The inspection took place on 14 and 15 August 2018 and was unannounced.

L'Arche Bethany provides care and support for up to six people with a learning disability and other complex needs, including autism and mental health issues. At the time of this inspection there were six people living at the home, all of whom were able to communicate verbally and independently.

L’Arche Bethany is a large three storey house. Rooms were of single occupancy. Communal areas included a large sitting room and a kitchen with a sitting area. The kitchen had access to a conservatory which was being used as a dining /activity room, overlooking an accessible garden to the rear of the property.

L'Arche originated in France in 1964 and is now an international movement that builds faith-based communities with people with learning disabilities. L’Arche Bethany is part of an ecumenical, meaning all inclusive, Christian community which welcomes people of all faiths and those who have none. The community has a cycle of events throughout the year that provide a focus for spiritual development. These include an annual pilgrimage, monthly community gatherings, days of reflection and occasional retreats and gatherings. People who live and receive a service at L’Arche Bethany are known as 'core members' and staff as 'assistants'. Due to the philosophy of L'Arche that people with disabilities live in a community, most assistants live in the service alongside core members, sharing all the facilities.

At the last inspection on 31 January 2017 we found the service was in breach of two regulations. The provider had failed to notify us of incidents which they were required to do as set out in regulations. We made a requirement notice regarding this and the provider sent us an action plan of how they would be addressing this. Since the inspection of 31January 2017 the Commission have been notified of those incidents defined by the regulations as needing to be reported to us. This regulation is now met.

At the last inspection of 31 January 2017 we found the provider had not ensured the home was adequately cleaned and hygienic. We made a requirement notice regarding this and the provider sent us an action plan of how they would be addressing this. At this inspection we found the home was clean and hygienic and there were no offensive odours. This regulation is now met.

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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At this inspection we identified some of the actions and decisions regarding the care of people were not always recorded. We have made a recommendation about this.

Staff had a good awareness of their responsibilities to protect people in their care and for reporting any concerns. People said they received a good standard of care.

Risks to people were assessed and care plans included details of measures to counter these risks.

Sufficient numbers of staff were employed to meet people’s needs. Staff recruitment procedures ensured only staff who were suitable to work in a care setting were employed.

Medicines were safely managed.

The home is a converted residential dwelling. The premises were safe and well maintained.

There were systems to review people’s care and when incidents or accidents had occurred.

People’s health and social care needs were comprehensively assessed and arrangements made

The inspection took place on 31 January 2017 and was unannounced.

L'Arche Bethany provides care and support for up to six people with a learning disability and other complex needs, including autism and mental health issues. At the time of this inspection there were five people living at the home, all of whom were able to communicate verbally and independently.

L’Arche Bethany is a large three storey house. Rooms were of single occupancy. Communal areas included a large sitting room and a kitchen with a sitting area. The kitchen had access to a conservatory which was being used as a dining /activity room, overlooking an accessible garden to the rear of the property.

L'Arche originated in France in 1964 and is now an international movement that builds faith-based communities with people with learning disabilities. L’Arche Bethany is part of an ecumenical, meaning all inclusive, Christian community which welcomes people of all faiths and those who have none. The community has a cycle of events throughout the year that provide a focus for spiritual development. These include an annual pilgrimage, monthly community gatherings, days of reflection and occasional retreats and gatherings. People who live and receive a service at L’Arche Bethany are known as 'core members' and staff as 'assistants'. Due to the philosophy of L'Arche that people with disabilities live in a community, most assistants live in the service alongside core members, sharing all of the facilities.

It is a condition of the provider's registration that a registered manager is in post at this location. The service did not have a registered manager in post at the time of our 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. L’Arche Bethany has not had a registered manager in post since March 2016. The service was managed day to day by a house leader. A co-ordinator responsible for three other services of the provider supported the house leader in their role. The house leader was present during our inspection. The house leader told us, a permanent manager had been appointed but was not due to commence until April 2017.

At the last inspection, on 20 January 2015, we asked the provider to take action to improve how medicine errors were managed. We had identified that when medicine errors occurred prompt and appropriate action was not taken that ensured people received their medicines safely. Following the last inspection, the provider wrote to us to confirm that they had addressed these issues. At this inspection, we found that the actions had been completed.

At this inspection, we found a range of audits in place to measure the quality of care delivered, including environmental and cleaning checks. However, the environmental and cleaning checks were not always effective in identifying areas of concern such as cleaning and maintenance issues. Premises were not always clean or properly maintained. There was a malodour in the shower room. We found that hand towels and bars of soap were in use, which did not promote infection control and cleanliness. The cleaning schedules in place were ineffective.

Staff were aware of their responsibilities in relation to safeguarding. The house leader and staff were clear about when to report concerns and the processes to be followed in order to keep people safe. Although safeguarding incidences had been submitted to the local authority, the provider had failed to act in line with their legal responsibilities in notifying the Commission of one incident of an allegation of abuse and one person’s injury that required hospital treatment as required.

People were able to make choices, to take control of their lives and be supported to

This was an unannounced inspection which took place on 20 January 2015.

L'Arche Bognor Regis Bethany provides support and accommodation for a maximum of six adults with a variety of learning disabilities. These include Down’s syndrome, autism and Asperger syndrome. At the time of this inspection there were five people living at the home, all of whom were able to communicate verbally and independently. People’s levels of support varied; with one person requiring one to one support whilst others needed emotional support and were independent in other aspects of their lives.

L'Arche Bognor Regis Bethany is part of an ecumenical Christian community which welcomes people of all faiths and those who have none. The community has a cycle of events throughout the year that provide a focus for spiritual development. These include an annual pilgrimage, monthly community gatherings, days of reflection and occasional retreats and gatherings. People who live and receive a service at L’Arche Bognor Regis Bethany are known as ‘core members’ and staff as ‘assistants’. Most assistants live in the home alongside the core members.

During our inspection the registered manager was present. 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 and associated Regulations about how the service is run.

The registered manager of L'Arche Bognor Regis Bethany is also the registered manager of another three services and shares her time between all three. In the registered managers absence the home is managed by a house leader. The house leader was present during our inspection.

People told us they felt safe. However, when medicine errors occurred prompt and appropriate action was not taken that ensured people received their medicines safely.

Staff were aware of their responsibilities in relation to safeguarding. The manager was clear about when to report concerns and the processes to be followed in order to keep people safe.

People were able to make choices, to take control of their lives and be supported to increase their independent living skills. Risk assessments and support plans were in place that considered potential risks to people. Strategies to minimise these risks were recorded and acted upon. People were supported to access healthcare services and to maintain good health.

There were enough staff on duty to support people and meet their needs. Appropriate recruitment checks were completed to ensure staff were safe to support people. Staff were sufficiently skilled and experienced to effectively care and support people to have a good quality of life. People told us that they were happy with the support they received from staff. Staff received training, supervision and appraisal that supported them to undertake their roles and to meet the needs of people.

L'Arche Bognor Regis Bethany met the requirements of the Deprivation of Liberty Safeguards (DoLS) and people confirmed that they had consented to the care they received. Staff were kind and caring and people were treated with respect. Staff were attentive to people and we saw high levels of engagement with them. Staff knew what people could do for themselves and areas where support was needed.

People were supported to express their views and to be actively involved in making decisions about their care and support. Staff knew in detail each person’s individual needs, traits and personalities. People were supported to access and maintain links with their local community. The importance of community links and social inclusion was reinforced in peoples support plans. Support plans were in place that provided detailed information for staff on how to deliver people’s care.

L'Arche Bognor Regis Bethany was generally well-led by a manager and house leader who encouraged people to work collaboratively to provide an holistic approach. Care was personalised and empowering, enabling people to take control of their lives and make decisions and choices. The manager and team leader were committed to providing a good service that benefited everyone.

The vision and values of the service were known by everyone and embedded at L'Arche Bognor Regis Bethany. As a result, relationships and spiritual needs flourished.

Regular meetings were held with people and staff which encouraged open and transparent communications between them and management. In addition, people were routinely asked their views about staff. People were routinely listened to and their comments acted upon. Weekly and monthly meetings took place where people could raise issues and a pictorial complaints procedure was in place that supported people to understand formal complaint processes.

During this inspection we spoke with three of the four people who lived at the service but their comments did not relate to infection control or cleanliness at the service. People were preparing to undertake activities of daily living and were focused on these events. As a result they did not want to take time to speak with us in detail.

We also spoke with a member of staff and the manager. Both demonstrated a commitment to ensuring appropriate standards of cleanliness and infection control were maintained at the service. We found that since our last inspection steps had been taken and people were being cared for in a clean and generally hygienic environment.

We spoke with three of the four people who lived at the service. Everyone told us that they were happy with the support they received. For example, one person told us, "I am happy. I'm doing gardening today". Another person told us, "We have meetings and talk about what we want. I like living here".

People also told us that they were happy with the environment that they lived in. However, we found that some improvements were required with regard to infection control practices in order to promote people's safety.

We also gathered evidence of people's experiences of the service by observing how people were supported by staff, looking at records and talking with a member of staff. We found that people's care needs were being managed safely by the service and that staff had a good understanding of their roles and responsibilities in this area. People's rights with regard to consent were being promoted by the service and staff understood how people's capacity should be considered.

Systems were in place that monitored the quality of service people received and considered their views. People told us that they had regular meetings where their views and opinions were sought and acted upon.

We also found that recruitment practices provided protection to people who lived at the service.

We were informed that there were four people living at Bethany and that three members of staff also lived in the home. On the day we visited, all the people were out for the day attending workshop activities and working in the gardens ran by L’Arche.

We looked around the building which was clean and free from unpleasant odours. The bedrooms were personalised with photographs, books, computers and pictures.

During our visit we were unable to speak to any of the people who use the service. One person did return to the home briefly during the lunch period but they did not want to speak to us. We spoke with one member of staff. The home leader who was responsible for the day to day management of the home was unavailable.

Bethany has two registered managers. One who was responsible for the day to day management of the home and the other is the L’Arche care coordinator who is responsible for all the homes the L’Arche Bognor Regis Community. We were advised by a representative from the L’Arche community office that the person who is currently registered as the day to day manager has not been working at the home since 2010. The L’Arche representative told us they were not aware that the Care Quality Commission need to be informed that when a registered person ceases to manage the regulated activity.

People told us that they like living at the home and have a full role in decision making and in participating in domestic tasks, such as choosing food and shopping with staff. This also included taking part in weekly house meetings and contributing to reviews of care needs. One person told us that there is a discussion about the home’s weekly newsletter at the house meeting.

People said that they are satisfied with the standard of care at the home, one person commenting, ‘The care standard is very high.’ People also said that they like the staff, adding that there is always someone available to talk to and that there are enough staff on duty.

People told us how they are involved in a number of activities including work schemes, gardening projects, trips out and holidays