We inspected the service on 25 March 2018. The inspection was unannounced. Betsy Clara 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. Betsy Clara is registered to provide accommodation and nursing or personal care for a maximum of 48 people. The home specialises in providing care to older people, people who have disabilities and some people living with dementia. At the time of our inspection there were 43 people living in the service. Betsy Clara is situated in Maidstone and is arranged over two floors.

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 were protected from abuse. Staff received regular safeguarding training, and were able to tell us about different types of abuse and what action they would take if they saw someone being abused. Risks to people had been identified and they had been involved in developing plans to minimise them. Positive risk taking was encouraged and guidance was provided to staff in order to help keep people safe. The provider had also ensured that the environment was safe for people. There were sufficient numbers of staff to keep people safe and meet their needs. The manager used a dependency tool to calculate the numbers of staff needed based upon the needs of the people living there. Staff were recruited safely. People received their medicines safely. The service had a close relationship with the local GP, who visited on a weekly basis to review each person’s medicines. People were protected by the prevention and control of infection. Accidents and incidents were reported by staff in line with the provider’s policy, and the registered manager took steps to ensure that lessons were learned when things went wrong.

People’s needs were assessed and their care was delivered in line with current legislation. Staff had the training and skills they needed to meet people's needs. Newly recruited staff received a comprehensive induction before they started to support people and regular ongoing face to face training sessions. People were supported to eat and drink enough to maintain a balanced diet. Staff referred to and followed guidance from health professionals such as dieticians and the local Speech and Language Therapy (SaLT) team. Suitable arrangements were in place to ensure that people received effective and coordinated care when they were referred to or moved between services, such as when they went to or returned from hospital. People’s needs were met by the adaptation, design and decoration of the service.

People were treated with kindness, respect and compassion. People had been supported to express their views and be actively involved in making decisions about their care and treatment as far as possible. People's privacy, dignity and independence were respected and promoted. Staff were able to give examples of how they treated people with dignity when supporting them.

People received personalised care that was responsive to their needs. Each person and their relatives were involved in the development of a personalised care plan which took into account their wishes and preferences. People were supported to follow their interests and take part in activities that were appropriate to them. The service employed a full-time activities coordinator who organised activities based on the interests of people. Complaints were listened and responded to. People told us they knew how to make a complaint and were confident to do so if they needed to. People were encouraged to mainta

We carried out an unannounced comprehensive inspection of this service on 13 and 16 September 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Betsy Clara Nursing Home on our website at www.cqc.org.uk.

Betsy Clara Nursing Home is a care home providing accommodation for up to 50 older people who are living with dementia and who require nursing and personal care. The accommodation is purpose built to care for people who use wheelchairs or have difficulty moving around. The home is located in a residential area in Maidstone, approximately one mile from the town centre. At the time of the inspection 39 people lived at the service.

There was a registered manager 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.

At our previous inspection on 13 and 16 September 2016, the service was in breach of regulation 12 (Regulated Activities) Regulations 2014. This breach was in relation to effective medicine management. We found that nurses had not always accurately documented when medicines were administered and people living with diabetes did not have guidance in place to manage their blood sugar levels. We also observed poor moving and handling techniques. At this inspection improvements had been made and the service was no longer in breach of the regulation.

Nurses were signing people’s medicine records accurately. There were no identifiable gaps in people’s medicine records. People living with diabetes had clear guides in their care plans.

Staff received appropriate training for moving handling. During our inspection we observed good moving and handling practices.

The provider had ensured that there were appropriate systems in place to identify and minimise risk for people living at the service. Risks to people's safety had been assessed and actions taken to protect people from the risk of harm.

There was sufficient staff to provide care to people. The provider had effective systems in place to ensure that there was appropriate cover when it was required. Staff had safety checks to ensure they were safe to work with adults.

People were protected from abuse by trained staff who could identify the forms of abuse and who they can report to. The provider had effective safeguarding systems in place.

We carried out this inspection on the 13 and 16 September 2016, it was unannounced.

Betsy Clara Nursing Home is a care home providing accommodation for up to 50 older people who are living with dementia, who require nursing and personal care. The accommodation is purpose built to care for people who use wheelchairs or have difficulty moving around. The home is located in a residential area in Maidstone, approximately one mile from the town centre. At the time of the inspection 43 people lived at the service.

We last inspected the service on 19 and 26 May 2015. We made recommendations in relation to practice that included, Regulation 12, Safe care and treatment; Regulation 15, Premises and equipment; Regulation 16, Complaints; Regulation 17, Good Governance and Regulation 18, Staffing, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found that the provider had implemented changes and improvements had been made.

People said they felt safe and relatives told us that they knew their relatives were safe. However, we observed moving and handling practice that were not safe.

Medicines were stored, and disposed of safely. However, medicines were not always administered safely. There were policies and procedures in place for the safe administration of medicines, however these had not always been followed. People had access to GPs and other health care professionals. Prompt referrals were made for access to specialist health care professionals.

There were risk assessments in place for the environment, and for each person who received care. Assessments identified some needs but were not specific in meeting people’s individual needs, and showing how risks could be minimised.

The newly appointed manager had worked at the service since February 2016. She confirmed that completed application forms to be the registered manager of the service had been accepted by the Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Management understood when an application should be made. They were aware of the Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

The manager and staff had received training about the Mental Capacity Act 2005 and understood when and how to support peoples best interest if they lacked capacity to make certain decisions about their care.

People were protected against the risk of abuse. Staff had been trained in how to protect people, and they knew the action to take in the event of any suspicion of abuse towards people. Staff understood the whistle blowing policy. They were confident they could raise any concerns with the manager or outside agencies if this was needed.

People had varied needs, and some of the people living in the service had a limited ability to verbally communicate with us or engage directly in the inspection process. These people demonstrated that they were happy by showing warmth to the manager and staff who were supporting them. For example by nodding their head or giving a smile. Staff were attentive and interacted with people in a warm and friendly manner. Staff were available throughout the day, and responded quickly to people’s requests for help.

People and their relatives were involved in planning their own care, and staff supported them in making arrangements to meet their health needs. Nursing staff carried out on-going checks for people’s health needs, and contacted other health professionals

The inspection was carried out by one Inspector over seven hours. During this time we met and chatted with people living in the home, and observed how staff interacted with them. We viewed a variety of documentation including care plans, medication charts, staff training records and some auditing processes. We talked with four relatives and friends, and 12 staff, as well as the manager and deputy manager.

We saw that people were generally relaxed with staff and seemed content. Some were smiling or talking, or playing with different items. People’s comments included “I am happy here”; “I like the activities but I don’t know what is happening this afternoon”; and “The staff are kind and friendly.”

We saw that care planning documentation was up to date and was appropriately completed to show people’s different needs and assessed risks.

We found that medication management was satisfactorily maintained.

We talked with staff about their training and support, and viewed training and supervision records. Staff worked well together and most said that they felt well supported by the management.

We saw that staff were aware of people’s different moods, and were able to assess if they were upset or anxious. Relatives told us that they could ask the staff or the manager about any concerns at any time, and were confident that their concerns would be addressed.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not always able to tell us their experiences. We observed how people interacted with staff and the management of the service. We saw they felt free to express their opinions and were listened to. We saw that people were comfortable in the environment and were usually able to find their way around.

People told us they were looked after well. They said. “They look after me very well, everything is done for you. There’s nothing to worry about here.” “I always have a good breakfast.” “There’s plenty to eat, too much sometimes.”

It was not possible to interview many people who live in the home as some were too unwell and others with dementia were not able to engage with the process. We were able to talk with relatives and four people who live in the home.

People who live in the home and visitors who we spoke with said they were satisfied with the service provided. People told us staff were kind and looked after them well. There were mixed views amongst the people who we spoke to about the food provided in the home. Some told us they enjoyed the meals, others were less happy. People who we spoke with told us they felt safe in the home. They knew who to talk to if they were unhappy with the service. People told us the home was always clean and tidy.

One visitor told us they had been involved in all aspects of their relative’s care. They told us staff respected privacy and dignity at all times. We spoke with two visitors who told us they were satisfied with the care, treatment and support their relatives received. One visitor told us they had been fully involved in the initial assessment and in developing their relative’s plan of care. They told us they were confident their views were taken into account in the service their relative receives.

We carried out this inspection on the 19 and 26 May 2015, it was unannounced.

Betsy Clara Nursing Home is a care home providing accommodation for up to 50 older people who are living with dementia, who require nursing and personal care. The accommodation is purpose built to care for people who use wheelchairs or have difficulty moving around. The home is located in a residential area in Maidstone, approximately one mile from the town centre. At the time of the inspection 45 people lived at the service.

Nursing staff managed and administered medicines for people. Not all medicines were stored, and disposed of safely. Some medicines had not been stored appropriately in a lockable cupboard or when not needed, disposed of in a timely manner. We have made a recommendation about this.

People demonstrated that they were happy at the service by showing open affection to the deputy manager and staff who were supporting them. Staff were available throughout the day, and responded quickly to people’s requests for help. Staff interacted well with people, and supported them when they needed it. However, it was observed that the provider did not at all times ensure that there were suitable numbers of staff deployed to care for people safely and effectively. We have made a recommendation about this.

The provider needs to enhance the environment for people living with dementia. Doors were all the same colour, and toilets and bathrooms were not always clearly identified to aid and support independence of people living with dementia. We have made a recommendation about this.

There were systems in place to obtain people’s views about the service. These included formal and informal meetings; events; questionnaires; and daily contact with the registered manager and staff. However, it was noted that records of meetings were not available at the time of the inspection, and no recent quality assurance surveys to evidence people’s views had been collected. We have made a recommendation about this.

The registered manager investigated and responded to people’s complaints. People knew how to raise any concerns and relatives were confident that the registered manager dealt with them appropriately and resolved them where possible. We found the company’s complaint policy and procedure was not being followed, as there were no recent written records of action taken and the outcome of concerns, that had been raised. We have made a recommendation about this.

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. The management and staff team included a registered manager, deputy manager, and nursing staff. The ancillary staff team included an activity co-ordinator, kitchen and housekeeping staff.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Some people were currently subject to a DoLS, the registered manager understood when an application should be made. They were aware of the Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

Staff had been trained in how to protect people, and they knew the action to take in the event of any suspicion of abuse towards people. Staff understood the whistle blowing policy. They were confident they could raise any concerns with the registered manager or outside agencies if this was needed.

People and their relatives were involved in planning their own care, and staff supported them in making arrangements to meet their health needs. Nursing staff carried out on-going checks for people’s health needs, and contacted other health professionals for support and advice.

People were provided with diet that met their needs and wishes. Menus offered variety and choice. People said they liked the home cooked food. Staff respected people and we saw several instances of a kindly touch or a joke and conversation as drinks or the lunch was served.

People were given individual support to take part in their preferred hobbies and interests.

Staff were recruited using procedures designed to protect people from unsuitable staff. Staff were trained to meet people’s needs and they discussed their performance during one to one meetings and annual appraisal so they were supported to carry out their roles.

There were risk assessments in place for the environment, and for each person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. There were systems in place to review accidents and incidents and make any relevant improvements as a result. However, the auditing systems in place were not effective as records were not being maintained to support the action taken to resolve issues.