and updated as people's needs and wishes changed. Risks to people's health and safety had been assessed and regularly reviewed. Each person had a number of detailed risk assessments, which covered a range of issues in relation to their needs, which included personal emergency evacuation plans (PEEP).

People received their prescribed medicines when they needed them and in a safe way. There was a safe system in place to monitor the receipt and stock of medicines held by the home. Medicines were disposed of safely when they were no longer required. Staff had received training in the safe administration of medicines.

People spoke positively about activities at the home and told us they had the opportunity to join in if they wanted. People chose to live at Bethesda because of its Christadelphian ethos. Although the home was able to accommodate people who were not Christadelphians, they understood that the home offered people this experience. People were supported, to attend the local Christadelphian church or if they wished, they could take part in Daily prayer meetings and Bible readings within the home.

People told us they enjoyed the meals provided by the home. Comments included, “the food is excellent”, “well cooked,” and “very nice.” One person said, “Ther

This was a scheduled inspection carried out on the 26 September 2013. We also followed up on concerns, which had been raised anonymously, in relation to staffing levels at the home. We found that this complaint was not substantiated.

There were 19 people living at Bethesda at the time of our inspection. We spoke with eight people who lived at the home and also spoke with three care workers a senior care worker, a head of care and the manager.

We found that people’s consent had been obtained for care and treatment provided to them by the service.

People who lived at the home told us they were well looked after and were happy. One person said "we are all very happy living here. We get the best of care, lovely food and the staff are lovely."

There were enough qualified, skilled and experienced staff to meet people’s needs.

People told us that they felt safe and knew what to do if they had concerns. One person said "We have regular residents’ meetings when we can raise any concerns we may have. If there are any urgent concerns we can talk to any of the staff."

People told us that they would not hesitate to report any issues to any member of staff. One person said, “I would complain if there was ever anything to complain about”.

We asked about respecting and involving people in their care. One person told us that “staff treat us respectfully, they listen to what we have to say. A care worker said “people had a choice. We try not to take people’s independence away, most people like to do things for themselves and every one has their own routines and preferences”.

People that lived at Bethseda told us they were very happy with the care they received. One person said “we love it here, we go out when we want to and we have a choice of food, they are good cooks”; another person told us that “you couldn’t improve how we are looked after. We are well fed and well looked after, small things are not overlooked”.

We asked four staff about infection control procedures. They all told us they received infection control training and this was updated annually. One care worker told us that staff were “trained to wash hands properly”.

Staff we spoke with told us that they felt well supported and senior staff were very accessible. One care worker told us “I have lots of training, my mandatory training is up to date, I have regular supervision and appraisals, we all get on well together here”.

We asked care staff how they knew day to day how they were doing a good job. One care worker told us that “staff tell me how I am doing, people tell me they like having me here; I am sure they would tell me if I was doing something wrong. I feel very privileged to work in a place like this”.

All of the people that we spoke with were happy with their care at Bethesda and said they had all the care and support they need. One person described the home as “wonderful”.

Some people told us they were able to manage the majority of their healthcare needs independently, whilst others said they asked staff for support. People said that they felt their care was coordinated well and explained that should they need any further support or care, this was arranged by staff, which then followed the guidance and advice given by the healthcare professionals.

People we spoke with said they felt they could voice their opinions on how the care home was run.

People said they enjoyed the activity in and out of the home. Others said they made their own entertainment or preferred to stay in their room and liked that they could chose what to do.

All of the people we spoke with said generally the food is ‘very good,’ ‘always good’ ‘delicious’ and ‘very nice’. People appreciate that they are able to go to have a hot drink or snack at anytime.

People said they felt safe at the home.

People told us they receive their medication on time and are able to ask for painkillers and other non prescribed medication if they need to.

People told us they thought there were enough staff and described them as ‘the best’ ‘lovely’ and ‘ really wonderful’. There were no negative comments about staff or the owners. Friendly chats and laughter was shared throughout the day between staff and people living in the home.

The inspection took place on the 27 and 28 January 2015 and was unannounced. Bethesda provides care and accommodation for up to 23 people. On the day of the inspection 18 people were living in the home. Bethesda provides care for older people who may have age related conditions such as dementia and restricted mobility. The service had a registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the 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 inspection on the 16 September 2014 we found breaches of legal requirements relating to consent to care and treatment, care and welfare, staffing, quality monitoring of the service and handling of complaints. The provider sent us an action plan, which explained how they would address the breaches of regulations. At this inspection we found these actions had been completed and improvements had been made. The provider now meets the legal requirements.

People spoke highly about the care and support they received. Comments included; “It is lovely, all the staff are kind and respectful”, and “The staff do just what I need and respect my privacy”.

During the inspection people and staff were relaxed, there was a calm and pleasant atmosphere. We saw people enjoying an afternoon drink in the siting room and listening to a visitor play the piano. People told us there were always lots of activities in the home and these were planned around what people requested and particular interests.

People told us they felt safe. Staff undertook training to ensure they understood how to recognise and report abuse. All the staff said they would not hesitate to raise any concerns and felt confident they would be listened to and taken seriously. However, some aspects of the service needed to be improved to ensure people’s safety and well-being. The home’s recruitment processes did not in all cases question gaps in employment history or ensure references were sufficient to demonstrate staff were suitable for employment. Plans were not sufficient to ensure people were safely evacuated from the building in the event of a fire. These issues were discussed with the registered manager at the time of the inspection and we were told they would be addressed as a matter of priority.

People’s risks were managed well and monitored. People were supported to maintain their independence and to live a full and active lifestyle. Staff were employed in sufficient numbers and received on-going training. This helped ensure people were supported in a way that met their needs and kept them safe.

People had their medicines managed safely. People received their medicines on time and in a way they chose and preferred. People were supported to maintain good health and to access specialist healthcare support as well as routine health checks. Systems were in place so staff could recognise changes in people’s health and take prompt action when required. People said they enjoyed the food in the home and were supported with any specific dietary needs.

Staff understood their role and the correct procedures had been followed when it had been assessed people did not have capacity to make decisions themselves. This helped ensure people’s rights were protected.

Support plans were personalised and ensured people received care and support in a way they chose and preferred. Clear and detailed documentation of people’s needs ensured people received good, consistent care when they moved between services.

Staff spoke highly of the provider and management. Comments included; “I feel well supported”, and “There is always someone available if you need any support or help”. Staff were clear about the values of the service and said they felt people were well cared for and safe.

There were effective quality assurance systems in place. The registered manager had worked hard to address areas of concern and to drive improvement in the home. Incidents were recorded and audited so that any learning for future practice could be considered. Feedback from people, relatives and other agencies had been encouraged and used to further improve the quality of the service.